University of California San Francisco

Anemia Tied to Increased Dementia Risk.

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Older adults who have anemia face increased risk for dementia, according to a prospective cohort study in Neurology.

Researchers studied some 2600 initially dementia-free older adults, 15% of whom had anemia at baseline. During 11 years’ follow-up, 18% of participants developed dementia. After adjustment for potential confounders such as age, sex, APOE genotype, comorbid conditions, and literacy, participants with anemia had a significant, 49% increase in risk for dementia relative to those without anemia.

The researchers say their findings are consistent with those from previous studies, and they suggest several possible mechanisms underlying the association. For example, the brain hypoxia that occurs with anemia might contribute to dementia risk, or anemia could be a marker of overall poor health. They call for additional research to determine whether hemoglobin levels should be the focus of prevention strategies.

Source: Neurology

Heritable genetic changes in the open.

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To correctly interpret human genetic variation in hereditary disorders, researchers and clinicians should populate databases that distribute aggregated information on the clinical significance of these variants.

Closely linked to the recent Supreme Court decision (docket 12-398) limiting the scope of patenting human genes, discussion has been growing about whether anonymized data collected by genetic testing laboratories should be freely available. The perceived unwillingness by some companies, who often are the sole provider of a particular test, to share such anonymized data on genetic variants has drawn sharp criticism from researchers and clinicians.

Myriad Genetics provides a good illustration for how big the difference between what is known by a company and what is available to the community can be. Until the court decision, the company held the monopoly on testing for hereditary mutations in the DNA repair proteins BRCA1 and BRCA2; some of these mutations confer a high risk for breast and ovarian cancer. With data from an estimated 1 million tested patients, Myriad’s database allows high-accuracy classification of a patient’s variants as one of four classes indicating the degree of pathogenicity. Only 3% of the variants Myriad encounters in the United States fall into a fifth class, that of variants of unknown significance (VUSs).

In contrast, with freely accessible databases, an average of 15% of BRCA1 and BRCA2 variants cannot be classified and remain VUSs, says Alvaro Monteiro, who is part of the Evidence-based Network for the Interpretation of Germline Mutant Alleles (ENIGMA) consortium focused on classifying BRCA mutations.

This puts researchers outside of Myriad, as well as clinicians, at a considerable disadvantage with respect to fully understanding the impact that changes in these genes can have.

Myriad’s and other companies’ hands may be tied when it comes to data sharing. According to a company spokesperson, Myriad is subject to oversight from the Clinical Laboratory Improvement Amendments and the US Food and Drug Administration. “Consistent with these regulations, we are not allowed to distribute our variant databases, as they may only be used to interpret clinical test results for patients tested in our laboratories.” The company does, however, collaborate with researchers, given their appropriate institutional approval, to help classify VUSs in the context of a specific study and allows the results to be published.

This is a laudable, if small, step that may narrow the knowledge gap, but scientists want to bring information on all variants into the public domain on a much larger scale and are organizing efforts to that end. These efforts will stand or fall depending on community support.

Robert Nussbaum from the University of California, San Francisco, started a grassroots effort, the Sharing Clinical Reports Project (SCRP), appealing to patients and clinicians to share data on BRCA testing in appropriately anonymized form. The aggregated data are submitted to open databases such as the Breast Cancer Information Core (BIC) or ClinVar. SCRP is ready to submit its first 1,885 variants, including 351 that are new to BIC, according to Lawrence Brody, who founded BIC in 1995. These numbers show that the project resonates with people and is gaining traction.

ClinVar strives to be the most comprehensive of such databases. Founded in 2012 and hosted by the US National Center for Biotechnology Information, it aims to collect information on variation in any gene that affects human health, together with phenotypic information for such variants. It currently hosts around 38,000 variants (in about 3,000 genes) from about 90 different submitters, including genetic-testing laboratories from industry and academia.

ClinVar does not provide recommendations for medical diagnosis to patients or physicians. It is meant to be a resource for scientists, clinicians and genetic counselors who want to investigate a particular variant and its clinical implications in more detail.

Hopefully community support to expand the number of genes that ClinVar covers will increase. To ensure high data quality, ClinVar will need independent confirmatory submissions on each gene variant. More detailed phenotypic description of the conditions associated with each variant and the likely pathogenicity, where appropriate, would further enhance value.

It is hard to forecast whether genetic testing will increase in the wake of the Supreme Court decision. Lawsuits filed by Myriad Genetics and other plaintiffs against Ambry Genetics and Gene by Gene on 9 and 10 July, respectively, indicate looming legal battles. Regardless, efforts such as SCRP and ClinVar need support to ensure that genetic information is shared in appropriate forms to benefit not only individual patients but the research community at large.

Source: http://www.nature.com

Space-age technology could help cut maternal deaths.

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A half-body suit that is strapped on to a woman’s legs and abdomen to slow post-natal bleeding is being used to save lives

Space-age technology, neoprene (the material used for wet suits) and Velcro have gone into an experimental garment that health experts hope can treat postpartum haemorrhage, the leading cause of maternal mortality.

MDG lifewraps and maternal health

A non-pneumatic anti-shock garment (NASG) – also called a “lifewrap” – is a half-body suit that is strapped on to a woman’s lower legs and abdomen to slow bleeding and prevent shock due to blood loss.

“It [the lifewrap] works in two ways: it compresses the blood vessels in the lower part of the body, reversing shock by giving back oxygen to the heart, lungs and brain, which are very oxygen-dependent tissues,” said Suellen Miller, director of the Safe Motherhood Programme/Bixby Centre for Global Reproductive Health at the University of California San Francisco (UCSF).

If it works as intended, pressure on the abdomen decreases the radius of the blood vessels and reduces overall bleeding.

According to the World Health Organisation (WHO), postpartum haemorrhage – the loss of 500-1,000ml or more of blood within 24 hours after birth – accounts for nearly a quarter of maternal deaths and is the leading cause of maternal mortality in most low-income countries.

“Maternal death tracks the inequity between countries. Death from postpartum bleeding is nearly unheard of in the developed world,” said Kate Gilmore, deputy executive director of the UN Population Fund (UNFPA).

The lifewrap, which evolved from a suit researched and developed by the US National Aeronautics and Space Administration for space programmes, was demonstrated to health experts at a maternal health conference in Kuala Lumpur, Malaysia.

Buying time

The lifewrap is not designed as a final solution to save women, but as a stabilising measure to buy time before transfer to a health facility for surgery or blood transfusion.

In developing countries most women in remote communities give birth at home, according to US-based reproductive research body the Guttmacher Institute. The proportion of births in health facilities varies widely globally, according to the institute, from half of deliveries in eastern and western Africa to 99% in east Asia.

In 2010, the institute recorded 284,000 women in developing countries dying from pregnancy and childbirth complications.

“A woman has maybe two hours [from the onset of bleeding] before she suffers from lack of oxygen to her vital tissues and bleeds to death. Delays are killers,” said Miller.

“Working in parts of the world where distance is the difference between life and death demands solutions that can begin in the community or in the home,” said Purnima Mane, president and CEO of Pathfinder International, a US non-profit family planning and reproductive health organisation.

Driving down costs

Clinical trials and studies on the lifewrap were conducted by the UCSF in Nigeria, Egypt, Zambia, Zimbabwe and India from 2004 to 2012. During that period, use of the lifewrap decreased maternal death by up to half.

Though cautious not to attribute the drop to these wraps alone, and recognising that multiple interventions may have been responsible for the decline, experts were encouraged by the correlation.

“Initial results from the testing of the garment are promising. We already have the [supporting] WHO policies. Now we want to encourage countries to review their maternal health protocols regarding postpartum haemorrhage and integrate the use of the lifewrap into their designed interventions,” said Amie Batson, Path chief strategy officer.

WHO guidelines on the management of postpartum haemorrhage call for timely medical intervention, which includes administering drugs like oxytocin and misoprostol during the third and final stage of labour. These drugs help contract the uterus, expedite delivery of the placenta and reduce blood loss.

In the event these drugs do not work, the WHO published guidelines in 2012 promoting uterine compression, and the use of NASGs specifically, as a temporary measure until appropriate care is available.

The lifewrap can be used up to 40 times and washed by hand with detergent after each use. From an original cost of $300 per garment, negotiations with manufacturers have driven down the cost to about $65.

Research and development of the wrap has been pursued jointly by theUNFPA, Pathfinder International, the UCSF, the US-based John D and Catherine T MacArthur Foundation, and Path.

 

Source: http://www.guardian.co.uk

Can you train yourself to get by on less sleep?.

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sleepMargaret Thatcher did it. So did Salvador Dali. They survived the day with only a few hours of sleep. The question is whether you can force yourself to do the same.

We waste a third of our lives sleeping – or that’s how some people see it. When there doesn’t seem to be enough hours in the day, you yearn to be like the former British Prime Minister Margaret Thatcher, who was said to get by on just four hours sleep a night, or the artist Salvador Dali who wasted as little time as possible slumbering.

There is a quite a range in the number of hours we like to sleep. As Jim Horne writes in Sleepfaring, 80% of us manage between six and nine hours a night; the other 20% sleep more or less than this. But how easy is it to change your regular schedule? If you force yourself to get out of bed a couple of hours early every day will your body eventually become accustomed to it? Sadly not.

There is plenty of evidence that a lack of sleep has an adverse effect. We do not simply adjust to it – in the short-term it reduces our concentration, and if it’s extreme it makes us confused and distressed, and turns us into such poor drivers that it’s the equivalent of being drunk. The long-term effects are even more worrying. Repeatedly getting less sleep than you need over the course of decades is associated with an increased risk of obesity, diabetes, high blood pressure and cardiovascular disease.

But what about those people who do happily appear to manage on fewer hours than the rest of us?  Why does it not seem to make them ill?

Firstly, you can console yourself with the fact that there are plenty of myths about people’s bold claims. Napoleon allegedly said that sleep was only for weaklings, but in fact he got plenty of shut-eye.

But there are a few very rare individuals who can manage with only five hours sleep a night without experiencing deleterious effects. They are sometimes known as the “sleepless elite”. In 2009, a team led by geneticist Ying-Hui Fu at the University of California San Francisco discovered a mother and daughter who went to bed very late, yet were up bright and early every morning. Even when they had the chance to have a lie-in at the weekend (a tell-tale sign that you are sleep-deprived) they didn’t take it.

Tests revealed that both mother and daughter carried a mutation of a gene called hDEC2. When the researchers tweaked the same gene in mice and in flies, they found that they also began to sleep less – and when mice were deprived of sleep they didn’t seem to need as much sleep in order to catch up again. This demonstrates that genetics play at least some part in your need for sleep; unfortunately the sleepless elites’ enviable state of affairs isn’t available to rest of us, because at the moment we are stuck with the genes we have (that’s my excuse anyway).

But while it might not be possible to train yourself to sleep less,researchers working with the military have found that you can bank sleep beforehand if you plan well in advance. At the Walter Reed Army Institute of Research they had people go to bed a couple of hours earlier than usual every night for a week. When they were subsequently deprived of sleep they didn’t suffer as much as the people who hadn’t had the chance to bank sleep in advance.

This does involve a lot of effort, so in general what you need to do is work out your personal sleep requirement and then try to stick to it. In his bookCounting Sheep Paul Martin describes a method of working this out. You probably need to do it while you’re on holiday because you need to wake up naturally, rather than rely on an alarm clock. Every night for two weeks you go to bed at the same time and see what time you wake up by yourself next morning.  For the first few nights you might well be catching up on missed sleep, but after that the time you wake up gives an indication of the length of your ideal night’s sleep.

 

You might be disappointed to find you need more sleep than you’d hoped, but don’t see it as a waste. This is time spent valuably allowing your body and mind to function at their best during waking hours.  It may use up a third of your life, but it makes the other two thirds so much better. The politician whose sleep patterns inspire me isn’t Margaret Thatcher, but Winston Churchill. He disliked getting out of bed so much that he stayed there working all morning, even receiving visitors in his bedroom.

Source:BBC

 

Urge Feds to Cut Funding for Cruel Experiments at UCSF.

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monkey

The University of California-San Francisco (UCSF)—which receives half a billion dollars a year in taxpayer funds for research—has a long history of abusing mice, monkeys, and other animals imprisoned in its laboratories and violating federal animal welfare laws and guidelines. New documents obtained by PETA reveal that these miserable conditions continue to plague the more than 1 million animals in UCSF’s laboratories.

Government reports and internal UCSF records document more than 100 violations of federal animal welfare laws and guidelines in just the past few years. Among the dozens of violations:

·         Experimenters didn’t provide pain relief to mice and rats who had their skulls, backs, and abdomens cut into.

·         Experimenters placed live newborn mice inside a freezer meant for dead animals.

·         Experimenters cut out both of a rabbit’s eyes in an unapproved surgery.

·         Experimenters cut the toes off of mice without pain relief, and mice died from dehydration because staff failed to notice that they didn’t have any water.  

A rhesus monkey named Peanut was subjected to multiple invasive brain surgeries and was deliberately deprived of food so that he would perform tasks while locked in a restraint chair. Peanut lost 25 percent of his body weight, but it was only after he was killed that experimenters realized that Peanut’s jaw didn’t open properly and that he probably hadn’t been able to chew food.

A monkey named Squinty suffered with chronic dermatitis for more than a year. Red rashes and open lesions covered his body, and one medical report noted that the condition was so severe that there was “[n]o normal skin to provide a comparison.”

Another monkey named Petra was subjected to invasive brain experiments and suffered chronic and painful complications, including a terrible bacterial infection in the wound where her head had been cut open. Experimenters continued to torment Petra for nearly two years despite her deteriorating health. She rapidly began to lose weight, circled endlessly in her cage, and ripped out her own hair.

UCSF’s history of violating federal animal welfare laws and guidelines dates back more than 15 years and includes a $92,500 fine that the university was forced to pay in 2005 for dozens of violations of the Animal Welfare Act.

National Institutes of Health (NIH) policies require facilities receiving taxpayer money to abide by animal welfare laws and guidelines as a condition of their receiving grants, but last year, UCSF received more than $500 million in taxpayer money—half of which was likely spent on experiments involving animals—even though it continues to regularly violate these provisions.

Please join PETA and call on NIH to cut taxpayer funding for experiments on animals at UCSF.

Source:PETA

URL: http://www.peta.org/index_landing.asp

More Evidence for Increased Skin Cancer Risk with Indoor Tanning.

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Exposure to ultraviolet radiation through indoor tanning devices is associated with increased risk for nonmelanoma skin cancer, according to a meta-analysis in BMJ.

The analysis included 12 studies (mostly case-control) comprising over 80,000 participants and 9300 cases of basal cell carcinoma or squamous cell carcinoma. Overall, individuals who’d ever used an indoor tanning device were about 25% more likely to have basal cell disease and nearly 70% more likely to have squamous cell disease, relative to unexposed participants. Risk for basal cell carcinoma was even higher among those with higher levels of exposure, as well as those exposed before age 25.

The authors calculate that in the U.S., more than 170,000 cases of nonmelanoma skin cancer each year can be attributed to indoor tanning.

Editorialists emphasize the role of healthcare providers in warning patients, especially young patients, about the risks of indoor tanning.

Source:BMJ