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Neuroscience Articles

  • Alcohol blackouts common in UK teens

    By Andrew M. Seaman

    (Reuters Health) - About a third of 15-year-olds in the UK have blacked out due to alcohol, a new survey indicates - and the rate rises to nearly three-quarters by the time they reach 19, researchers found.

    "Blackout is associated with pretty severe intoxication," said Dr. Marc Schuckit, the study's lead author from the University of California, San Diego. It occurs when the blood alcohol level "is about double what is legally drunk."

    "We found that (blackouts) were shockingly common" among the teens in the survey, Schuckit told Reuters Health.

    Although there are some variations among U.S. states, most set a blood alcohol content of 0.08 percent as the legal limit. The National Transportation Safety Board recommended lowering that level to 0.05 percent, which is the cutoff in many European countries.

    Schuckit believes teens, and popular culture, view blacking out as funny. But it's very serious, he said, adding that when blood alcohol levels are high enough to cause blackouts, "people are very likely to get into trouble."

    The 1,402 teens in the study, all of whom reported drinking when surveyed at age 15, were surveyed again at ages 16, 18 and 19.

    At age 15, 30 percent reported drinking to the point where they could not remember what happened the next day. By age 19, about 74 percent had experienced an alcohol-related blackout.

    There were four distinct drinking patterns, researchers found. About 5 percent of participants did not report any blackouts. In about 30 percent, blackouts increased rapidly as kids got older. In about 45 percent, blackouts slowly increased with age. And in about 20 percent, there was a steady rate of blackouts throughout the study.

    "What is really important is the 'never had a blackout' group was relatively uncommon, compared to the other groups," Schuckit said.

    Some students were more likely to report alcohol-related blackouts, compared to other students.

    "The first was a surprise to me," Schuckit said. "That is if you're female."

    His group also reports in the journal Alcoholism: Clinical and Experimental Research that drinking more, smoking, having fewer inhibitions and having more friends thought to be drinking and using drugs were all tied to an increased number of blackouts.

    While Schuckit said these numbers may be less dramatic among U.S. teens, "there's no way I'm ever going to see a kid from (age) 14 on without asking about their drinking pattern."

    If doctors do suspect a teen is on a dangerous path with drinking, he said "what you do is as a clinician is a brief intervention."

    A brief intervention is a quick session to make a person think about their drinking and giving them resources to drink more responsibly.

    Parents, Schuckit said, should start a discussion about drinking.

    SOURCE: http://bit.ly/1Jky40q Alcoholism: Clinical and Experimental Research, online December 16, 2014.

  • Federal judge rebuffs NCAA concussion settlement

    By Reuters Staff

    (Reuters) - A federal judge on Wednesday rebuffed a $75-million NCAA settlement that aimed to end a massive class-action lawsuit over head injuries suffered by student athletes, court records show.

    U.S. District Judge John Lee wrote in a 21-page opinion that while the proposed agreement was a step in the right direction, the $70 million devoted to fund concussion testing and diagnosis for players might not cover potential costs, among other issues.

    "Although these concerns may prove surmountable, the Court cannot grant preliminary approval of the settlement as currently proposed," Lee wrote.

    There was no immediate reply to a request for comment from the National Collegiate Athletic Association (NCAA), which had previously welcomed the agreement as a way to improve sports safety.

    The lawsuit was first filed in 2011 on behalf of former Eastern Illinois football player Adrian Arrington, who said he suffered headaches and seizures as a result of five documented concussions. The proposed settlement covers other cases.

    The deal also addressed some guidelines, such as barring a student with a concussion from returning to play or practice on the same day and requiring a doctor's clearance.

    It would have also set aside $5 million for concussion research, although research done by member schools can be credited toward that amount.

    The opinion highlighted that not all plaintiffs in the case were happy with the settlement, with some taking issue over the provision barring players from bringing bodily injury claims as a class.

    The proposed NCAA settlement came a few weeks after a federal judge's preliminary approval of an open-ended settlement between the National Football League and thousands of former players in June.

    The NFL settlement money was intended to resolve all the personal injury claims for the plaintiffs' out of pocket damages.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years, with much of the focus on football.

    More than 450,000 NCAA student athletes compete in 23 sports. The NCAA makes revenue of about $740 million each year, court documents show.

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: http://bmj.co/1zCnywT Annals of the Rheumatic Diseases, online December 4, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

Oncology Articles

  • Cigarette smoking costs weigh heavily on the healthcare system

    By Madeline Kennedy

    (Reuters Health) - Of every $10 spent on healthcare in the U.S., almost 90 cents is due to smoking, a new analysis says.

    Using recent health and medical spending surveys, researchers calculated that 8.7 percent of all healthcare spending, or $170 billion a year, is for illness caused by tobacco smoke, and public programs like Medicare and Medicaid paid for most of these costs.

    "Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence," said Xin Xu from the Centers for Disease Control and Prevention (CDC), who led the study.

    Over 18 percent of U.S. adults smoke cigarettes and about one in five deaths are caused by smoking, according to the CDC.

    Xu and colleagues linked data on healthcare use and costs from the 2006-2010 Medical Expenditure Panel Survey to the 2004-2009 National Health Interview Survey for a nationally-representative picture of smoking behavior and costs.

    Out of more than 40,000 adults, 21.5 percent were current smokers, 22.6 percent were former smokers and 56 percent had never smoked. The researchers used prior data on smoking-related disease and deaths to calculate the proportion of healthcare spending by each person that could be attributed to smoking.

    They also adjusted their figures for factors like excess drinking, obesity and socioeconomic status, and calculated the proportion of spending by payer.

    In that analysis, 9.6 percent of Medicare spending, 15.2 percent of Medicaid spending and 32.8 percent of other government healthcare spending by sources such as the Veterans Affairs department, Tricare and the Indian Health Service, were attributable to smoking.

    Of the $170 billion spent on smoking-related healthcare, more than 60 percent was paid by government sources, they wrote in the American Journal of Preventive Medicine.

    Smoking-related healthcare costs affect most types of medical care, said Kenneth Warner at the University of Michigan School of Public Health. "Smoking infiltrates the entire body, through the blood stream, and causes disease in many of the body's organs," he told Reuters Health in an email.

    Along with lung and heart problems, smoking can cause eye disease, skin problems and many cancers including pancreatic and bladder cancer, noted Warner, who was not involved in the new analysis.

    "This study shows that, in addition to the human misery it inflicts, (smoking) imposes a substantial burden on the nation's health care institutions, especially those funded by the public's tax dollars," he said.

    The true cost of tobacco use may be even higher, Xu said. His study didn't include medical costs linked to other tobacco products like cigars and chewing tobacco.

    In 1964, the Surgeon General gave the first report on smoking and health. Since then, there have been many anti-tobacco efforts, ranging from banning tobacco in workplaces to quit-smoking help lines.

    Mass media campaigns can be effective in reducing cigarette use, Xu said. In particular, the CDC's current "Tips from Former Smokers" campaign is credited with an estimated 100,000 smokers quitting permanently.

    The combination of research, publicity, policy and treatment has prevented eight million premature deaths in the U.S. since 1964, according to a 2014 Surgeon General's report. Based on research published this year by Warner and his colleagues, he said, "Almost a third of the increase in adult life expectancy since 1964 is attributable to tobacco control."

    "Smoking kills about 480,000 Americans each year and remains the leading cause of preventable death and disease in the United States. No matter what age, it is never too late to quit," Xu said.

    SOURCE: http://bit.ly/1sCvb0k American Journal of Preventive Medicine, online December 9, 2014.

  • 'Surveillance' may be safest for low-risk prostate cancer

    By Kathryn Doyle

    (Reuters Health) - Among men whose low-risk prostate cancer was managed with so-called active surveillance for up to 15 years, just 1.5 percent died of the cancer, according to new data from a Canadian study.

    That result is similar to outcomes in men whose cancers are treated immediately, the authors write.

    Prostate cancer often grows very slowly. In some men, such as the elderly or those with serious health problems, it may never need to be treated, says the American Cancer Society.

    In the Canadian trial, 993 men with low or intermediate risk cancers were enrolled in active surveillance between 1995 and 2013. By now, more than 200 of them have been observed for more than 10 years and 50 for more than 15 years.

    "This is the third time we've published the key results of our long term surveillance cohort," said lead author Dr. Laurence Klotz of Sunnybrook Health Sciences Center in Toronto.

    The men were monitored with regular testing. Treatment was started if the cancer progressed.

    As of now, only 27 percent of the men have been treated for their cancers with radiation therapy, radical prostatectomy or androgen-deprivation therapy.

    Of the 933 patients, 149 have died, but only 15 died from prostate cancer, the researchers reported in the Journal of Clinical Oncology.

    All the men who died from the cancer had metastases by the end. Another 13 patients had metastases but died from causes other than prostate cancer. In all, less than three percent of the men developed metastatic cancer.

    That's similar to the rate of metastases in another study of men with low-risk disease who were treated immediately, according to Dr. Matthew R. Cooperberg of the University of California, San Francisco.

    "In recent years, active surveillance has evolved from an experimental protocol to a broadly accepted - in fact, preferred - management strategy for men diagnosed with low-risk prostate cancer," he wrote in an editorial in the journal.

    Twenty years ago, treating every prostate cancer patient was the norm, Klotz told Reuters Health by phone.

    "Over the years this has evolved," he said.

    "This whole approach is one of evolution and we can do better with that one or 1.5 percent," who end up dying from the disease, Klotz said.

    In this group of low-risk cancers, about 25 percent turned out to be "wolves in sheep's clothing," he said. Those that metastasized weren't low-grade disease that spread, rather they were hidden higher-grade disease that doctors missed, he said.

    But doctors are getting better at identifying those cases. Now, magnetic resonance imaging can detect many of the more dangerous cancers that may have missed with a biopsy 20 years ago, Klotz said.

    Men in the study who died from prostate cancer succumbed about 15 years after diagnosis, usually in their 80s, he noted.

    "It really looks like (active surveillance) is a safe strategy for the management of probably 40 to 50 percent of newly diagnosed prostate cancer patients," he said.

    Overtreating prostate cancers that would not ultimately be fatal can lead to incontinence, erectile dysfunction and other problems, he said.

    "That's why I think this approach is so important, if you can significantly reduce overtreatment but you still have the benefit of screening," Klotz said.

    Active surveillance has been widely embraced in Canada and has been somewhat slower to catch on in the U.S., but is becoming more common, he said.

    "The bottom line is, it's catching on and I also think the role of MRI will provide further reassurance," for doctors and patients, Klotz said.

    SOURCE: http://bit.ly/1wFImCZ Journal of Clinical Oncology, online December 15, 2014.

  • Teen contraband cigarette use linked to other drugs

    By Kathryn Doyle

    (Reuters Health) - Compared to those who don't smoke illicit tobacco, kids who do are more likely to try other illegal drugs like cocaine, heroin and amphetamines, according to a recent Canadian study.

    The researchers used survey data from one point in time, so they can't say that smoking illegal cigarettes leads to drug use, only that the two often coincide and that's enough to warrant stronger tobacco control policies.

    "The concern for us is that contraband tobacco may be a gateway to other drugs, but we cannot infer causality," said coauthor Mesbah F. Sharaf of the economics department at the University of Alberta in Edmonton.

    In Canada, unmarked and untaxed contraband cigarettes are either illegally manufactured domestically or illegally imported across the U.S. border, often from Native American reservations, the authors write in The Journal of Primary Prevention.

    They cite a national survey from 2007 that found 18 percent of all cigarettes used by teens who smoked daily were contraband.

    "Here in Canada the contraband market is really substantial, almost 30 percent of tobacco sales in the whole country," Sharaf told Reuters Health.

    For the new study, he and his coauthors used data from Canada's 2010-2011 Youth Smoking Survey, a school-based survey of kids in grades six through 12.

    It included questions about smoking unbranded or Native American-brand cigarettes over the previous twelve months as well as use of amphetamines, cocaine, heroin, ecstasy and ketamine over the same period.

    Focusing on the answers from kids who smoked, the researchers found that 31 percent of them had used contraband cigarettes at least once in the previous year. And contraband cigarette smokers were more likely to report using other drugs than kids who only smoked legal cigarettes.

    Twenty percent of contraband cigarette users reported trying heroin, compared to three percent of non-contraband smokers. For hallucinogens, 46 percent of contraband smokers reported trying it, compared to 30 percent of non-contraband smokers.

    "The issue of illicit tobacco is a prominent problem worldwide," said Dr. Russ Callaghan, associate professor in the Northern Medical Program at the University of Northern British Columbia in Prince George, who was not part of the new study.

    "In general, the way it is defined is any tobacco product that doesn't have the full set of taxes or levies applied to the purchase price," Callaghan told Reuters Health.

    Illicit tobacco is less of an issue for kids in the U.S., but it is contributing to a lot of youth smoking in Canada, and the tobacco products they get largely come across the border from upstate New York, he noted.

    The new study does show an association between contraband tobacco and illegal drugs, but it cannot say anything about causation, which is important, Callaghan noted.

    Sharaf cites a Royal Canadian Mounted Police drug bust in which contraband tobacco was found with other illicit drugs as evidence that kids may be getting their illegal cigarettes and other substances from the same source.

    "So it seems that this contraband market is managed by probably organized crimes and criminal gangs that may be using contraband as an avenue to other illicit drugs," Sharaf said. "Most likely it is the same source."

    But in interviews with teen smokers in Canada, Callaghan has not found that to be the case.

    "When I've asked young people about whether their sources of illicit cigarettes and illicit drugs are the same, they say no," he said.

    Some corner stores sell the cigarettes, which could be where young people purchase them, he noted.

    Although the authors suggest the "gateway hypothesis," wherein illegal tobacco leads to the use of other illegal drugs, "I don't think they are really warranted in inferring that at all," Callaghan said.

    "I think what's probably happening here is you have young people who may be marginalized, have low academic achievement, more deviance, and they engage in both of these activities," he said.

    In the past, some have argued that marijuana is a gateway drug to more dangerous substances, and that has been mostly disproved, Callaghan said.

    "It's not that I don't think that illicit drugs are a problem, but I'd be wary of that particular line of reasoning," he said. "There's a relation, but we need to be careful. I hope it's not alarmist."

    Linking contraband tobacco to further drug use could bring more attention to the problem, but policymakers may argue to lower taxes on legitimate cigarettes to reduce the contraband market, which would in turn lead to cheaper cigarettes and more smokers, Callaghan said.

    Earlier this year, Canadian criminal codes were amended to make trade, promotion or sales of contraband a criminal offense, which is a step in the right direction, Sharaf said.

    "This needs to be supplemented with creative government measures," he said.

    SOURCE: http://bit.ly/1zu7vlf The Journal of Primary Prevention, online November 1, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

Orthopedic Articles

  • In overweight kids, some exercises can strain feet

    By Roxanne Nelson

    (Reuters Health) - In overweight children, exercise can put pressure on their developing feet, say Australian researchers.

    They point out that overweight children are at risk for foot pain and discomfort because they tend to have fatter and flatter feet, which can lead to increased pressure on the arched portion of the sole.

    That, in turn, could stop kids from participating in physical activity, they warn in a recent paper.

    "Physical activity is certainly crucial to health and well-being, and halting weight gain is important," said Diane L Riddiford-Harland of the University of Wollongong, who led a study of the effect of exercise on overweight kids' feet.

    Since these children might be uncomfortable while exercising, alternate forms of activity are probably necessary, she explained.

    "Non-weight bearing physical activity such as swimming or cycling may be a good option," Riddiford-Harland told Reuters Health in an email. "There are all types of aquatic movement activities and cycling-type activities children can participate in, but going to the pool/beach or on a bike ride with an adult can be enjoyable and are usually quite affordable."

    She and her coauthors had found in a previous study that overweight kids had higher "plantar pressures" on the middle and fore-foot areas of the sole while walking than normal-weight kids.

    They also linked the higher pressures and a flattening of the arches to a likelihood the kids would be less physically active.

    In the new study, they divided a group of children who were already participating in a obesity treatment trial into three groups. One group focused on getting the children to be more physically active. A second group emphasized activity plus a parent-centered diet-modification program. The third group did not involve physical activity, only the dietary modification.

    Thirty-four kids participated. They were five to nine years old and generally healthy, except for being their obesity.

    After six months, all the children had grown in height and lost some weight.

    All the children's feet also grew in length and arch height, representing normal growth, but none of the other proportions of their feet had changed.

    The lack of structural differences between the kids who exercised and those who didn't was surprising to the researchers. But, they say, the measurement at six months may have taken place too long after the 10-week weight-loss trial ended to detect changes caused by exercise.

    "As the musculoskeletal system is still developing in young children, carrying excessive body mass will likely lead to long term health complications as they continue to age," Riddiford-Harland said.

    "We still need to systematically determine just what causes the pain or discomfort that has been reported by these children, how prevalent it is, what makes it worse and does anything make it better, because being physically active and remaining physically active throughout life is imperative for good health," she added.

    Podiatrist Alan MacGill, a fellow of the American College of Foot and Ankle Surgeons who wasn't involved in the study, pointed out that supportive shoes and orthotics would help children with flat feet.

    "The devices can help control excessive motion in the foot," he said. "The shoe should be the correct size for the child and not too flimsy from toe to heel."

    SOURCE: http://bit.ly/1x35nSc Journal of Science and Medicine in Sport, online November 13, 2014.

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: http://bmj.co/1zCnywT Annals of the Rheumatic Diseases, online December 4, 2014.

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Women’s Health Articles

  • It's time to fight traditions that harm women's health-WHO

    By Magdalena Mis

    LONDON (Thomson Reuters Foundation) - Some of the major health problems faced by women in developing countries are caused by "terrible" traditions that must be stopped, said the head of public health at the World Health Organization (WHO).

    Traditions such as child marriage or female genital mutilation (FGM), widely practiced in some communities, contribute to high maternal mortality rates in some poor countries where girls as young as 13 get married and give birth.

    Tackling traditions that can be detrimental to health and backing those changes by legislation are essential to protecting women and girls, Maria Neira told the Thomson Reuters Foundation.

    "A tradition that forces a girl to get married at 13 is a bad tradition," Neira said on the sidelines of a London event on maternal mortality and access to water and sanitation. "It's time to fight all of those traditions."

    Customs like child marriage mean that teenage girls get pregnant and give birth, often before their bodies are ready, and often in clinics without basic facilities like clean water or toilets.

    Nearly 16 million adolescent girls give birth every year and at least 70,000 girls die each year due to pregnancy and childbirth complications, according to UNICEF.

    Although maternal mortality worldwide has dropped by 50 percent in the last two decades, 289,000 women died from complications related to pregnancy and childbirth in 2013, the majority of them in developing countries, according to WHO.

    Education is key to giving women a voice and empowering them to speak up for their rights, said Neira. "As soon as (women) get a minimum of education, their voice is stronger," she said.

    It's also the role of global institutions, including WHO, to help women fight for their rights, she said.

    "We need to focus on women because they don't have yet the power to fight for themselves. We need to empower them."

  • Federal judge rebuffs NCAA concussion settlement

    By Reuters Staff

    (Reuters) - A federal judge on Wednesday rebuffed a $75-million NCAA settlement that aimed to end a massive class-action lawsuit over head injuries suffered by student athletes, court records show.

    U.S. District Judge John Lee wrote in a 21-page opinion that while the proposed agreement was a step in the right direction, the $70 million devoted to fund concussion testing and diagnosis for players might not cover potential costs, among other issues.

    "Although these concerns may prove surmountable, the Court cannot grant preliminary approval of the settlement as currently proposed," Lee wrote.

    There was no immediate reply to a request for comment from the National Collegiate Athletic Association (NCAA), which had previously welcomed the agreement as a way to improve sports safety.

    The lawsuit was first filed in 2011 on behalf of former Eastern Illinois football player Adrian Arrington, who said he suffered headaches and seizures as a result of five documented concussions. The proposed settlement covers other cases.

    The deal also addressed some guidelines, such as barring a student with a concussion from returning to play or practice on the same day and requiring a doctor's clearance.

    It would have also set aside $5 million for concussion research, although research done by member schools can be credited toward that amount.

    The opinion highlighted that not all plaintiffs in the case were happy with the settlement, with some taking issue over the provision barring players from bringing bodily injury claims as a class.

    The proposed NCAA settlement came a few weeks after a federal judge's preliminary approval of an open-ended settlement between the National Football League and thousands of former players in June.

    The NFL settlement money was intended to resolve all the personal injury claims for the plaintiffs' out of pocket damages.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years, with much of the focus on football.

    More than 450,000 NCAA student athletes compete in 23 sports. The NCAA makes revenue of about $740 million each year, court documents show.

  • Obesity can be deemed a disability at work -EU court

    By Julia Fioretti

    BRUSSELS (Reuters) - Europe's top court ruled on Thursday that obese people can be considered as disabled, but stopped short of saying that obesity was a condition that needed specific protection under European anti-discrimination laws.

    The landmark decision will be closely read by European employers and means that companies might have to provide greater support to obese staff.

    The case was instigated by a Danish court, which wanted guidance over a complaint of unfair dismissal brought by a child-minder who was sacked by a local authority.

    Karsten Kaltoft, who never weighed less than 160 kilograms (352 pounds) during his employment, argued that his obesity was one of the reasons he lost his job and that this amounted to unlawful discrimination - an allegation the council denied.

    The Court of Justice of the European Union (EJC) ruled that EU employment law did not specifically prohibit discrimination on the grounds of obesity, and said the law should not be extended to make it a protected category.

    However, the Luxembourg-based court said that if an employee's obesity hindered "full and effective participation of that person in professional life on an equal basis with other workers" then it could be considered a disability. This, in turn, is covered by anti-discrimination legislation.

    Classifying obesity as a protected characteristic - such as sex, race or age - would have required employers to take measures to ensure obese workers could perform their duties on an equal footing with others.

    "It would have opened a can of worms," said Crowley Woodford, employment partner at law firm Ashurst.

    However, Friday's nuanced ruling still leaves companies open to potential discrimination suits.

    "If you consider the obese disabled, all of a sudden it triggers certain protections for employees," said Jacob Sand, a partner at Danish law firm Gorrissen Federspiel which represented Kaltoft.

    Considering obesity a disability also reverses the burden of proof in workplace disputes over discrimination, Sand added, meaning it will be easier for employees to argue they had been discriminated against on the basis of their disability.

    "That makes it a whole lot easier for employees in that it is easier to win the case," Sand said.

    However it does not mean that employers cannot fire someone whose size means that they are unable to do their job, rather that they must consider whether any adjustments need to be made to help the employee perform their role first, said Stefan Martin, employment partner at law firm Mayer Brown.

    According to statistics from the World Health Organization (WHO), based on 2008 estimates, roughly 23 percent of European women and 20 percent of European men were obese.

    The issue of whether obesity is a disability has also been dealt with in U.S. courts, where almost one in three adults is obese, according to WHO data. Some states, such as Michigan, have enacted legislation that explicitly prohibits discrimination on the basis of a person's weight.

    The Danish court must now decide whether Kaltoft's obesity represented a disability. It is expected to reach a decision before the end of next year. Kaltoft had asked for compensation equivalent to 15 months' salary for his dismissal, Sand said.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: http://bit.ly/1zt1Iw6 European Heart Journal, online December 9, 2014.

  • Autism risk linked to particulate air pollution

    By Reuters Staff

    (Reuters) - Children whose mothers were exposed to high levels of fine particulate pollution in late pregnancy have up to twice the risk of developing autism as children of mothers breathing cleaner air, scientists at Harvard School of Public Health reported on Thursday.

    The greater the exposure to fine particulates emitted by fires, vehicles and industrial smokestacks, the greater the risk, according to the study published online in Environmental Health Perspectives.

    Earlier research also found an autism-pollution connection, including a 2010 study that found the risk of autism doubled if a mother, during her third trimester, lived near a freeway, a proxy for exposure to particulates. But this is the first to examine the link across the United States, and "provides additional support" to a possible link, said Heather Volk of the University of Southern California Children's Hospital, who led earlier studies.

    U.S. diagnoses of autism soared to one in 68 children in 2010 (the most recent data) from one in 150 in 2000, government scientists reported in March. Experts are divided on how much of the increase reflects greater awareness and how much truly greater incidence.

    Although the disorder has a strong genetic basis, the increasing incidence has spurred scientists to investigate environmental causes, too, since genes do not change quickly enough to explain the rise.

    The Harvard study included children of the 116,430 women in the Nurses' Health Study II, which began in 1989. The researchers collected data on where the women lived while pregnant and levels of particulate pollution. They then compared the prenatal histories of 245 children with autism spectrum disorder to 1,522 normally-developing children, all born from 1990 to 2002.

    There was no association between autism and fine particulate pollution exposure before or early in pregnancy, or after the child was born. But high levels of exposure during the third trimester doubled the risk of autism.

    Evidence that a mother-to-be's exposure to air pollution affects her child's risk of autism "is becoming quite strong," said Harvard epidemiologist Marc Weisskopf, who led the study, suggesting a way to reduce the risk.

    It is not clear how tiny particles might cause autism, but they are covered with myriad contaminants and penetrate cells, which can disrupt brain development.

    Last year the Environmental Protection Agency, citing the link to asthma, lung cancer and cardiovascular disease, tightened air quality standards for fine particulate pollution. States have until 2020 to meet the new standards.

    SOURCE: http://1.usa.gov/1w2lTep Environmental Health Perspectives, online December 18, 2014.