Lower Folate Levels Increase Risk for Depressive Symptoms, Particularly in Women

Lower serum folate levels appear to be associated with an increased risk for depressive symptoms, a large population-based, cross-sectional study suggests.

Data on US adults from the National Health and Nutrition Examination Survey (NHANES) show elevated depressive symptoms were inversely associated with folate status, particularly among women.

"We found that the odds of having elevated depressive symptoms among individuals with the highest serum folate levels were about half that of those with the lowest levels," lead investigator May A. Beydoun, PhD, MPH, National Institute on Aging, told Medscape Medical News.

The study was published online September 14 in Psychosomatic Medicine.

First Nationally Representative Study

Previous research indicates that high levels of total homocysteine (tHcy) and low levels of folate and vitamin B12 are associated with depression or elevated depressive symptoms in adults.

However, investigators note that earlier studies examining the impact of low folate, low vitamin B12, and elevated tHcy status simultaneously on depressive symptoms did not examine interaction among those 3 risk factors and have had inconsistent findings as to the individual associations.

"To our knowledge this is the first nationally representative study conducted among U.S. adults after mandatory fortification of food with folic acid that examines associations of serum folate, vitamin B12, and tHcy levels with depressive symptoms," they write.

For the study the researchers used cross-sectional data from NHANES from 2005 to 2006 by assessing interactions (2 way and 3 way) among the 3 exposures and testing effect modification of the associations by sex.

The study sample included 2524 adults aged 20 to 85 years with complete data on demographics, diet, plasma folate, vitamin B12, and tHcy status, as well as information on physical activity, smoking status, blood pressure, and depressive symptoms.

Depressive symptoms were measured using the Patient Health Questionnaire (PHQ), and elevated symptoms were defined as a PHQ total score of 10 or greater.

Study Underpowered to Detect Effect in Men

With an odds ratio of 0.52 (95% confidence interval [CI], 0.35 – 0.76), adjusted analyses revealed that among the total population the odds of having elevated depressive symptoms was close to half that in the lowest tertile.

Further, with an odds ratio of 0.37 (95% CI, 0.17 – 0.86), the likelihood of women in the highest tertile of serum folate (mean ± SE, 21.1 ±0.29 ng/mL) to experience elevated depressive symptoms was about a third that of their counterparts in the lowest tertile (7.02 ± 0.08 ng/mL).

The study showed no relationship between B12 and tHcy levels and elevated depressive symptom risk — a finding that is consistent with previous research the researchers note.

In addition, researchers report that B12 and tHcy did not interact with folate status to affect its inverse association with depressive symptoms among women.

However, elevated homocysteine level was positively associated with elevated depressive symptoms in adults 50 years and older.

Although a significant association between folate levels and risk for elevated depressive symptoms was only observed in women, the investigators believe this is because the study was underpowered to detect the effect in men.

Boosting Folate Levels

The investigators point out that although the study has several strengths, it also has limitations, including its cross-sectional design, which prevents examination of the relationship between depression and serum folate levels over time.

Therefore, they note, it is possible that reverse causality is at play such that depressed individuals may be more likely to have a poor diet and therefore lower folate intake than nondepressed individuals.

Future interventions to improve mental health outcomes among US adult should focus on increasing levels of serum folate say investigators.

For instance, said Dr. Beydoun, clinicians should consider screening patients with depressive symptoms for serum folate and, if indicated, consider supplementation in addition to standard antidepressant therapy.

In addition, dietary and lifestyle advice to enhance serum folate should also be considered. Such counseling, she said, should include education about folate-rich foods, the beneficial effect of physical activity on folate levels, and the negative impact of cigarette smoking.

Diet Important in Mental Health

Commenting on the study, Felice Jacka, PhD, a researcher from the University of Melbourne in Australia, who has conducted a number of studies examining the impact of diet on mental health status, said given the fact that previous studies have reported this relationship the results are not surprising.

"However," she said, "the NHANES data are very good quality and, therefore, a very good vehicle to examine the relationships between nutritional status and mental health."

"This is the first large-scale population-based study in the US to show that folate status is associated with the presence of depressive symptoms since the fortification of foods with folate became mandatory," she added.

Dr. Jacka said this study also lends further support to the premise that diet is an important factor for mental health in the general population.

"It also suggests that blood tests to examine folate and homocysteine levels (and levels of other nutrients) in individuals with depressive symptoms may be of utility in clinical settings. If nutrient deficiencies and/or excess homocysteine are identified, dietary and/or supplementation strategies could then be considered," she said.

The study authors have disclosed no relevant financial relationships

Antipsychotic drugs 'appear to raise blood clot risk'

Antipsychotic drugs taken by thousands in the UK raise the risk of dangerous blood clots, scientists believe.

The latest research, published in the British Medical Journal, provides the strongest evidence yet of a link.

People given antipsychotics in the past two years had a third greater risk of clots like deep vein thrombosis (DVT).

The Nottingham University study looking at 25,000 cases found the risk was even higher for the newer "atypical" antipsychotics.

Antipsychotic drugs are usually given to patients with conditions such as schizophrenia and bipolar disorder, but are sometimes used to ease persistent nausea and vertigo or to calm agitated dementia patients.

Higher stroke risk

Some scientists had already spotted a higher risk of clots in people taking antipsychotics, but the new study, which looked at more than 25,500 cases, appears to confirm this.

Almost 16,000 of the people in the study suffered a DVT and just over 9,000 suffered a clot on the lung, called a pulmonary embolism.
Those taking newer "atypical" antipsychotics had 73% more chance of developing a clot, compared with a 28% increase for other types of antipsychotic.

Patients appeared to be most at risk shortly after starting to take the new drug.

But the researchers stress that blood clots remain uncommon, and the increase in risk equates to only a handful of new cases per 10,000 patients treated with the drugs.

Nevertheless, they say that if other studies further confirm their results, the drugs might need to be used "more cautiously" for patients who either have less serious conditions, or who are at higher risk of clots for other reasons.

Also writing in the BMJ, Professor Giovanni Gambassi and Dr Rosa Liperoti, from the Centro di Medicina dell'Invecchiamento in Rome, said it was important for doctors to identify those patients at highest risk of side-effects.

Other studies have already revealed a higher stroke risk among patients taking antipsychotics, and Dr Sharlin Ahmed, from the Stroke Association, said that anyone concerned should contact their GP.

"Although the overall risk of a stroke is low, the results of this study remind us that antipsychotics are powerful drugs and should be prescribed carefully, with regular follow-ups."

According to the Medicines and Healthcare products Regulatory Agency (MHRA), the following atypical antipsychotics are licensed for use in the UK: amisulpride (brand name Solian), aripiprazole (Abilify), clozapine (Clozaril, Denzapine), olanzapine (Zyprexa), paliperidone (Invega), risperidone (Risperdal, Risperdal Consta) and zotepine (Zoleptil).

Blood clots can be deadly, with up to one in four patients dying within a week.

It's good to think - but not too much, scientists say

People who think more about whether they are right have more cells in an area of the brain known as the frontal lobes.

UK scientists, writing in Science, looked at how brain size varied depending on how much people thought about decisions.

But a nationwide survey recently found that some people think too much about life.

These people have poorer memories, and they may also be depressed.

Stephen Fleming, a member of the University College London (UCL) team that carried out the research, said: "Imagine you're on a game show such as 'Who Wants to Be a Millionaire' and you're uncertain of your answer. You can use that knowledge to ask the audience, ask for help."

The London group asked 32 volunteers to make difficult decisions. They had to look at two very similar black and grey pictures and say which one had a lighter spot.

They then had to say just how sure they were of their answer, on a scale of one to six. Although it was hard to tell the difference, the pictures were adjusted to make sure that no-one found the task harder than anyone else.

People who were more sure of their answer had more brain cells in the front-most part of the brain - known as the anterior prefrontal cortex.

This part of the brain has been linked to many brain and mental disorders, including autism. Previous studies have looked at how this area functions while people make real time decisions, but not at differences between individuals.

Illness link

The study is the first to show that there are physical differences between people with regards to how big this area is. These size differences relate to how much they think about their own decisions.

The researchers hope that learning more about these types of differences between people may help those with mental illness.

Co-author Dr Rimona Weil, from UCL's Institute of Cognitive Neuroscience, said: "I think it has very important implications for patients with mental ill health who perhaps don't have as much insight into their own disease."

She added that they hope they may be able to improve patients' ability to recognise that they have an illness and to remember to take their medication.

However, thinking a lot about your own thoughts may not be all good.

Cognitive psychologist Dr Tracy Alloway from the University of Stirling, who was not involved in the latest study, said that some people have a tendency to brood too much and this leads to a risk of depression.

More than 1,000 people took part in a nationwide study linking one type of memory - called "working memory" - to mental health.

Working memory involves the ability to remember pieces of information for a short time, but also while you are remembering them, to do something with them.

For example, you might have to keep hold of information about where you saw shapes and colours - and also answer questions on what they looked like. Dr Alloway commented: "I like to describe it as your brain's Post-It note."

Those with poorer working memory, the 10-15% of people who could only remember about two things, were more likely to mull over things and brood too much.

Both groups presented their findings at the British Science Festival, held this year at the University of Aston in Birmingham.

Drinking Coffee Lowers Risk of Gout in Older Women

NEW YORK (Reuters Health) Sep 16 - A few cups of coffee every day over many years cuts the risk of gout in postmenopausal women in half, Boston researchers report.

"The pain is described as one of the most severe pains a human being experiences, like a breaking bone. You can't walk and even the weight of a bed sheet is not bearable," lead author, Dr. Hyon Choi of Boston University's School of Medicine, told Reuters Health.

Dr. Choi had previously shown that drinking coffee lowers gout risk for men. He and his colleagues wanted to see if the same held true in women, especially older women who, after menopause, lose the uric-acid clearing benefits of estrogen. Gout is rare in younger women but occurs in about one in 20 postmenopausal women.

The researchers looked for cases of gout in 89,433 women enrolled in the Nurses' Health Study, which began in 1976. The researchers also analyzed the lifestyles, diet, and beverage consumption habits of the women since 1980, as reported in questionnaires they filled out every two to four years.

Eight-hundred ninety-six cases of gout were confirmed among the study participants. But within that group, the number of cases dropped as coffee consumption increased from less than a cup a day (226 cases) to more than four cups a day (85 cases).

After statistically controlling for other gout risk factors such as body-fat mass, alcohol consumption, use of diuretics and dairy intake, they found that a lifetime of drinking coffee appeared to make a significant difference in the risk of a first attack of gout.

"The higher the consumption level, the lower the risk," Dr. Choi said.

"The risk of gout was 22% lower with coffee intake of 1-3 cups a day and 57% lower with a coffee intake of more than 4 cups a day" compared to those with no coffee consumption, the authors wrote in the August 25th issue of American Journal of Clinical Nutrition.

Caffeinated tea or soda pop did not confer a similar advantage, whereas drinking decaffeinated coffee did offer a "modest" benefit. That observation led the researchers to conclude that "components other than caffeine may also contribute" to the risk reduction.

How coffee staves off gout is still not clear, Dr. Choi said. And not everybody can tolerate it, he added, so he is not advocating that all older women start gulping coffee.

It would be "too much of a jump" for a doctor to recommend that anyone, especially an older woman, take up coffee drinking to reduce their gout risk, he said. Not only can caffeine raise blood pressure and leach calcium, he noted, but the research only speaks to a benefit in long-term consumption.

"If you start coffee in a gout patient, it's possible this benefit does not exist and might make it worse," he said.

On the other hand, if you already drink coffee, and have a family history of gout -- it does run in families -- "I wouldn't stop," Dr. Choi said.

Am J Clin Nutr. Posted August 25, 2010. Abstract

NSAID Use Associated With Atrial Fibrillation

September 15, 2010 (Chieti, Italy) — The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of chronic atrial fibrillation (AF), a new study suggests [1]. However, the researchers do not believe the drugs are causing AF; rather, they suggest that the underlying inflammation necessitating the NSAID therapy might be the culprit.

Dr Raffaele De Caterina (G d'Annunzio University, Chieti, Italy) and colleagues found a statistically significant 44% increase in the risk of chronic AF, but no association with paroxysmal AF, in users of NSAIDs. They also confirmed previous findings regarding the association of steroids with AF, with those taking steroids two and a half times more likely to develop chronic AF than those not taking them, they report in their paper in the September 13, 2010 issue of the Archives of Internal Medicine.

"A likely explanation for our findings is the existence of an underlying inflammatory condition, increasing the risk of AF on the one hand and prompting the use of NSAIDs on the other," they say. Future research should ideally include a description of left ventricular function, atrial size and/or function, and inflammatory markers, which would help make the association "more biologically plausible," they add.

A Hypothesis That Deserves Further Investigation

De Caterina et al identified patients aged 40 to 89 years with a first-ever diagnosis of AF in 1996 in the UK General Practice Research Database and classified them as having paroxysmal or chronic AF. After validation with their primary-care physicians, 1035 patients were confirmed as having incident chronic AF and 525 as having paroxysmal AF. Two separate nested case-control analyses estimated the risk of first-time chronic and paroxysmal AF among users of steroids and NSAIDS.

Increased risk of chronic AF with NSAID use was present irrespective of treatment duration, although the researchers did find an even greater risk associated with long-term use (RR 1.80 in those who used NSAIDs for more than one year). But there was no apparent dose-response relationship when they divided daily use into low, medium, and high.

The findings cannot be explained by the occurrence of heart failure, either, say De Caterina and colleagues, because further stratification found the increased risk of AF associated with NSAIDs was absent in those with prior HF (but present in those without HF).

They go on to explain that the most frequent pathoanatomical changes in AF are atrial fibrosis and loss of atrial muscle mass, and although it is difficult to distinguish between changes due to AF and those due to associated heart disease, fibrosis may precede the onset of AF and may be caused by inflammation.

"It is possible, and we would like to propose, that conditions presenting systemic inflammation, such as autoimmune and rheumatic disorders, represent an independent risk factor for atrial fibrosis and subsequently for an increased risk of onset or persistence of AF. We believe this hypothesis deserves further investigation," they conclude.

Data collection for the determination of AF cases was performed with an unrestricted research grant to Centro Español de Investigación Farmacoepidemiológica from AstraZeneca. The authors report no disclosures.

Depressed heart patients 'at risk'

The combination of depression and coronary heart disease in a patient could be much more deadly than either condition alone, researchers say.

French and British experts say people with both conditions could be four times more likely to die from heart or circulatory disease.

The study, in Heart journal, tracked the mental and physical health of 6,000 middle-aged people over five years.

Experts said doctors must pay more heed to depression in heart patients.

Experts from the University College London and the University of Versailles followed the health of just under 6,000 male and female civil servants for an average of five and a half years.

The volunteers were taking part in the British Whitehall Study II, which is looking at social and economic factors in long-term health.

Exercise

They found people with heart disease alone had a 67% higher chance of dying from any cause than those without either heart disease or depression.

But the combination of heart disease and depression tripled the risk of death from any cause and quadrupled the risk of dying from cardiovascular disease.

Amy Thompson, a senior cardiac nurse at the British Heart Foundation, which partly funded the study, said: "This study builds on previous research which suggests that depression is linked to coronary heart disease.

"Enjoying regular exercise and eating a healthy, balanced diet can help if you are feeling low - so, good news for your mental health as well as your heart health.

"Whether or not you have heart disease, if you feel depressed it's essential to talk to your doctor."

Gene therapy for blood disorder a 'success'

Gene therapy has been used for the first time to treat an inherited blood disorder in what doctors say is a major step forward.

A man given pioneering treatment to correct a faulty gene has made "remarkable" progress, a US and French team has revealed.

Gene therapy is an experimental technique that manipulates genes in order to treat disease.

It has seen some successes, but also setbacks, including a patient's death.

Beta thalassaemia is an inherited blood disorder that affects the body's ability to create red blood cells.

The first gene therapy trial was in an 18-year-old man with a severe form of the condition, who had been receiving regular blood transfusions since the age of three.

Stem cells from his bone marrow were treated with a gene to correct for the faulty one.

They were then transfused back into his body, where they gradually gave rise to healthy red blood cells.

Three years after the treatment, which took place in 2007, the man remains mildly anaemic, but no longer needs blood transfusions, doctors said.

The team, led by Philippe Leboulch, of Harvard Medical School in Boston, said: "At present, approximately three years post-transplantation, the biological and clinical evolution is remarkable and the patient's quality of life is good."

But, reporting in the science journal Nature, the doctors sounded a note of caution, saying there was a possibility that the patient could be at risk of developing leukaemia in the future due to side effects from the gene therapy.

Gene therapy has been used since the 1990s as a new approach to treating a number of incurable conditions, including inherited disorders, some cancers, and viral infections.

There have been some positive results, but in 1999 an 18-year-old US volunteer, Jesse Gelsinger, died after the treatment.

And some children given gene therapy for the immune disorder "bubble baby" syndrome have developed cancer.

Proof of principle

Prof Adrian Thrasher, of University College London, has carried out gene therapy on children with immune disorders.

He said the latest study was an encouraging proof of principle that gene therapy could have genuine therapeutic effects in other blood disorders.

"The good news is that technology is advancing rapidly, and it shouldn't be too long before diseases such as thalassaemia can be reliably and safely treated in this way," he said.

Dr Derek Persons, of St Jude Children's Research Hospital in Memphis, Tennessee, said the work was "a major step forward for the gene therapy of haemoglobin disorder".

He said further trials were planned at several centres in the US, including his own.

"This is very early days," he added. "The field will advance from people doing different trials."

Test To Speed up Meningitis Fight

The most dangerous form of meningitis can kill within hours - but doctors think they have developed the best way to identify it early.The "predictive model" developed by the Health Protection Agency could clear the way for the right treatment to be given quickly.

It uses a combination of blood tests and symptoms to help identify bacterial meningitis.

Charities welcomed the model, while calling for further testing.

Meningitis is an inflammation in the membranes surrounding the spinal cord and brain. It is most often caused by either bacterial or viral infection.

Knowing which is which can make a big difference to the best treatment.

Bacterial meningitis needs antibiotic treatment as soon as possible - and it is often prudent to give these drugs to close family members as well.

Rash

There are tests to identify the cause of meningitis, the best known being a lumbar puncture to obtain spinal fluid for analysis.

However, this does not always yield clear-cut results.

The new model has a simple set of three criteria which helps doctors tell the difference without having to wait for conclusive spinal fluid results.

Researchers found them by examining 385 confirmed meningitis cases over a 12-month period.
The first two criteria are blood tests positive for two specific chemicals associated with bacterial meningitis, the third is the presence of the "classic" meningitis rash of spots which do not disappear when pressed with a glass.

The three results are combined to provide a score which then tells the doctor how likely bacterial meningitis is.

Dr Toyin Ejidokun, a consultant in communicable disease at the HPA, said: "The total score allows a treating clinician to simply and quickly assess the likelihood of whether or not the case is bacterial meningitis by checking it against the predictive probabilities we have developed.

"While further testing needs to take place to test the accuracy of the model, it offers the prospect of a rapid predictive tool to help clinical and public health management of suspected bacterial meningitis cases."

'Step forward'

Steve Dayman, the chief executive of Meningitis UK, said the protocol was "an excellent step forward".

He said: "It's vital that the differentiation between bacterial and viral meningitis is made straight-away because the bacterial form can kill in less then four hours. Quick treatment can mean the difference between life and death.

"In the absence of a vaccine to protect against all forms of meningitis, this new model could help to save precious lives."

Experts said people should still be vigilant for the warning signs of meningitis to maximise the chances of recovery.

Although not every patient has every symptom, common signs include a combination of "classic rash", suddenly appearing high fever, a severe and worsening headache, stiff neck, vomiting, joint and muscle pain, a dislike of bright lights, very cold hands and feet, and severe drowsiness.

A spokesman for the Meningitis Research Foundation said: "Early detection of meningitis and septicaemia is critical when treating these diseases, every second matters.

"We welcome all research and development to identify meningitis early so treatment of antibiotics can be administered as soon as possible to prevent the worst outcome."

However, she said that doctors should stick with existing protocols for diagnosing and treating meningitis until the new version had been fully tested.

Chest Compressions Alone Can Save Lives

Chest compressions prior to defibrillation are just as good as immediate treatment with an electrical defibrillator for out-of-hospital cardiac arrest, according to a new research study. In some respects, chest compression may even be better, particularly with regard to one-year survival, Dr. Pascal Meier of the University of Michigan and colleagues reported in BMC. "Based on our study, current guidelines emphasizing early defibrillation still are important," Meier said in a statement. "However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines." Still, survival rates for out-of-hospital cardiac arrest are low, hovering at about 7.6 percent over the last 30 years, the researchers noted. Current guidelines recommend immediate electrical defibrillation for this type of cardiac arrest. But some recent studies have shown an advantage for earlier treatment with chest compressions before defibrillation. So to compare the effects of compression-first versus defibrillation-first on outcomes for out-of-hospital cardiac arrest, the researchers conducted a review of the literature, and came up with four randomized controlled trials totaling 1,503 patients. They found no differences between the approaches in terms of the rate of return of spontaneous circulation, survival to hospital discharge or favorable neurologic outcomes. There was, however, a trend toward an advantage for one-year survival that didn't reach statistical significance. The proportion of patients able to leave the hospital after cardiac arrest with chest compression first was 11 percent compared with 8.6 percent of those treated with defibrillation first, the researchers wrote. There was also a trend for better outcomes among patients with a response interval greater than five minutes that pointed to the superiority of chest compression-first approach, but again, the finding was not significant. But the researchers emphasized that the study was not sufficiently powered to detect this relationship, which should be explored further.

Statins may cut arthritis risk, study suggests

Taking statins may reduce the risk of rheumatoid arthritis, a study suggests.

Israeli researchers looked at 1.8m patients and found fewer incidents of the joint condition among those who took the cholesterol-busting drugs.

It was thought statins could ease symptoms in those already diagnosed by stopping the over-production of tissue between the joints.

But the Maccabi Healthcare Services Research Institute study suggested they could stop it developing altogether.

The team discovered 2,500 cases of rheumatoid arthritis, the debilitating inflammation of the joints which affects about one in 100 people.

Heart and joints

They found that those people who were on statins, now commonly prescribed to prevent heart attacks, were 50% less likely to develop the condition than those who were not regularly taking the drugs.

The relationship in this trial between adherence to statin therapy and incidence of rheumatoid arthritis is unclear, but the work builds on existing knowledge.

However, the researchers acknowledged that the work, published in the journal PLOS Medicine, now needed to be confirmed in other populations.

Jane Tadman, of Arthritis Research UK, said: "Our own published research and that of researchers in Japan has shown a modest but significant effect on inflammation in rheumatoid arthritis, and this latest piece of research adds further evidence of this link.

"We now need larger clinical trials to confirm further that statins can reduce the risk of developing rheumatoid arthritis."

MS activity alters with seasons, US researchers say

Brain scans of patients compared with weather patterns at the time showed higher levels of disease activity in the spring and summer.

The US researchers said the findings had implications for testing new medicines, which may show up different results depending on the time of year.

It is not clear why warmer weather would have this effect.

Other studies have shown that vitamin D from exposure to sunlight may have a protective effect against MS - a long-term inflammatory condition of the central nervous system.

For the study, researchers compared MRI brain scans of 44 people taken from 1991 to 1993 to daily temperature, solar radiation and precipitation measurements over the same time.

The adults in the study, who had untreated MS, had eight weekly scans followed by eight scans every fortnight then six monthly check-ups - an average of 22 scans per person.

After one year, 310 new brain lesions were found in 31 people, they reported in Neurology.

The lesions were up to three times more likely to appear in the warmer spring and summer months.

Further analysis also showed that there was a link between both new disease activity and intensity of disease activity and the warmer months.

Trial results

Study leader Dr Dominik Meier, from Brigham and Women's Hospital in Boston, said: "Not only were more lesions found during the spring and summer seasons, our study also found that warmer temperatures and solar radiation were linked to disease activity."

He pointed out that clinical trials often use MRI (magnetic resonance imaging) to assess the effectiveness of a drug and studies commonly last between six and 12 months, which may have implications for how effective a new medication seems.

In an accompanying editorial Dr Anne Cross, from Washington University School of Medicine, added: "This is an important study because it analyses records from the early 1990s, before medications for relapsing MS were approved, so medicines likely could not affect the outcome.

"Future studies should further explore how and why environmental factors play a role in MS."

Dr Susan Kohlhaas, research communications officer at the MS Society, said more research was needed.

But added: "This small study is intriguing and, if validated in larger studies, has the potential to influence the way clinical trials are designed."

Fear of Falling Linked to Future Falls in Elderly

August 20, 2010 — Seniors who have an irrationally high fear of falling are at increased risk for future falls, irrespective of their actual physiological risk, according to a new study published online today by the British Medical Journal.

"Both falls and fear of falls can substantially reduce quality of life and independence and so contribute to the placement of an elderly person into institutionalized care," write Kim Delbaere, PhD, from the University of New South Wales, Sydney, Australia, and colleagues. "However, the complex nature of psychological risk factors for falling and the limited background information on this phenomenon hamper its inclusion in falls prevention programmes."

Excessive fear of falling can cause seniors to limit their participation in physical and social activities, so that they become physically deconditioned, socially isolated, and depressed. In contrast, an inappropriately low fear of falling can cause seniors to take risks that are beyond their true ability to cope, the authors write.

The aim of this study was to expand understanding about irrational fear — either too much or too little — and to study its effect on the risk for future falls.

The study included 500 seniors aged 70 to 90 years living in Sydney. Their mean age was 77.9 years, and 54% were women. All underwent extensive medical, physiological, and neuropsychological assessment.

The investigators used the Physiological Profile Assessment (PPA) to determine participants' physiological (actual) fall risk and the Falls Efficacy Scale International to determine their perceived risk of falling. Participants were followed up monthly for falls for 1 year.

The researchers found that actual and perceived fall risk were both independent predictors of future falls. The risk for falls significantly increased with a higher PPA score (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.06 - 1.61; P = .011) and a higher Falls Efficacy Scale International score (OR, 1.05; 95% CI, 1.02 - 1.08; P = .001).

The researchers then split the study participants into 4 groups — vigorous, anxious, stoic, and aware — according to the disparity between their actual and perceived risk.

Most of the participants had an accurate perception of their risk of falling. Those in the vigorous group, who had low actual and perceived fall risk, were considered at low risk for future significant falls, and those in the aware group, who had high actual and perceived fall risk, were deemed to be at high risk for future significant falls.

However, about a third of the study cohort either underestimated or overestimated their risk for falls.

The anxious group had a low actual risk but high perceived risk; this was related to depressive symptoms (P = .029), neurotic personality traits (P =.026), and decreased executive functioning (P = .010).

In contrast, the stoic group had a high actual but low perceived fall risk, which was protective against falling and was related through a positive outlook on life (P = .001) and continuation of physical activity and community participation (P = .048).

"Overall, it seems that high levels of perceived fall risk may lead to future falls, independent of physiological risk, and that the disparity between physiological and perceived fall risk contributes to fall risk mainly through psychological pathways," the study authors write. "This indicates that measures of both physiological and perceived fall risk should be included in fall risk assessments."

Limitations of the study include the use of the PPA, which is an estimate and may result in measurement error, and the fact that the data used to develop the psychological profiles of the participants were self-reported, the authors note. Also, the population studied were healthy community-dwelling elders; results, therefore, cannot be generalized to those with cognitive impairment or others at particularly high risk of falling such as patients with Parkinson’s disease.

They conclude that fall risk assessments should include measures of both actual and perceived risk, and that this may assist in designing specific interventions to prevent falls in the elderly.

The study was supported by the Australian National Health and Medical Research Council.

Green leafy veg 'may cut diabetes risk'

A diet rich in green leafy vegetables may reduce the risk of developing diabetes, UK research says.

In an analysis of six studies into fruit and vegetable intake, only food including spinach and cabbage was found to have a significant positive effect.

A portion and a half a day was found to cut type 2 diabetes risk by 14%, the British Medical Journal (BMJ) reports.

But experts urged people to continue to aim for five portions of fruit and vegetables a day.
The researchers from Leicester University reviewed data from the studies of 220,000 adults in total.

They found that eating more fruit and vegetables in general was not strongly linked with a smaller chance of developing type 2 diabetes but "there was a general trend in that direction".

Yet when it came to green leafy vegetables, which the researchers said also includes broccoli and cauliflower, the risk reduction was significant.

The team calculated that a daily dose of 106g reduced the risk of diabetes by 14% - a UK "portion" is classed as 80g.

It is not clear why green leafy vegetables may have a protective effect but one reason may be they are high in antioxidants, such as vitamin C and another theory is that they contain high levels of magnesium.

Study leader Professor Melanie Davies, professor of diabetic medicine at the University of Leicester, said the message to eat five portions of fruit and vegetables a day remains an important one.

But she added: "People like very specific health messages.

"We know that intake of fruit and vegetables is important, but this study suggests that green leafy vegetables seem to be particularly important in terms of preventing diabetes."

The team are now planning a study in people at high risk of developing the condition to see if increasing their intake of vegetables like spinach and kale can help to reduce their chances of being diagnosed with diabetes.

Fruit and veg

In 2008/09, the National Diet Nutrition Survey showed that, although fruit and vegetable intake has risen over the past decade, only a third of men and women eat the recommended five-a-day.

In an accompanying editorial in the BMJ, Professor Jim Mann from the University of Otago in New Zealand, stressed that the message of increasing overall fruit and vegetable intake must not be lost "in a plethora of magic bullets," even though green leafy vegetables clearly can be included as one of the daily portions.

Dr Iain Frame, director of research at Diabetes UK said: "We already know that the health benefits of eating vegetables are far-reaching but this is the first time that there has been a suggested link specifically between green leafy vegetables and a reduced risk of developing type 2 diabetes."

But he warned the evidence was limited and it was too early to isolate green leafy vegetables and present them alone as a method to cut the chances of developing the condition.

"We would be concerned if focusing on certain foods detracted from the advice to eat five portions of fruits and vegetables a day, which has benefits in terms of reducing heart disease, stroke, some cancers and obesity as well as type 2 diabetes."

Diabetes UK is currently funding research into whether fermentable carbohydrates found in foods such as asparagus, garlic, chicory and Jerusalem artichokes could help weight loss and prevent Type 2 diabetes.

Blood Test for Right Blood Pressure Meds

CHICAGO, Aug 18 (Reuters) - Tests for a blood-pressure regulating hormone called renin may help doctors decide which blood pressure drugs their patients should take, researchers said on Wednesday. They said a mismatch between drugs and patient characteristics may help explain why many people do not benefit from blood pressure drugs, and testing for renin levels may help. "The one-size-fits-all approach must be abandoned," said Dr. Curt Furberg of Wake Forest University School of Medicine in North Carolina, who wrote a commentary on the studies in the American Journal of Hypertension. Currently, fewer than half of patients are helped when they take just one blood pressure drug, and many must take more than one to keep blood pressure down. A study in May in the Journal of the American Medical Association found that about half of the 65 million people in the United States with high blood pressure have it under control. Furberg said researchers have known for years that patients respond differently to different drugs for high blood pressure, yet this has not translated into tests and strategies that help find the best treatments for individual patients. In a series of studies in the same journal, three research teams looked at different aspects of this problem. Stephen Turner and colleagues of the Mayo Clinic in Rochester, Minnesota, found that blood tests measuring for renin, a hormone produced in the kidney, can help guide doctors in selecting blood pressure drugs. Patients who had high levels of renin were more likely to respond to the common beta blocker atenolol and less likely to respond to hydrochlorothiazide, a diuretic used to rid the body of unneeded water and salt. A team led Michael Alderman of Albert Einstein College of Medicine in New York and colleagues found that some peopletaking blood pressure drugs actually have an increase in their systolic blood pressure -- the top blood pressure reading. This was more common in people with low renin levels who were given a calcium channel blocker or an ACE inhibitor. And a third study by Ajay Gupta of Imperial College London found that blacks were less likely than whites to respond to anti-renin drugs. Furberg says the findings suggest the need for new guidelines for treating high blood pressure that incorporate tests to measure a patient's renin levels. Morris Brown of Britain's University of Cambridge said in a commentary that it may be useful to identify patients with extremely high or low renin levels who may not benefit from standard combination of drugs. Brown said it may be time to consider measuring renin as a part of routine care for high blood pressure. High blood pressure, or too much force exerted by blood as it moves against vessel walls, is the second-leading cause of death in the United States. About $73 billion is spent per year in the United States treating it.

Predictive blood test for TB 'a step closer'

International researchers say they have made a "significant step" towards a predictive blood test for tuberculosis.

A DNA fingerprint in the blood shows promise in identifying which carriers of TB will go on to get symptoms and spread the infection.

Such a test would allow earlier diagnosis and treatment of the lung disease, potentially saving many lives.

Experts say the research, published in Nature, is "remarkable" but needs to be proven by further work.

Tuberculosis, or TB, is an infectious bacterial disease of the lungs, causing symptoms such as coughing, chest pains and weight loss.

Someone in the world is newly infected with TB every second, with nearly two million deaths each year.

Only around one in 10 people infected with TB go on to develop the active form of disease.

Currently, although a skin or blood test can show if someone is harbouring TB, but not showing symptoms, it is impossible to predict who will get the full-blown disease.

Researchers from the UK, US and South Africa examined the genetic signature in the blood of patients with active TB.

The same genetic markers were found in about 10% of patients with latent infections, suggesting they are candidates for the full-blown form of the disease.

These patients will now be followed up in the future, to see if they do go on to get symptoms.

Promise

Lead researcher Dr Anne O'Garra of the MRC's National Institute for Medical Research in London, said the blood test showed promise but needed further work.

She told the BBC: "If you could predict which so-called carriers of TB will progress to the full-blown disease, this would have major ramifications for stopping the global epidemic.

"We just have to prove it now, but it's very promising."

Mike Mandelbaum, chief executive of the charity TB Alert, said good progress had been made in the diagnosis of latent TB infection in recent years, but there was a need for a specific test for the active disease.

The diagnosis of TB is often difficult to make until the disease has become infectious to others, he said, particularly in the developing world which has fewer resources.

"A new diagnostic technique based on a blood test would be extremely valuable to save lives and prevent the spread of this disease," he said, "and may be particularly important in HIV positive patients with TB where the usual technique of diagnosis from sputum is often unhelpful."

Dr Marc Lipman, chairman of the TB special advisory group at the British Thoracic Society, said it was "a remarkable piece of research".

He explained: "This for the first time perhaps enables us to start to design tests which can predict who is at highest risk of progressing to active disease and also how we might stop that occurring in the first place.

"Any such advance is 20-30 years away," he added.

Heart Attack, Stroke-Prone Arteries More Common in Nasty People

People with antagonistic or disagreeable personalities have thicker arterial walls that may make them more prone to heart attacks and strokes, researchers said. The carotid artery lining was significantly thicker in people who rated low on a scale of agreeableness, reported Angelina Sutin of the National Institute on Aging in Bethesda, Md., and colleagues. In a study of 5,614 residents of the Italian island of Sardinia, those ranking in the lowest 10 percent of agreeableness were 1.4 times as likely to have thickening in their lining of their carotid artery, the researchers found. This held true even after the researchers adjusted for cholesterol levels, smoking status and other risk factors. The researchers also found that an antagonistic personality predicted increased thickening over approximately three years of follow-up.Previous studies have linked cardiovascular disease with certain personality types, notably the hard-charging "Type A" personality. Subsequent research showed that hostility was a major contributor to these findings, Sutin and colleagues reported.

They also cited some earlier studies linking various antisocial behavior patterns to arterial thickening. But these focused on specific populations, including poor young adults, women transitioning to menopause and men with untreated high blood pressure.

"Large, population-based samples are needed to test whether these associations hold across different demographic groups," Sutin and colleagues wrote.
Their sample came from an ongoing, prospective study in Sardinia designed to uncover genetic and environmental factors associated with complex and age-related health problems. Approximately 62 percent of the population in four towns has participated in the study.

One of the questionnaires included in the study was the Revised NEO Personality Inventory (Italian translation), a self-assessment that includes 48 items covering six traits associated with agreeableness: trust, straightforwardness, altruism, compliance, modesty, and tendermindedness. Each is rated on a five-point scale from "strongly agree" to "strongly disagree."

Carotid artery thickening was assessed by ultrasound at the time of enrollment and approximately three years later. The follow-up measurement was performed in 83 percent of participants.

Other risk factors included in the statistical analysis were age, sex, education, waist circumference, systolic and diastolic blood pressure, LDL and HDL cholesterol, triglycerides, fasting plasma glucose and insulin, smoling status, and use of antihypertensive, statin, or diabetic medications.

Sutin and colleagues found that agreeableness scores were significantly associated with initial arterial thickness and with changes during the three-year follow-up. The specific traits of straightforwardness and compliance were most strongly associated with the arterial thickness.
On the other hand, when the researchers looked at the risk of being in the top quartile of arterial thickness, high agreeableness scores did not appear to have a protective effect in participants from either gender.

Dr. Redford Williams of Duke University in Durham, N.C., who was not involved with the study, commented that the findings highlight the largely unappreciated role of psychological factors in cardiovascular disease risk.

"Psychological and social factors are just as strong, as this study clearly documented, in putting people at higher risk of heart disease and other health problems," he said in an interview.

Williams noted the degree of cardiovascular event risk suggested by the study findings as associated with antagonistic personality traits was comparable to that of high LDL cholesterol, hypertension, or smoking.

"We really need, in this country and around the world, to begin to focus on ameliorating the effect of psychosocial risk factors just as we are on the physical risk factors," he said.

He suggested that patients with these traits should consider anger-management training, though he cautioned that cardiovascular benefits remain uncertain.

"I think we need the clinical trials -- carefully done, randomized clinical trials -- to make sure the kinds of anger-management training we might employ really are not only reducing anger, but reducing the rate of disease development. That's the gold standard we have to hit," Williams said.

But he adds, "It's certainly not going to hurt you to learn how to manage anger better."

Women beer drinkers 'increase psoriasis risk'

Women who drink beer regularly are more likely to develop the skin disease psoriasis, a US study suggests.

The study found that women who drank five beers a week doubled their risk of developing the condition compared with women who did not drink.

The Boston study, in Archives of Dermatology, looked at more than 82,000 female nurses aged 27 to 44 and their drinking habits from 1991 until 2005.

Non-alcoholic beer, wine and spirits were not found to increase the risk.

In the study, researchers said that woman who drank more than two alcoholic drinks a week increased their risk of psoriasis by two-thirds compared with non-drinkers.

For women who drank five glasses of beer per week their risk of developing psoriasis was 1.8 times higher again
When stricter criteria were used to confirm psoriasis cases, their risk was increased 2.3 times.

Yet women who drank any amount of low- or non-alcoholic beer, white wine, red wine or spirits per week were not found to be at increased risk.

Barley content

Author Dr Abrar Qureshi, from Harvard Medical School, Boston, wrote in the journal: "Non-light beer was the only alcoholic beverage that increased the risk of psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis."

The study suggests that it could be the gluten-containing barley, used in the fermentation of beer, which is the cause of the increased psoriasis risk.

Previous studies have shown that a gluten-free diet may improve psoriasis in patients who are sensitive to gluten.

People with psoriasis may have a so-called latent-gluten sensitivity, compared with people without psoriasis, says the study.

"Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer," the authors conclude.

Psoriasis is a chronic skin disease characterised by itchy red scaly patches that most commonly appear on the knees, elbows and scalp but can show up anywhere, including the face.

The effects can range from mild to disfiguring enough to be socially disabling.

Immune genes 'key in Parkinson's disease'

The immune system may have a key role in the development of Parkinson's disease, say US researchers.

In a 20-year study of 4,000 people, half with Parkinson's disease, the team found an association between genes controlling immunity and the condition.

The results raise the possibility of new targets for drug development, Nature Genetics reports.

Parkinson's UK said the study strengthened the idea that immunity is an important driver of the disease.

The team were not just looking for a genetic cause of the disease, but also considered clinical and environmental factors.

During their search, they discovered that groups of genes collectively known as HLA genes are associated with the condition.

These genes are key for the immune system to differentiate between foreign invaders and the body's own tissues.

In theory, that enables the immune system to attack infectious organisms without turning on itself - but it is not always an infallible system.

The genes vary considerably between individuals.

Some versions of the genes are associated with increased risk or protection against infectious disease, while others can induce autoimmune disorders in which the immune system attacks the body's own tissues.

Inflammation

Multiple sclerosis has already been shown to be associated with the same HLA genetic variant seen in the latest study in Parkinson's disease, the researchers said.

It was already known that people who take anti-inflammatory drugs, such as ibuprofen, have a decreased risk of developing Parkinson's disease, which also supports the idea that the immune system has a role in the disease.

But this protective effect is not the same for everyone, probably because of genetic differences.

With better understanding of the link between Parkinson's disease, immunity and inflammation, it may be possible to design more effective drugs for treating the condition, the researchers said.

"Over the years, there have been subtle hints that immune function might be linked to Parkinson's disease," said study leader Dr Cyrus Zabetian, associate professor of neurology at the University of Washington.

"But now we have much more convincing evidence of this and a better idea of which parts of the immune system might be involved."

He added: "Our results also pointed to several other genes that might play a role in developing Parkinson's disease, and these findings need to be confirmed, so we have a lot of work ahead of us."

Dr Kieran Breen, director of research at Parkinson's UK, said the work provides additional evidence of the role of inflammation in the development of Parkinson's disease.

"We know already that some people are more susceptible to getting Parkinson's due to their genetic makeup. This study also points to some genes that may be involved."

He added: "This research, combined with Parkinson's UK funded research at Oxford University into the role of inflammation, may lead to the development of new drug treatments for the condition."

Swine flu pandemic over, says world health body

The swine flu pandemic has been declared officially over by the World Health Organization.

The body said it was moving to the "post-pandemic phase" after many countries, including the UK, had scaled down their emergency measures.

WHO director general Dr Margaret Chan said the virus had "largely run its course".

Millions of people were affected across the world by the infection after it emerged in April last year.

But the pandemic - the first for 40 years - proved much less deadly than many had feared.

In the UK, more than 450 people died, but that was well short of the 65,000 predicted as the worst-case scenario.

The decision by WHO reflects the fact that the virus is only circulating at relatively low levels, in most cases on par with seasonal flu activity.

In a telephone news conference, Dr Chan said: "The world is no longer in phase six of the pandemic alert. We are now moving into the post-pandemic period.

"The new H1N1 virus has largely run its course."

The WHO still said health officials should continue monitoring infection rates - as there is still a chance they could rise again - as well as updating their plans on the basis of what was learnt during the pandemic.

High stress 'delays pregnancy'

A scientific study has shown for the first time that high stress levels may delay pregnancy.

Oxford University experts measured stress hormones in women planning a baby naturally and found the most stressed had a reduced chance of becoming pregnant.

Relaxation might help some couples but more research is needed, they say.

The study, in the journal Fertility and Sterility, followed 274 healthy women aged 18-40 planning a pregnancy.

Age, smoking, obesity and alcohol are known to affect pregnancy success, but the influence of stress is less clear.
Markers for two stress hormones - adrenalin, the body's fight or flight hormone, and cortisol, connected with chronic stress - were measured in saliva.

Women with the highest levels of alpha-amylase (an indicator of adrenalin levels) had about a 12% reduced chance of getting pregnant during their fertile days that month compared with those with the lowest levels of the marker.

No difference in the chance of becoming pregnant was found with cortisol.

Anecdotal reports have long linked stress with infertility, but direct scientific evidence has been hard to find.

Dr Cecilia Pyper, of the National Perinatal Epidemiology Unit at the University of Oxford, said their study aimed to improve understanding of the factors that influence pregnancy in normal healthy women.She said: "'This is the first study to find that a biological measure of stress is associated with a woman's chances of becoming pregnant that month.

"The findings support the idea that couples should aim to stay as relaxed as they can about trying for a baby.

"In some people's cases, it might be relevant to look at relaxation techniques, counselling and even approaches like yoga and meditation."

The research was carried out in collaboration with the Eunice Kennedy Shriver National Institute for Child Health and Human Development in the US.

It is part of a larger study looking at the effect of factors like smoking, alcohol, and caffeine on chances of pregnancy.

Commenting on the study, Joanne Taylor, midwife for baby charity Tommy's said: "Stress does affect people in different ways, and therefore may affect some women's chances of trying to conceive.

"There are a number of ways in which women can prepare themselves for a healthy pregnancy - maintaining a healthy diet, taking folic acid supplements and keeping stress levels to a minimum is a good start."

Ovulation hormones make women 'choose clingy clothes'

Women are more likely to select clingy clothes when they are ovulating, a study has found.

But the University of Minnesota study of 100 women found these hormonal shopping habits were triggered by the proximity of attractive women.

The researchers suggest in selecting tighter clothes, the women were trying to stand out from love rivals.

The Journal of Consumer Research study said there should be more analysis of how hormones affected shopping habits.

Women at different stages of their menstrual cycle were shown images of attractive women living locally or far away.

They were then asked to choose clothes and accessories which they would like to buy.

Women who were ovulating and who had seen photos of attractive local women were most likely to buy "sexier" clothes compared with those shown photographs of unattractive local women or women who lived more than 1,000 miles (1,600km) away.

'Eye-catching'

Dr Kristina Durante, who led the research, said: "The desire for women at peak fertility to unconsciously choose products that enhance appearance is driven by a desire to outdo attractive rival women.

"If you look more desirable than your competition, you are more likely to stand out."

The team said even though the end result was about attracting the best romantic partner available, ovulating women's choice of dress was motivated by the other women in their environment.

"In order to entice a desirable mate, a woman needs to assess the attractiveness of other women in her local environment to determine how eye-catching she needs to be to snare a good man," she said.

And she said the study's findings could influence how and when products were marketed to women.

"Our findings suggest marketers for many types of female products are well served to strategically time their mailings, coupons, electronic solicitations, and direct requests to the specific window when women are ovulating."

Dr George Fieldman, a London-based psychotherapist, said the findings were interesting.

"What this study in part reveals is that people are only semi-conscious of the underlying reasons behind the choices they make in the context of buying sexy clothes," he said.

"Women do the choosing [of mates] but in order to enable them to choose, they need a good number of suitors to select from."

Girls now reaching puberty before 10 – a year sooner than 20 years ago

The latest generation of girls are reaching puberty before the age of 10, a new study suggests, raising fears they may also begin sexual activity earlier. Scientists have found that the average age that breast development begins is now nine years and 10 months – almost a year earlier than a previous study in 1991.

They have yet to discover the reason behind the phenomenon but believe it could be linked to unhealthy lifestyles or exposure to chemicals in food.

The study was carried out in Denmark in 2006, the latest year for which figures were available, but experts believe the trend applies to Britain.

Data from America also points to the earlier onset of puberty.

Scientists are worried that young girls are ill-equipped to cope with sexual development when they are still at primary school – and that exposure to hormones earlier could increase their risk from breast cancer.

“We were very surprised that there had been such a change in a period of just 15 years,” Anders Juul, head of the Department of Growth and Reproduction at the University hospital in Copenhagen, told the Sunday Times.

“If girls mature early, they run into teenage problems at an early age and they’re more prone to diseases later on.

"We should be worried about this regardless of what we think the underlying reasons might be.

"It’s a clear sign that something is affecting our children, whether it’s junk food, environmental chemicals or lack of physical activity.”

Hitting puberty early can mean longer exposure to oestrogen, which is a factor in breast cancer. There is also a greater risk of heart disease.

A number of artificially produced chemicals have been blamed for interfering with sexual development, notably bisphenol A, a plastic found in the lining of tin cans and babies’ feeding bottles.

Mr Juul’s research team is now testing blood and urine samples from girls in the study to see if a direct link can be drawn between early sexual maturation and bisphenol A.

Another factor in puberty could be diet. Children are eating more than previous generations and growing bigger — and in many cases becoming obese.

There has been a steady lowering in the onset of puberty. In the 19th century, it was at about 15 for girls and 17 for boys.

The international standard for normal puberty in white girls was set in the 1960s at 12 for the age when periods begin and at about 14 for boys when their voices break and their growth surges.

A more recent consensus in Britain has proved less conclusive.

“Although we don’t have clear data here, there is evidence the same thing [as in Denmark] is happening for reasons that we don’t understand,” said Richard Sharpe, head of the Medical Research Council’s human reproductive sciences unit in Edinburgh.

“We don’t know if this is the result of better nutrition or environmental factors, but it does create social problems for girls who are already living in a sexualised society.”

Gene link to meningitis infection

A set of genes which renders people more prone to meningitis has been pinpointed by researchers.

The international team compared DNA from 1,400 people with bacterial meningitis and 6,000 healthy individuals, Nature Genetics reports.

They found differences in a family of genes involved in the immune response seem to make people more or less susceptible to the infection.

It is hoped the findings will lead to the development of new vaccines.

The researchers were looking at meningitis caused by the Neisseria meningitidis bacterium, which leads to swelling of the lining of the brain and blood poisoning.

It is not the first time researchers have attempted to find out if some people are more likely to catch meningitis because of their genetic make-up.
But results have previously been unclear, probably because of the small number of people studied.

In the latest study, researchers first scanned the whole genetic code of 475 British patients with meningococcal disease and 4,700 healthy individuals.

They found a clear difference in a small set of genes known to be involved in the immune system response.

When they looked again in two other European populations they found the same result.

Vaccine

The genetic differences found means that, in some people, the bacteria is able to evade the immune system and cause infection, while other people' immune systems are better equipped to fight it off.

The genes encode for a protein called factor H, and factor H related proteins.

Where there are flaws, the meningococcal bacteria is able to bind to these proteins to prevent the immune system from recognising it - almost like a Trojan horse - enabling it to get a foothold.

Study author Professor Michael Levin, an expert in international child health at Imperial College London, said the findings would be particularly useful in developing a vaccine against meningitis B, which is now responsible for most cases in the UK.

There is already an effective vaccine against meningitis C.
"It seems that the genetic differences in factor H between people is what determines susceptibility or resistance.

"It suggests it may be an important protein to include in vaccines, and factor H is already one of the candidates for meningitis B vaccine."

He said the results will also help scientists better tailor vaccines to be effective in the whole population.

It may also open up avenues for improving treatment once people have bacterial meningitis, he said.

Sue Davie, chief executive of the Meningitis Trust, said: "This exciting work has thrown new light on factors that play a part in determining why some people get meningococcal disease and others do not.

"Further work will be needed to establish just what the genetic differences are in the genes which actually cause this susceptibility to invasive infection, but this is a promising start."

Large waist size linked to 'higher risk of death'

Men and women with large waists are at increased risk of dying young, a US study has found.

This is true regardless of their body mass index (BMI), research published in Archives of Internal Medicine suggests.

But very high waist measurements equivalent to UK size 24-26 in women and XXXXL in men appear to double the risk of mortality.

For the study researchers tracked more than 100,000 men and women aged 50 and older over nine years.

They also found that in women the link between a larger waist and a higher risk of death was strongest for those of normal weight.

More research is needed to find out why this is so, say the authors of the study.

Dr Eric Jacobs and his team at the American Cancer Society in Atlanta examined the link between waist circumference and risk of death among 48,500 men and 56,343 women.

Participants were predominantly white. At the start of the study, the average age of the men was 69 years and of the women, 67 years.

From 1997 until 2006 the deaths of any participants were tracked and the causes noted.

A total of 9,315 men and 5,332 women died during this time.

Whether participants were of normal weight, overweight or obese, researchers found that risk of death increased with increasing waist circumference.

This risk significantly increased in men with waists measuring 110cm or more and in women with waists measuring 95cm or more, the study found.

But it is only in men and women with very large waists (120cm or larger in men and 110cm in women) that the risk of death appears to double during the nine-year study.

The most common cause of death in those with the strongest link between mortality and waist size was respiratory disease, followed by cardiovascular disease and then cancer.

The study concludes: "Our results suggest that, regardless of weight, avoiding gains in waist circumference may reduce risk of premature mortality."

Dr David Haslam, chair of the National Obesity Forum, said the research is important.

"This underlines the message that fat inside the belly is dangerous.

"Even if you have a normal BMI and a big tummy then you are just as much at risk as someone who is classified as obese with a large tummy."

Previous studies have shown that abdominal obesity is a strong indicator for the development of coronary artery disease and is associated with insulin resistance and the development of Type 2 diabetes.

The risk is associated with the fat stores, which are not just under the skin but deep within the abdominal cavity.

WAIST SIZES - WOMEN*
Size 10 = 69 cm
Size 12 = 74 cm
Size 14 = 79 cm
Size 16 = 84 cm
Size 18 = 89 cm
Sizes 20-22 = 90-101cm
Sizes 24-26 = 102-113cm

WAIST SIZES - MEN*
Small - up to 78cm
Medium - 82.5-87.5cm
Large - 90-94cm
X Large - 96.5-101.5cm
XX Large - 104-109cm
XXX Large - 112-117cm
All sizes according to M&S*

Researchers Develop Wireless Glucose Monitor for Diabetics

Bioengineers in the United States have developed an implantable wireless monitor for diabetics that can measure glucose levels continuously for up to a year before needing replacement. The device, if approved by federal regulators, would give diabetics a more reliable and less painful alternative to current glucose monitoring devices.

The glucose monitoring system is designed to be implanted just under the skin, where it automatically measures glucose or blood sugar levels and transmits the data to an external receiver. The device, a small disc about 38 millimeters across and 16 millimeters thick, could be substituted for painful finger-stick devices and implanted needle-like sensors that monitor glucose levels continuously, but need to be replaced every three to seven days.

Diabetics have difficulty maintaining healthy blood glucose levels because they cannot produce enough of the sugar-processing hormone insulin - a condition called Type 1 or juvenile diabetes - or because the insulin they do produce is unable to properly convert dietary glucose into energy - a condition known as Type 2 or adult-onset diabetes.

Large studies have shown that strict blood sugar control, through continual glucose measurements and adjustment when blood sugar levels get too high or too low, reduces the risk of diabetic complications, including kidney, eye and heart disease.

Bioengineer David Gough of the University of California, San Diego is lead author of the study describing the new monitoring system and its successful performance in animal tests.

Gough says the sensor would allow diabetics to keep a much closer eye on their blood sugar levels than conventional methods. "So they could adjust the insulin or exercise, diet or other therapy and better manage their diabetes. So this device would be implanted subcutaneously for long periods of time, say a year or more," he said.

The monitor is made up of two oxygen sensors. One contains an enzyme catalyst called glucose oxydase that triggers a chemical reaction in proportion to the amount of oxygen consumed by sugar in the interstitial fluid beneath the skin.

The second sensor reads the amount of oxygen from the first sensor and compares it to a reference level, producing a blood glucose reading.

Gough says the dual sensors could be implanted during a simple outpatient procedure, at the waist or lower abdomen, or just below the collar bone, where heart pacemakers are often located.

The bioengineer says the readings would be sent wirelessly to a receiver outside the body. "You could have the receiver attached to your belt or it might ultimately be a cell phone or something like that," he said.

The wireless glucose monitor would guard against one of the most dangerous aspects of diabetes - hypoglycemia, a condition in which blood sugar levels fall very low. It is especially dangerous, Gough says, if the condition develops while a patient is asleep.

"Those people are under an immediate concern because they can lose cognitive ability and have an accident or something. So this device would warn when glucose was too low as well. And both of those things - both the short term problems of diabetes and long term problems of diabetes - could, in principal, be ameliorated," he said.

Gough says the glucose sensors could be used to send a cell phone wake-up call to parents of diabetic children if their child's glucose level dropped dangerously low during the night.

Researchers say their goal is to create a closed-loop system in which the wireless monitor continuously measures blood glucose and an external insulin pump automatically adjusts the amount of insulin being administered.

Gough says researchers hope to begin human clinical trials of the glucose monitor within the next few months and to gain federal regulatory approval soon after that.

An article describing the wireless blood sugar monitor is published in the journal Science Translational Medicine.

Rotavirus Vaccine Trials Successful; Researchers Call for Global Distribution

After successful clinical trials, researchers are calling for widespread distribution of a vaccine to prevent rotavirus - a severe gastrointestinal illness that kills more than a half a million children around the world each year.

Investigators are urging the use of the rotavirus vaccine in poor and developing countries after two clinical trials that showed it is safe and highly effective in protecting newborns against the deadly virus.

The vaccine, manufactured Merck, already is approved for use in the United States, but researchers wanted to see how well it works in less developed countries.

Dr. Roger Glass is Director of the John E. Fogarty International Center for Advanced Study in the Health Sciences at the National Institutes of Health near Washington.

In an interview from Swaziland, Glass said the vaccine has resulted in a significant decrease in the number of rotavirus cases in the United States.

"The vaccines that we are talking about have been licensed and used in the United States since 2006 and have already made a tremendous impact to reduce hospitalizations and clinic visits for diarrhea in just 3.5 years," said Dr. Glass.

But Dr. Glass noted that rotavirus kills 500,000 children a year in the 72 poorest countries.

Two international trials were carried out to test the vaccine's safety and effectiveness - one involving more than 2,000 healthy infants in Bangladesh and Vietnam. Some of the babies received the oral drug at 6, 10 and 14 weeks of age; another group of infants was given a placebo.

Researchers conducting a follow-up study nearly two years later found the rotavirus vaccine had reduced the number of severe gastrointestinal disease cases by nearly 50 percent.

A second study was conducted in Africa, where rotavirus claims almost a quarter of a million lives each year. Researchers conducting the trial in Ghana, Kenya and Mali, gave three doses of the vaccine to infants without symptoms. Investigators found there were 39 percent fewer cases of severe rotavirus with the vaccine.

Researchers found the vaccine had little or no side effects, according to Dr. Glass, who said widespread use of the rotavirus vaccine would save lives.

"We really hope that we with these results and with these findings that that mortality, those half a million deaths from rotavirus could be reduced by more than 50 percent through the use of this vaccine," he said. "This would further reduce diarrheal deaths in the world by about a quarter. And diarrhea, remember, is the second most common cause of death in children under five."

Three years ago, the World Health Organization recommended routine use of the rotavirus vaccine in countries where it has been found to be safe and effective. Dr. Glass says he hopes the results of these two studies lead to the use of the vaccine in other countries where it is needed most.

The two studies on the effectiveness of the rotavirus vaccine in Asia and Africa are published in the journal The Lancet.

No need to delay pregnancy after miscarriage

Women who have had a miscarriage do not need to wait before trying to get pregnant again, say doctors.

A study by the University of Aberdeen of 30,000 women found that conceiving within six months offered the best chance for a healthy pregnancy.

The findings, published in the British Medical Journal, counter international guidelines that women should wait at least six months before trying again.

Doctors said the study would help them reassure and advise patients.

The researchers looked at data between 1981 and 2000 relating to women who had a miscarriage in their first pregnancy before going on to becoming pregnant again.

Women who conceived within six months were less likely to have another miscarriage, termination or ectopic pregnancy, the figures showed.


AdvertisementReport author Dr Sohinee Bhattacharya: "There are no physiological reasons why you should delay"
Also, among those who went on to give birth, conceiving within six months was associated with reduced risk of Caesarean birth, a premature delivery or a low birthweight baby compared with those women who had conceived between six months and a year.

Around one in five pregnancies ends in miscarriage before 24 weeks, a risk that increases with age.

Fertility

Study leader Dr Sohinee Bhattacharya, a lecturer in obstetric epidemiology, said current World Health Organization guidelines recommend that women delay by at least six months.

The NHS Choices website advises waiting three months to give women time to come to terms with the loss and for their menstrual cycle to re-establish itself.

But Dr Bhattacharya said that for older women, who are more at risk of miscarriage, a delay may actually hamper their chances of a successful pregnancy.

"Women wanting to become pregnant soon after a miscarriage should not be discouraged.

"If you're already over 35, I would definitely advise to try again within six months as age is more of a risk than the interval between pregnancies."

The only reason women may need to delay is if they have had a complication such as infection, she advised.


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It is not clear why waiting longer than six months may be associated with more risk.

One theory is that underlying fertility problems may get worse with time.

Another possibility is that women trying for another baby shortly after a miscarriage may be highly motivated to stick to a healthy lifestyle.

Dr Tony Falconer, president-elect of the Royal College of Obstetricians and Gynaecologists, said the study showed women did not have to worry about trying again once they are physically and emotionally ready.

"It may be worth taking this opportunity to talk to your GP about anything you can do to prepare for a pregnancy," he said.

Professor Steve Field, chairman of the Royal College of GPs, said: "Miscarriages are a very traumatic event for prospective mums-to-be, and this new evidence will help health professionals reassure patients and enable them to give some good news and hope to patients at a time when they are often very anxious and under great stress."

Mary Newburn, head of research and information at parenting charity NCT, said: "It will be very reassuring to many women planning a pregnancy in their 30s or 40s to know that if they miscarry they do not need to wait before conceiving again."

New throat surgery 'a success'

Pioneering surgery to rebuild an 11-year-old boy's windpipe using his own stem cells has been hailed a success as he prepares to leave hospital.

Ciaran Finn-Lynch became the first child in the world to undergo the pioneering trachea transplant in March.

Ciaran, who is originally from Castleblayney, County Monaghan, is now due to return to his home in London.

Ciaran was born with Long Segment Tracheal Stenosis, which leaves sufferers with a very narrow windpipe.

Doctors at Great Ormond Street Hospital in London took stem cells from his bone marrow and injected them into a donor windpipe.

They implanted the organ and allowed the stem cells to transform themselves in his own body.

By using his cells, doctors hoped to avoid the potential problem of Ciaran's immune system rejecting the organ.

Great Ormond Street revealed on Thursday that the transplant, carried out four weeks ago was considered a success after doctors proved the blood supply had returned to the trachea.

Ciaran's parents, Colleen and Paul, now hope to take him home for the first time since November.

They said the last few months had been a "rollercoaster" and paid tribute to the surgeons who saved their son.

Operation

He underwent major surgery to reconstruct his airways but, at the age of two-and-a-half, a metal stent used to hold his airway open eroded into his aorta, a major artery.


AdvertisementProfessor Martin Birchall: "It could replace transplantation"
He went through more surgery, including two attempts to rebuild his airway, and finally left hospital after eight months.

Ciaran lived a full and active life until November last year when a stent again started to erode, causing a "massive bleed".

As options for Ciaran ran out, his specialists turned to stem cell treatment.

The surgery had been tried in Spain in 2008 on mother-of-two Claudia Castillo - the first person to receive a transplant organ created from stem cells - but Ciaran was to be the first child.

Ciaran was operated on in March, just four weeks after a donor trachea was found in Italy, and now doctors have confirmed his new windpipe is working well.
We didn't have much choice when it came to the operation," his mother Colleen said.

"If Ciaran had one more bleed I don't think he would have made it."

She said they had "100% faith" in the transplant team, led by Great Ormond Street's Professor Martin Elliott.

She said Ciaran's recovery had been "up and down" but he kept his spirits up.

"Because it's so new, nobody knows what's ahead, or how long his full recovery is going to be, but we are on the right road now," she said.

Ciaran, who turned 11 last month, is looking forward to going home and is likely to return to school in September.

A keen drummer, he is most excited about being able to play in his band again, and even started practising with a lesson in the hospital's intensive care unit recently.

Prof Elliott said the transplant team was "delighted" Ciaran could go home.

"He is a wonderful boy who has become a great friend to us all, and he and his infinitely patient family have charmed us all," he said.

"His recovery has been complicated, as one might expect for a new procedure, and we have kept him under close surveillance, hence the length of time he has been here.

"It is wonderful to see him active, smiling and breathing normally. We are very proud of him."

He said Ciaran would need regular follow-ups to check on his progress and to learn what to expect for the next patient who may need the innovative therapy.

"The treatment offers hope to many whose major airways were previously considered untreatable or irreplaceable," Prof Elliott added.