Heart and Blood Pressure

The first ever National Heart Failure Audit today highlights the need for more NHS hospital trusts to submit information about patient care.

As of March 2008, 105 of 147 trusts providing services had registered with the audit, which is commissioned by the Healthcare Quality Improvement Partnership and run jointly by The NHS Information Centre and the British Society for Heart Failure.

But only a quarter of trusts (37) submitted data about cases of heart failure – which affects at least one in every 100 people in the UK and is predicted to affect even more people in the future due to an aging population.

Good participation levels and data submissions among trusts are vital; to measure progress towards meeting national guidance and standards, to support standards of care, support patient choice and to help effective commissioning.

The audit received anonymised data from only 6,299 cases – approximately six per cent of all cases of patients discharged from hospital with a diagnosis of heart failure.

As data submission was limited, early findings cannot be seen as conclusive, but do appear to reinforce previous studies into heart failure.

Early findings include:

– Just under a third (31 per cent) of patients were treated on cardiology wards. The majority (61 per cent) were treated in general medicine wards and 7.9 per cent were treated on other wards.

– The majority of patients received at least one of the five key drug therapies for heart failure. Four per cent (215) did not receive any. These were mostly patients between the age of 75 and 84 treated within general medicine.

– Electrocardiogram (ECG) was recorded in nearly 35 per cent (2,173) of cases, while echocardiography results were recorded in 32 per cent of cases (2,014). NICE (The National Institute for Clinical Excellence) and NSF (National Service Framework for Coronary Heart Disease) guidelines emphasise the importance of having a confirmed diagnosis of heart failure, which can be done via ECG, as many symptoms are similar to those of other conditions such as asthma.

Among its recommendations, the audit identified a need for the NHS Information Centre to work with partner organisations to identify ways of supporting local implementation of the audit, and of using audit findings to support local improvements of heart failure services.

NHS Information Centre chief executive Tim Straughan said: “At least one person in every hundred coming through the door of an NHS hospital has heart failure, and clearly the treatment of this condition has huge implications for patients, staff and the NHS as a whole.

“The National Heart Failure Audit is therefore essential in providing The NHS with a comprehensive picture of heart failure treatment and outcomes, and in helping to improve patient care. I welcome the input from hospital trusts that submitted data to this vital audit, and urge other trusts to do so in the future.”

Click here to see the full report.

– The NHS Information Centre is England’s authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

– This report summarises key findings from the first eight months of the national roll out of the audit between July 2007 and March 2008.

– Previous studies into heart failure, which appear to support early findings from the audit, are included in section 7 (references) of the report.

– The five key drugs for heart failure are:

- ACE inhibitors, which have a protective effect on the heart and when added to diuretics, improve symptoms, exercise tolerance, and survival and reduce hospital admission rates in chronic heart failure.

- Beta-adrenoreceptor blocking drugs (beta-blockers) , which work on the heart and blood vessels to reduce blood pressure and the amount of work the heart does. A beta-blocker is usually prescribed in addition to an ACE inhibitor.

- Angiotensin-II receptor antagonists (ARB) work in a similar way to ACE inhibitors and are used instead of an ACE inhibitor if a patient has problems or side-effects with taking an ACE inhibitor (such as a persistent cough).

- Loop diuretics, which are commonly needed to ease fluid retention. Diuretics are taken in addition to an ACE inhibitor and beta-blocker.

- One receptor antagonists (SARA) . The aldosterone antagonist sprionolactone has been shown to reduce mortality in patients with severe heart failure.

ic.nhs.

With the release of the National Preventative Health Taskforce’s discussion paper Australia: The Healthiest Country By 2020 The Royal Australian College of General Practitioners (RACGP) is calling on the Australian Government to boost resources available to the sector of the health care workforce that delivers on prevention; general practice.

“We welcome the discussion paper as it backs up much of what has been reported in the international evidence; that primary care helps to prevent illness and death,” said Dr Chris Mitchell, RACGP President and GP in northern New South Wales.

“The strength of a nation’s primary health care system has been associated with lower mortality rates from preventable diseases and we have known this for some time.

“The evidence also shows that primary care is associated with a more equitable distribution of health, a finding that is particularly important given the poor health outcomes in some of our most disadvantaged communities, including people on low incomes and Aboriginal and Torres Strait Islander communities.

“We know the benefits of prevention, but we need the tools to deliver the care to our patients. For too long, the Australian Government’s health policy has been focused on reform in the hospital sector. While we agree that significant changes in this sector are needed, this is not the main game in health. We need real, sustained investment in all primary care services including in general practice, the branch of health care that has the closest contact with the community.

“More than 80 percent of Australians see a GP each year. General practice is best placed to support our patients in making decisions to adopt healthier lifestyles by increasing exercise, adopting a healthy diet and eliminating smoking and excess alcohol consumption.

“The RACGP also applauds the willingness of the Taskforce to look at the other actions needed to have a healthy country, including exploring the role of appropriate pricing and subsidies for some products and activities, taxation reform, and the role of legislation in supporting healthy choices. We need to make sound choices in these areas, just as we need to do in health policy and funding.

“We need to look at other funding models as for too long general practice has been over stretched. In meeting Australia’s health challenges we need a healthy general practice profession; a well resourced primary health care sector is strongly associated with benefits to all Australians, and to our economy.

“Well resourced general practice – with well trained GPs and allied health professionals, safe workplaces, modern equipment – can reduce the pressure on our hospitals and emergency departments through delivering high quality preventive care, health promotion and coordinated chronic disease management.

“Through additional resources for general practice and reform of the Medicare Benefits Schedule, the Australian Government can make a real and positive difference to the health of our patients. Yet, why did the government cut funding for children’s vaccinations in their last budget? This approach is an example of policy approaches that do not support the government’s stated commitment to prevention.

“We welcome the Australian Government’s commitment to health reform, but we need the right reform that will deliver benefits to all Australians. We need a health system that places a well-resourced general practice profession at the centre of patient care,” said Dr Mitchell.

The RACGP encourages all GPs to have a voice in the health reform discussion. The RACGP has outlined the role of the general practitioner and general practice in prevention in a policy statement that is available here (PDF). GPs can send their thoughts to advocacyracgp.au. GPs who wish to make their own submission to the National Preventative Health Taskforce can do so at www.preventativehealth.au Submissions are due by 2 January 2009.

The Royal Australian College of General Practitioners (RACGP) is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia and represents the majority of Australia’s general practitioners. Visit www.racgp.au

Time constraints frequently limit the amount of face time doctors and patients share together. To optimize their office visit, patients often answer written questions while awaiting their turn to see their doctors. In two separate studies presented at the 2008 Clinical Congress of the American College of Surgeons, Viraj A. Master, MD, PhD, assistant professor of urology at Emory University School of Medicine, Atlanta, GA, pointed out a profound gap in the understanding of physicians about the literacy levels of their patients as it relates to the efficacy of screening tools.

In reporting on the first of the Emory studies on literacy, Dr. Master said, “In our particular 300-patient cohort of men with an average age of 61, the average reading level in our inner-city hospital was fourth grade. In the seven questions that we asked from the International Prostate Symptom Score (IPSS), for example, only 16 percent of patients understood all seven questions. Possibly the most worrisome thing was the number of patients who thought they understood this test–the most commonly used instrument in urology worldwide–but did not.”

Evaluation of responses to the IPSS test, which asks such questions as: “During the last month or so, how often have you had to push or strain to urinate?” further showed that only 38 percent of patients understood more than half the questions, 18 percent understood fewer than half, and 28 percent understood none. After controlling for education, age, income, employment status, race, homelessness, and English as a second language, however, the only thing that emerged as an independent predictor of understanding of this instrument was the number of years of schooling.

The most frightening thing about these poor results, according to Dr. Master, is that communication and understanding is not as simple as being able to read a sentence. “We also expect people to be reasonably numerate and capable of discussing numbers and quantities. Doctors, in particular, want patients to be able to answer, on a scale of one to 10, ‘How are you?’ and be able to communicate whether symptoms occur ‘half the time,’ or ‘a third of the time.’

Dr. Master had previously thought that if a patient were literate, he would be numerate as well. And, if he were illiterate, he would be innumerate. His curiosity was aroused, however, after meeting a patient who was a distinguished PhD. Despite years of schooling, this patient had no clear idea that 33 percent was a different quantity than one-in-four, when they were reviewing the patient’s Symptom Score together. As a result of that interaction, Dr. Master decided to design a study based on numeracy, and in the second study, which he presented during the Clinical Congress, Dr. Master reported on what he calls the “shocking results” of this research.

In the second study, 266 patients with an average age of 58 completed a validated, three-question Woloshin-Schwartz numeracy quiz. The quiz asked questions such as “Imagine that we flip a coin 1,000 times. What is your best guess about how many times the coin will come up heads in 1,000 flips?” (Answer: 500 times).

Results showed that only 16 percent of respondents answered all three questions correctly and 15 percent answered two correctly, so only 31 percent fell into the ‘numerate’ category. Most respondents were innumerate, with 33 percent having one correct answer and 35 percent having no correct answers.

“Even after controlling for age, race, homelessness, English as a second language, income, and a host of other variables–including educational level–numeracy was shown to be an independent predictor of misunderstanding,” Dr. Master said. “Being innumerate, in addition to being illiterate, results in high levels of misunderstanding that severely limit access to appropriate health care for millions of patients.”

Having established that both words and numbers are drivers of illiteracy in America, Dr. Master and his colleagues suspected that adding carefully designed pictures to their screening tests to help depict the concept being discussed would improve patient understanding. To test this hypothesis, they designed a robust randomized prospective trial, which has been completed, and is to be published as a letter to the editor in the October 2008 issue of the Journal of Urology. However, the results show that pictures did not improve understanding. During a shopping trip with his family, Dr. Master was struck by the number of people pleasantly immersed in video games, rapidly absorbing an incredible amount of information. Suddenly an idea was born. “I thought, how do we translate that into the health care arena?” he said. So, he and his colleagues designed another randomized clinical trial–this one a computer program. The program allowed patients to look at a figure who was speaking to them and asking the very same questions that were on the Symptoms Score questionnaire.

This third study, presented at the American Urology Association meeting in May 2008, was highly significant and quite successful, Dr. Master said. “The computer program improved understanding for all patients at all educational levels. Importantly, it even improved understanding for individuals who had no familiarity with computers.”

The lesson in all of this research is that “there is a true epidemic of health illiteracy in this country. Do not assume that your patients are literate with either prose or numeracy,” Dr. Master said.

Assisting Dr. Master with these studies were Timothy Van Johnson; Ammara Abbasi; Samantha Ehrlich; Renee Kleris; Evan Schoenberg; Ashli Owen-Smith; and Michael Goodman, all from Emory. He received no funding for this research.

American College of Surgeons
facs

In situations of chronic food shortage, parents are inclined to give boys a preferential treatment. Anyway, the health of their daughters suffers more from food insecurity. This is shown by research fromp the Institute of Tropical Medicine in Ethiopia, appearing in the journal Pediatrics.

It is self-evident that food shortages are not healthy, but up to now nobody hat looked if all children in a family suffer equaly, or if there are gender differences. In most studies into the effects of food insecurity, parents were questioned, not their children. Scientists of Jimma University (Ethiopia), assisted by American and Flemish scientists, during five years followed two thousand teenagers in as many households, in urban as wel as rural communities.

In food insecurity an average of three girls out of ten reported having been ill during the previous month; against two boys out of ten. In food insecure households, girls were twice more likely to report suffering from illness. The girls even reported seven times more often difficulties with activities due to poor health, or feeling tired.

In situations of food insecurity, aid workers should take this into account, the authors say.

In fact, girls should be healthier. Biologically spoken, they are tougher; as teenager they smoke less and show less risk seeking behaviour than boys. But cultural discrimination makes that girls suffer more from situations of shortage.

The teenagers and their family were questioned during the hunger season (the rainy season) and during spring, when there is less food insecurity. The scientists noted, among other things, how much and how varied the ate, their length and weight. They asked for tiredness and lack of energy in the previous month; for problems with activities for school, work or household due to poor health; if they had been ill during the previous month. A quarter of the girls and 16% of the boys were food insecure.

The scientists adjusted for dietary diversity, BMI, place of residence, cooking place (sleeping room, living room, separate kitchen) distance to a garbage disposal site, presence of animals in house, to isolate the effect of gender on illness. Even then, the girls reported seven times as much low energy; and 7.4 times more often problems with activities.

The difference between boys and girls was more intense in rural areas than in cities.

It is known that women rate their health always poorer than men, and that they more often report health problems, being more cautious of their health than men. But in this case that can not be an explanation, because when they were food secure, boys and girls reported no differences.

In many cultures, sons are more valued than daughters. Previous research in the Philippines, Ethiopia, Nepal, India and Guatemala showed that sons receive more and better food. But in Ethiopia at any rate this discrimination only leads to health problems when there is not enough food available.

The researchers conclude that aid workers who provide people with more or better food, need to give extra attention to girls when dealing with food insecurity. They suggest a good way to reduce gender disparities is to remove resource constraints. This might be somewhat easier than shifting population-level norms around gender.

Sources: Institute of Tropical Medicine Antwerp, AlphaGalileo Foundation.

Patients have on average a 70 percent lower chance of dying at the nation’s top-rated hospitals compared with the lowest-rated hospitals across 17 procedures and conditions analyzed in the eleventh annual HealthGrades Hospital Quality in America Study, issued by HealthGrades, the leading independent healthcare ratings organization.

While overall death rates declined from 2005 to 2007, the nation’s best-performing hospitals were able to reduce their death rates at a much faster rate than poorly performing hospitals, resulting in large state, regional and hospital-to-hospital variations in the quality of patient care, the study found.

HealthGrades Hospital Quality in America Study, also found that if all hospitals performed at the level of five-star rated hospitals, 237,420 Medicare dealths could potentially have been prevented over the three years studied. More than half of those deaths were associated with four conditions: sepsis (a life-threatening illness caused by systemic response to infection), pneumonia, heart failure and respiratory failure.

The HealthGrades study of patient outcomes at the nation’s approximately 5,000 hospitals is the most comprehensive annual study of its kind, analyzing more than 41 million Medicare hospitalization records from 2005 to 2007. The study examines procedures and conditions ranging from heart valve-replacement surgery to heart attack to pneumonia.

Based on the study, HealthGrades today made available its 2009 quality ratings for all nonfederal hospitals in the country at healthgrades/, a Web site designed to help individuals research and compare local healthcare providers.

Full reports on death rate trends in each of the 50 states and the District of Columbia are available in the study. And, for the first time, HealthGrades has released hospital death rates for the nation’s 15 largest metropolitan statistical areas: New York, Los Angeles, Chicago, Dallas, Philadelphia, Houston, Miami, Washington D.C., Atlanta, Boston, Detroit, San Francisco, Phoenix, Riverside-Inland Empire (CA) and Seattle. Large variation exists between major metropolitan areas.

“Geography should not be a major factor in patients’ outcomes. If our nation’s hospitals are to close the quality gap and guarantee an equally high level of medical care for every patient, no matter where he or she lives, it will require a commitment by our nation and its communities to demand more from quality improvement,” said Samantha Collier, MD, HealthGrades’ chief medical officer and a study author. “Until then, it is imperative that anyone seeking medical care at a hospital do their homework and know the hospital’s quality ratings before they check in.”

The study’s major findings are:
The nation’s inhospital risk-adjusted mortality rate improved, on average, 14.17 percent from 2005 to 2007, but the degree of improvement varied widely by procedure and diagnosis studied (range: 6.30% to 20.94%). Five star-rated hospitals’ mortality rates continue to improve at a faster rate (13.18%) than 1- or 3-star hospitals (12.30% and 13.14%, respectively).

Large gaps persist between the “best” and the “worst” hospitals across all procedures and diagnoses studied. Five star-rated hospitals had significantly lower risk-adjusted mortality across all three years studied. Across all procedures and diagnoses studied, there was an approximate 70 percent lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital. Across all procedures and diagnoses studied, there was an approximate 50 percent lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average.

If all hospitals performed at the level of a 5-star rated hospital across the 17 procedures and diagnoses studied, 237,420 Medicare lives could have potentially been saved from 2005 to 2007.

Fifty-four percent (128,749) of the potentially preventable deaths were associated with just four diagnoses: Sepsis, heart failure, pneumonia and respiratory failure.

Variation in risk-adjusted mortality exists not only at the national level but also at the state and regional levels. The greatest quality differences between states occurred in hospital death rates for heart failure, pulmonary, stroke and cardiac surgery.

The region with the lowest overall risk-adjusted mortality rates was the East North Central region (IL, IN, MI, OH, and WI), while the East South Central region (AL, KY, MS, and TN) had the highest mortality rates.

The East North Central region (IL, IN, MI, OH, and WI), had the highest percentage of best-performing hospitals at 26 percent. Less than seven percent of hospitals within the New England region (CT, MA, ME, NH, RI, and VT) were top-performing hospitals.

In the study’s analysis of hospital death rates, the following 17 procedures and conditions were analyzed: bowel obstruction, chronic obstructive pulmonary disease, coronary bypass surgery, coronary interventional procedures (angioplasty/stent), diabetic acidosis and coma, gastrointestinal bleed, gastrointestinal surgeries and procedures, heart attack, heart failure, pancreatitis, pneumonia, pulmonary embolism, resection/replacement of the abdominal aorta, respiratory failure, sepsis, stroke, and valve replacement surgery. The full study, along with its methodology and state-by-state hospital-quality statistics, can be found at healthgrades/.

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HealthGrades’ Star Ratings of Hospitals

On its Web site, HealthGrades offers, free to consumers, quality ratings of 27 procedures and treatments for every nonfederal hospital in the country. The Web site is designed so that consumers can easily compare patient outcomes at their local hospitals for procedures ranging from aortic aneurysm repair to bypass surgery. Each hospital receives a star rating based on its patient outcomes in terms of mortality or complication rates for each procedure or treatment. Hospitals with outcomes that are above average to a statistically significant degree receive a five-star rating. Hospitals with average outcomes receive a three-star rating, and hospitals with outcomes that are below average receive a one-star rating. Because no two hospitals or their patients’ risk profiles are alike, HealthGrades employs extensive risk-adjustment algorithms to ensure that it is making fair comparisons.

About HealthGrades

Health Grades, Inc. (Nasdaq: HGRD) is the leading healthcare ratings organization, providing ratings and profiles of hospitals, nursing homes and physicians. Millions of consumers and many of the nation’s largest employers, health plans and hospitals rely on HealthGrades’ independent ratings, advisory services and decision-support resources to make healthcare decisions based on the quality and cost of care. More information on the company can be found at healthgrades/.

Source: Scott Shapiro

HealthGrades

“Grandma’s penicillin” also may help high blood pressure

Chicken soup, that popular home remedy for the common cold sometimes known as “Grandma’s Penicillin,” may have a new role alongside medication and other medical measures in fighting high blood pressure, scientists in Japan are reporting. Their research is scheduled for the October 22 issue of ACS’ biweekly Journal of Agricultural and Food Chemistry.

Ai Saiga and colleagues cite previous studies indicating that chicken breast contains collagen proteins with effects similar to ACE inhibitors, mainstay medications for treating high blood pressure. But chicken breast contains such small amounts of the proteins that it could not be used to develop food and medical products for high blood pressure. Chicken legs and feet, often discarded as waste products in the U.S. but key soup ingredients elsewhere, appear to be a better source.

In the new study, Saiga and colleagues extracted collagen from chicken legs and tested its ability to act as an ACE inhibitor in the laboratory studies. They identified four different proteins in the collagen mixture with high ACE-inhibitory activity. Given to rats used to model human high blood pressure, the proteins produced a significant and prolonged decrease in blood pressure, the researchers say. – MTS

“Angiotensin I-Converting Enzyme-Inhibitory Peptides obtained from Chicken Collagen Hydrolysate”

CONTACT:
Ai Saiga
Nippon Meat Packers, Inc.
Ibaraki, Japan

Toward an effective treatment for a major hereditary disease

Scientists are reporting a key advance toward developing the first effective drug treatment for spinal muscular atrophy (SMA), a genetic disease that involves motor neuron loss and occurs in 1 out of every 6,000 births. SMA is the leading cause of hereditary infant death in the United States. The study is scheduled for publication online Oct. 8 by ACS Chemical Biology, a monthly journal.

Mark E. Gurney, Jill Jarecki, and colleagues note that SMA is caused by a defective gene, SMN1, which fails to produce sufficient amounts of a key protein, called SMN (survival motor neuron), needed for normal motor neuron development. Scientists have screened more than 550,000 compounds in the search for a new SMA drug. Recent research pointed to a group of compounds called C5-quinazolines that can boost SMN2 activity, a uniquely existing back-up gene for SMN1. In doing so, they showed promise for treating SMA by producing increased amounts of the needed protein.

In the new study, researchers identified exactly how these promising compounds work, a key step in moving forward toward medical use. They found that the substance targets a normal cellular protein, DcpS, involved in mRNA metabolism whose inhibition causes increased SMN expression. The finding could help guide the development of the first effective drugs for treating SMA and also lead to second generation drugs targeting this enzyme, the researchers say. “The results outlined in the paper and carried out in collaboration with Families of SMA, deCODE chemistry & biostructures, Invitrogen Corporation, and Rutgers University represent a new understanding of the physiological mechanisms that can increase SMN expression and will allow us to move forward in advancing potential treatments for it, says Jill Jarecki, Ph.D., Research Director at Families of SMA. – MTS

“DcpS as a Therapeutic Target for Spinal Muscular Atrophy”

CONTACT:

Mark E. Gurney, Ph.D.
dCODE Genetics, Inc.
Woodridge, IL

Jill Jarecki, Ph.D.
Research Director
Families of SMA
P.O. Box 196
Libertyville, IL 60048-0196

Brian Pollok, Ph.D.
Chief Scientific Officer
Invitrogen Corporation
Carlsbad, CA 92008

Byproduct of steel shows potential in CO2 sequestration

With steelworks around the world emitting huge amounts of carbon dioxide, scientists are reporting that a byproduct of steel production could be used to absorb that greenhouse gas to help control global warming. The study is scheduled for the October 15 issue of ACS’ Industrial & Engineering Chemistry Research, a bi-weekly journal.

Professor Mourad Kharoune and colleagues point out that production of one ton of steel releases up to one ton of CO2. With global steel production standing at 1.34 billion tons in 2007, that adds up to a substantial contribution of carbon dioxide. Kharoune suggests a new method to sequester, or capture, carbon dioxide so that it does not contribute to global warming – using steel slags, which are complex mixtures of compounds produced during the separation of the molten steel from impurities.

In the study, Kharoune suggests that electric arc furnace (EAF) and ladle furnace (LF) slag suspensions could be used for greenhouse-gas sequestration. According to the report, the ladle furnace slag suspension’s capacity to sequester emissions was 14 times higher than that of the EAF suspension, possibly due to the LF’s higher content of a rare mineral called portlandite. – JS

“CO2 Sequestration Potential of Steel Slags at Ambient Pressure and Temperature”

CONTACT:
Mourad Kharoune, Ph.D.
Professor, Industrial Process Engineering
Department of Automated Manufacturing Engineering
Г‰cole de Technologie SupГ©rieure
1100, rue Notre-Dame Ouest, MontrГ©al (QuГ©bec) Canada H3C 1K3

First evidence that a common pollutant may reduce iodine levels in breast milk

Researchers in Texas are reporting the first evidence from human studies that perchlorate, a common pollutant increasingly found in food and water, may interfere with an infant’s availability of iodine in breast milk. Iodine deficiency in infants can cause mental retardation and other health problems, the scientists note. The study also provides further evidence that iodine intake in U.S. mothers is low and that perchlorate may play a key role.

In a study scheduled for the November 1 issue of ACS’ semi-monthly Environmental Science & Technology, Purnendu Dasgupta and colleagues note that perchlorate occurs naturally in the soil and is also manufactured as a rocket fuel and explosive ingredient. Past studies showed that perchlorate can inhibit iodine uptake. However, scientists did not know its effects on iodine levels in the milk of nursing mothers.

To find out, the researchers collected breast milk samples from 13 breastfeeding mothers and measured their content of iodine, perchlorate, and thiocyanate, another iodine inhibitor found in certain foods. The study showed that if these breast milk samples were fed to infants, 12 of 13 infants would not have an adequate intake of iodine. It also showed that nine of the infants would have ingested perchlorate at a level exceeding those considered safe by the National Academy of Sciences. “Even though the number of subjects was not large, in terms of the number of total samples analyzed, this is the most extensive study on the topic,” the researchers say, adding that the low iodine levels are “disconcerting.” – MTS

“Intake of Iodine and Perchlorate and Excretion in Human Milk”

CONTACT:
Purnendu K. Dasgupta, Ph.D.
The University of Texas at Arlington
Arlington, Texas 76109-0065

Freeing protein-based drugs from bacteria’s natural traps

In a finding that could speed the development of new protein-based drugs for fighting diabetes, hepatitis, and other diseases, researchers are reporting progress toward preventing or destroying an unusual structure that reduces the production yield of bioengineered drugs. The article is scheduled for the Oct. 13 issue of Chemical & Engineering News, ACS’ weekly newsmagazine.

In the article, C&EN Associate Editor Jyllian Kemsley notes that genetically-engineered E. coli bacteria are increasingly used to produce protein-based drugs for a variety of diseases. However, these proteins are often not usable because they become trapped in large, insoluble clumps called “inclusion bodies.” Current methods to extract proteins trapped in these clumps involve breaking down the clumps chemically and refolding the proteins, a process that is inefficient and sometimes destroys the desired protein.

In the article, Kemsley describes new research insights into the structure and formation of these unusual clumps that could lead to their prevention. Scientists, for instance, have discovered evidence that inclusion bodies form due to interactions between molecular structures called beta-sheets and that clumping could be prevented by preventing beta-sheet interactions.

“Protein Aggregates Probed”

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Have a Ball with National Chemistry Week Oct. 19 – 25

Activities will be held in communities around the United States Oct. 19-25 during National Chemistry Week, the American Chemical Society’s annual showcase of chemistry’s central role in everyday life. The theme will be “Having a Ball with Chemistry,” emphasizing the role chemistry plays in fitness and athletics. Thousands of students will learn about chemistry’s role in providing new materials and technology to improve athletic equipment and performance, and the importance of nutrition and maintaining an active lifestyle. For more information, including the location of local NCW events, please visit chemistryweek/.

The American Chemical Society – the world’s largest scientific society – is a nonprofit organization chartered by the U.S. Congress and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.

Source: Michael Woods

American Chemical Society

Doctors could learn a lot about how to treat and interact with their patients by employing techniques used by magicians, says an article in this month’s Journal of the Royal Society of Medicine.

Author Daniel Sokol, a lecturer in medical ethics and law and a close-up magician, draws comparisons with how a magician interacts with a spectator and how a doctor interacts with patients. He describes how “both groups deal with people, often in an intimate and intense context, and strive to effect a positive change in their audience. They rely heavily on trust, fairness and clear communication for their success.” However, although both medics and magicians may use deception in their work, the magician has a harder time because, unlike the doctor, they work in an atmosphere of mistrust.

The author illustrates that, like a magician, “a doctor who wishes to influence a patient’s decision can use similar techniques to indicate approval or disapproval.” Desirable traits or techniques that a doctor could benefit from include; being clear and precise when presenting information, having likeable characteristics to reduce suspicion and build trust, and using different tones of voice or body language to convey different messages.

Dr Kamran Abbasi, Editor of the Journal, comments “Doctors and magicians, medicine and magic, were all once the same. A talented magician will leave you aghast at the sleight of hand, but a talented doctor might persuade you to consent to an operation or a change of lifestyle.”

The authors made a total of 657 calls (at their own cost) over a one month period and at three specific timeslots on different days. The data measured answering times provided by human operators and answering services, and consistency of response.

“Medicine as performance: what can magicians teach doctors?” by Daniel K Sokol is published in the latest issue of the JRSM.

The JRSM is the flagship journal of the Royal Society of Medicine. It has full editorial independence of the RSM. It has been published continuously since 1809.

Its Editor is Dr Kamran Abbasi.

About The Royal Society of Medicine

The Royal Society of Medicine is an independent, apolitical organisation, founded over 200 years ago.

We are one of the largest providers of continuing medical education in the UK.

We provide accredited courses for continuing professional development, which is so vital in allowing doctors, dentists, veterinary surgeons and other healthcare professionals their continuing freedom to practise.

Our aims are:

– to provide a broad range of educational activities and opportunities for doctors, dentists and veterinary surgeons, including students of these disciplines, and for allied healthcare professionals.

– to promote an exchange of information and ideas on the science, practice and organisation of medicine, both within the health professions and with responsible and informed public opinion.

We receive no state funding to carry out our core work and are dependent on generous donations and legacies.

rsm.ac

The World Health Report 2008, launched today, critically assesses the way that health care is organized, financed, and delivered in rich and poor countries around the world. The WHO report documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance.

“The World Health Report sets out a way to tackle inequities and inefficiencies in health care, and its recommendations need to be heeded,” said WHO Director-General Dr Margaret Chan at the launch of the report in Almaty, Kazakhstan. “A world that is greatly out of balance in matters of health is neither stable nor secure.”

The report, titled Primary health care – now more than ever, commemorates the 30th anniversary of the Alma-Ata International Conference on Primary Health Care held in 1978. That event was the first to put health equity on the international political agenda.

Striking inequities

In a wide-ranging review, the new report found striking inequities in health outcomes, in access to care, and in what people have to pay for care. Differences in life expectancy between the richest and poorest countries now exceed 40 years. Of the estimated 136 million women who will give birth this year, around 58 million will receive no medical assistance whatsoever during childbirth and the postpartum period, endangering their lives and that of their infants.

Globally, annual government expenditure on health varies from as little as US$ 20 per person to well over US$ 6000. For 5.6 billion people in low- and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments.

With the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year.

Vast differences in health occur within countries and sometimes within individual cities. In Nairobi, for example, the under-five mortality rate is below 15 per 1000 in the high-income area. In a slum in the same city, the rate is 254 per 1000.

“High maternal, infant, and under-five mortality often indicates lack of access to basic services such as clean water and sanitation, immunizations and proper nutrition,” said Ann M. Veneman, UNICEF Executive Director. “Primary health care, including integrated services at the community level, can help improve health and save lives.”

Health systems lose focus

Data set out in the report are indicative of a situation in which many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people, especially in impoverished and marginalized groups.

As the report notes, conditions of “inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability.”

To steer health systems towards better performance, the report calls for a return to primary health care, a holistic approach to health care formally launched 30 years ago. When countries at the same level of economic development are compared, those where health care is organized around the tenets of primary health care produce a higher level of heath for the same investment.

Such lessons take on critical importance at a time of global financial crisis.

“Viewed against current trends, primary health care looks more and more like a smart way to get health development back on track,” said Dr Chan.

As initially articulated, primary health care revolutionized the way health was interpreted and radically altered prevailing models for organizing and delivering care. It represented a deliberate effort to counter trends responsible for the “gross inequality” in the health status of populations.

Increasing relevance of primary health care

In calling for a return to primary health care, WHO argues that its values, principles and approaches are more relevant now than ever before. Several findings support this conclusion. As the report notes, inequalities in health outcomes and access to care are much greater today than they were in 1978.

In far too many cases, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves. Health care is often delivered according to a model that concentrates on diseases, high technology, and specialist care, with health viewed as a product of biomedical interventions and the power of prevention largely ignored.

Specialists may perform tasks that are better managed by general practitioners, family doctors, or nurses. This contributes to inefficiency, restricts access, and deprives patients of opportunities for comprehensive care. When health is skewered towards specialist care, a broad menu of protective and preventive interventions tends to be lost.

WHO estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%.

Inequities in access to care and in health outcomes are usually greatest in cases where health is treated as a commodity and care is driven by profitability. The results are predictable: unnecessary tests and procedures, more frequent and longer hospital stays, higher overall costs, and exclusion of people who cannot pay.

Fragmented health care

In rural parts of the developing world, care tends to be fragmented into discrete initiatives focused on individual diseases or projects, with little attention to coherence and little investment in basic infrastructures, services, and staff. As the report observes, such situations reduce people to “programme targets.”

Above all, health care is failing to respond to rising social expectations for health care that is people-centred, fair, affordable and efficient.

A primary health care approach, when properly implemented, protects against many of these problems. It promotes a holistic approach to health that makes prevention equally important as cure in a continuum of care that extends throughout the lifespan. As part of this holistic approach, it works to influence fundamental determinants of health that arise in multiple non-health sectors, offering an upstream attack on threats to health.

Primary health care brings balance back to health care, and puts families and communities at the hub of the health system. With an emphasis on local ownership, it honours the resilience and ingenuity of the human spirit and makes space for solutions created by communities, owned by them, and sustained by them.

Working towards fairness and efficiency

The core strategy for tackling inequalities is to move towards universal coverage in a spirit of equity, social justice, and solidarity. Fairness and efficiency in service delivery are overarching goals.

Primary health care also offers the best way of coping with the ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends contribute to a rise in chronic diseases, like heart disease, stroke, cancer, diabetes and asthma, that create new demands for long-term care and strong community support. A multisectoral approach is central to prevention, as the main risk factors for these diseases lie outside the health sector.

The report says that health systems will not naturally gravitate towards greater fairness and efficiency. Deliberate policy decisions are needed. The evidence and arguments set out in the report should help in this task.

“We are, in effect, encouraging countries to go back to the basics,” said Dr Chan. “Thirty years of well-monitored experience tell us what works and where we need to head, in rich and poor countries alike.”

– World Health Report 2008

World Health Organization
who.int

One thing that all western nations have in common is our ever evolving societies. In order to understand the impact of such changes on our communities, the Economic and Social Research Council (ESRC) launched Understanding Society, the world’s largest ever household longitudinal study on Monday 13th October 2008. Understanding Society will provide valuable new evidence to inform research on the vital issues facing our communities.

Initial funding for the project is ВЈ15.5 million, which comes from the Department of Innovation, Universities and Skills and the ESRC and represents the largest single investment in academic social research resources ever launched in the UK. As a longitudinal study, the initial funding will carry the study though to 2012, however it is envisaged that the project will continue for decades to come.

For at least the last 50 years, social scientists have been capturing information to study these changes, in studies such as the British Household Panel Survey, and successive Governments have been using that information to inform policy decisions, such as the long term health implications of smoking and how poverty impacts on children.

This ambitious study, Understanding Society, will be the largest study of its type ever undertaken, anywhere in the world. It will collect information from 100,000 individuals, across 40,000 households from across the country, from Lands End to the Highlands and Islands of Scotland. It will assist with the understanding of the long term effects of social and economic change, and will provide tools to study the impact of policy interventions on the well being of the UK population.

The large sample size will give a unique opportunity to explore issues for which other longitudinal surveys are too small to support effective research. It will permit analysis of small subgroups, such as teenage parents or disabled people.

Speaking about the launch, Professor Ian Diamond, Chief Executive of the ESRC, said: “This is an exciting and important development that will increase our understanding of communities and society in general. The study will benefit policy researchers and policy makers in the UK, and researchers and research users in a wide range of academic and non-academic environments around the world.”

Understanding Society Director, Professor Nick Buck of University of Essex, said: “We are very pleased to lead this exciting project which will provide high quality longitudinal data about the people of the UK, their lives, experiences, behaviours and beliefs, and will enable an unprecedented understanding of diversity within the population. It represents the latest stage in the UK’s uniquely successful tradition of longitudinal data and we aim to ensure it becomes a flagship resource for the research and user community in the UK – and beyond.”

###

NOTES:

1. Understanding Society will be based at and led by the Institute for Social and Economic Research (ISER) at the University of Essex, together with colleagues from the University of Warwick and the Institute of Education. The survey work will be undertaken by the National Centre for Social Research (NatCen).

It will be, in global terms, a unique research resource in terms of size and ambition, and will be a major advance on the British Household Panel Survey (BHPS). iser.essex.ac/ulsc/bhps/

2.The study will collect data about each sample member and his or her household at annual intervals. Such panel surveys provide unique information on the persistence of such states as child poverty or disability, on factors that influence key life transitions, such as marriage and divorce, and on the effects of earlier life circumstances on later outcomes. They also support research relevant to the formation and evaluation of policy.

3. Key Features

Understanding Society has a number of key features that reflect its scientific rationale, and which can be exploited to generate major innovations in scientific research:
Sample Size

The study has a target sample size of 40,000 households, bigger than any comparable longitudinal study and permitting a much more fine-grained analysis of UK society.

Household focus

Through annual data collection, will track relatively short term or frequent changes in the lives of people, and the factors that are associated with them.

Data will be collected on all members of sample households and their interactions within the household. This has major advantages for important research areas such as consumption and income, where within-household sharing of resources is important, or demographic change, where the household itself is often the object of the study. Compared with individual-based birth cohorts, it will give better and more continuous information on the family and household environment within which child development takes place. Observing multiple generations and all siblings allows examination of long-term transmission processes and isolates the effects of commonly shared family background characteristics. The study will also provide opportunities to explore linkages outside the household.

A full age range

The study will complement existing age-focused studies sampling elderly people (such as the English Longitudinal Study of Ageing) or young people (such as the 1958, 1970 and Millennium birth cohort studies), and provide a unique look at behaviours and transitions in mid-life. Moreover, the large sample size means that all cohorts can be analysed at a common point in time.

Innovative data collection methods

The study will incorporate a range of other data from external sources, ranging from administrative data to data about the areas in which people live. It will also include qualitative supplements to gain greater understanding of respondents’ perceptions and motivation.

Continuous development in data collection methods will benefit from the experience of other longitudinal surveys and the introduction of new technologies. This entails additional methods of interviewing, collection of qualitative and visual data, external record linkage and an ‘innovation panel’ of around 1,500 households, to allow experimentation and methodological development and the testing of mixed mode data collection strategies.

Broad, interdisciplinary topic coverage

The study will address new and emerging research issues, such as the environmental impacts of household behaviour, health related behaviours or emerging diversity in UK society, in terms of a range of factors from class, ethnicity, religion to consumption and lifestyle.

While meeting the needs of ‘traditional’ quantitative social science disciplines such as economics, sociology and social policy, it will also serve other disciplines (both in the social sciences and biomedical sciences) and make possible a wider set of methodological approaches (for example, via linked qualitative studies).

Ethnic Minority Boost

The study will contain a significant sample boost for key ethnic minority groups and specially designed questionnaire supplements, which will provide the base for the first ever significant longitudinal analysis of minority experiences in the UK. The incorporation of an ethnicity research agenda within the study recognises the increasing prominence of research into ethnic difference for our understanding of the make-up of British society and issues of diversity and commonality.

Biomedical research

The study aims to collect biomedical measures and samples, subject to obtaining appropriate consents from respondents, to enable new research on the social determinants and impacts of health in a household context. This opens up exciting prospects for advances at the interface between social science and biomedical research. It will provide the opportunity to assess exposure and antecedent factors of health status, understanding disease mechanisms household and socio-economic effects and analysis of outcomes using direct assessments or data linkage. Direct physical measurements are currently planned to be included at wave 3 of the survey.

Consultation

Extensive consultation on the study coverage and content continues to ensure that the study meets the current and future needs of the user community. Consultation with potential stakeholders include:

academic researchers and analysts

central and local government

current BHPS users

other UK survey resources and survey developers

researchers at the interface between social science and biomedical research

devolved administrations, regional development agencies and local authorities

other public organisations and agencies

research charities, foundations, and think tanks

commercial users, including knowledge brokers

The key aims of the consultation are to establish priorities concerning the topics addressed, the content of the core questionnaire (the part repeated at each wave), and the content and sequencing of modules included on a rotating or occasional basis.

Leadership and Governance

Primary scientific leadership of the study is provided by a team drawn from both ISER and colleague institutions.

Reflecting its multi-disciplinary research and broad-ranging client focus, Understanding Society will be guided by and responsive to different bodies responsible for its long term growth and development:

The Governing Board will be responsible for the study’s long-term development of Understanding Society, and will also ensure that the financial resources required for the future of the study are in place at the appropriate time

The Scientific Advisory Committee will provide generic oversight and stewardship of Understanding Society content and data collection methods

Specialist advisory committees for both ethnicity and biomarkers strands will provide expert advice on content and data collection methods specific to their specialist domains.

For further information on the study, see: understandingsociety/

4. The Economic and Social Research Council (ESRC) is the UK’s largest funding agency for research, data resources and postgraduate training relating to social and economic issues. It supports independent, high quality research which impacts on business, the public sector and the third sector. The ESRC’s planned total expenditure in 2008/09 is ВЈ203 million. At any one time the ESRC supports over 4,000 researchers and postgraduate students in academic institutions and research policy institutes. More at esrcsocietytoday.ac/

5. ESRC Society Today offers free access to a broad range of social science research and presents it in a way that makes it easy to navigate and saves users valuable time. As well as bringing together all ESRC-funded research and key online resources such as the Social Science Information Gateway and the UK Data Archive, non-ESRC resources are included, for example the Office for National Statistics. The portal provides access to early findings and research summaries, as well as full texts and original datasets through integrated search facilities. More at esrcsocietytoday.ac/

Source: Danielle Moore

Economic & Social Research Council

Two new national health studies show that more adults in the US are living with hypertension than ever before; while this is bad news in that the
proportion of the population with high blood pressure has gone up, it is also good news in that more people are living with rather than dying from high blood
pressure. The investigators also concluded that obesity is the main reason so many adult Americans have high blood pressure.

The findings are published as a paper in the October 13 issue of Hypertension: Journal of the American Heart Association, and were the work of
researchers at the the National Heart, Lung, and Blood Institute (NHLBI), of the National Institutes of Health, based in Bethesda, Maryland.

Lead author dr Jeffrey A Cutler, who is a consultant to NHLBI’s Divisions of Prevention and Population Sciences and Cardiovascular Diseases, said their
findings confirmed:

“What others have observed based on more limited data and what one would expect, because obesity is an important cause of high blood pressure.”

For the study, Cutler and colleagues compared data from two similar surveys taken roughly ten years apart. The first set of data came from the third
National Health and Nutrition Examination Survey (NHANES III), which ran from 1988-1994, and the second set of figures came from the first six years
(covering 1999 to 2004) of the current NHANES, which collects data continuously in blocks of two years.

This gave them a total data set covering 16,351 adult participants (aged 18 and over) from the first survey and 14,430 from the second survey.

After standardizing the figures according to age, the results showed the overall prevalence of high blood pressure rose from 24.4 to 28.9 per cent over the
ten years or so between the two sets of figures.

The investigators defined prevalence as an “estimate of the total number of cases of a disease existing in a population during a specified period”; expressed
as a percentage of the population.

The results also showed that being overweight explained part but not all of the increase in high blood pressure across all age and ethnic/race
groups.

Study co-author Dr Paul D. Sorlie, who is Epidemiology Branch Chief in the Division of Prevention and Population Sciences at the NHLBI said:

“We see that much of the magnitude in men is accounted for by obesity, but less so in women, possibly because of some unexplored changes in risk factors for
hypertension.”

The results also showed that:

The most notable change in most gender and race groups was a reduction in the percentage of American adults in the population who have normal blood
pressure (from 55.5 to 50.3 per cent): due to the rise of prevalence in all high blood pressure categories.
The percentage of the population estimated to be prehypertensive (between 120 and under 140 systolic, and/or 80 to 89 diastolic) went up from 32.3 to
36.1 per cent.
Awareness of having high blood pressure went up by more than 5 per cent among men, and it also went up among non-Hispanic black women.
During 1999 to 2004, 72 per cent of American adults with high blood pressure were aware of it, 61 per cent were being treated and 35 per cent were
keeping it under control.
Treatment rates also went up in all race and gender groups.
All race and gender groups also showed a tendency to improve their control of blood pressure, with non-Hispanic white and black men showing the highest
increases, from 22 to 39 per cent and from 17 to 30 per cent respectively between the two surveys.
One group that failed to show any significant improvement between the two surveys in their control of blood pressure was white women .
Mexican Americans appear to have the lowest proportion of adults in control of their blood pressure, especially among young men (16 per cent) and older
women (19 per cent).

Systolic blood pressure is when the heart is beating (the higher pressure reading), and diastolic is when the heart is relaxing (the lower pressure
reading).

Cutler commented that while there has been a considerable improvement in the treatment and control of high blood pressure, it is “far from ideal”,
and:

“Most importantly, we have to do a better job of prevention.”

He also said that the gender pattern appears to have reversed over the decade or so covered by the two surveys, with white men now able to control their blood pressure as well as
if not better than white women.

Dr Theodore A. Kotchen, Professor of Medicine and Epidemiology, Associate Dean for Clinical Research, Medical College of Wisconsin in Milwaukee said in an
accompanying editorial that from an overall and a patient care perspective, the study emphasizes the importance of:

“Preventing obesity and encouraging weight loss for the overweight as strategies for hypertension prevention.”

He said this was particularly relevant because the past decade has seen a several fold increase in childhood obesity.

“In 2003-2006, 16.3 percent of children and adolescents were at or above the 95th percentile of BMI [body mass index] for age, based on the 2000 Centers for
Disease Control and Prevention growth charts,” said Kotchen.

“Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988-1994 and 1999-2004.”
Jeffrey A. Cutler, Paul D. Sorlie, Michael Wolz, Thomas Thom, Larry E. Fields, and Edward J. Roccella.
Hypertension, Published Online on October 13, 2008.
doi:10.1161/HYPERTENSIONAHA.108.113357.

Click here for Abstract.

Source: AHA, journal abstract.

: Catharine Paddock, PhD.