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Feb 24
Vitamin B And Folic Acid May Reduce Risk Of Age-Related Vision Loss
Age-related macular degeneration (AMD) is a leading cause of vision loss in older Americans, according to background information in the article. Treatment options exist for those with severe cases of the disease, but the only known prevention method is to avoid smoking. Recent studies have drawn a connection between AMD and blood levels of homocysteine, an amino acid. High levels of homocysteine are associated with dysfunction of the blood vessel lining, whereas treatment with vitamin B6, vitamin B12 and folic acid appears to reduce homocysteine levels and may reverse this blood vessel dysfunction.

William G. Christen, Sc.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a randomized, double-blind clinical trial involving 5,442 women age 40 and older who already had heart disease or at least three risk factors. Of these, 5,205 did not have AMD at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid (2.5 milligrams per day), pyridoxine hydrochloride (vitamin B6, 50 milligrams per day) and cyanocobalamin (vitamin B12, 1 milligram per day). Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that were visually significant (resulting in a visual acuity of 20/30 or worse). Of these, 55 AMD cases, 26 visually significant, occurred in the 2,607 women in the active treatment group, whereas 82 of the 2,598 women in the placebo group developed AMD, 44 cases of which were visually significant. Women taking the supplements had a 34 percent lower risk of any AMD and a 41 percent lower risk of visually significant AMD. "The beneficial effect of treatment began to emerge at approximately two years of follow-up and persisted throughout the trial," the authors write.

"The trial findings reported herein are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention," the authors write. Because they apply to the early stages of disease development, they appear to represent the first identified way-other than not smoking-to reduce the risk of AMD in individuals at an average risk. "From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans."

Feb 24
Short-Term Memory Decoded With FMRI
People voluntarily pick what information they store in short-term memory. Now, using functional magnetic resonance imaging (fMRI), researchers can see just what information people are holding in memory based only on patterns of activity in the brain.

Psychologists from the University of Oregon and the University of California, San Diego, reported their findings in the February issue of Psychological Science. By analyzing blood-flow activity, they were able to identify the specific color or orientation of an object that was intentionally stored by the observer.

The experiments, in which subjects viewed a stimulus for one second and held a specific aspect of the object in mind after the stimulus disappeared, were conducted in the UO's Robert and Beverly Lewis Center for Neuroimaging. In 10-second delays after each exposure, researchers recorded brain activity during memory selection and storage processing in the visual cortex, a brain region that they hypothesized would support the maintenance of visual details in short-term memory.

"Another interesting thing was that if subjects were remembering orientation, then that pattern of activity during the delay period had no information about color, even though they were staring at a colored-oriented stimulus," said Edward Awh, a UO professor of psychology. "Likewise, if they chose to remember color we were able to decode which color they remembered, but orientation information was completely missing."

Researchers used machine-learning algorithms to examine spatial patterns of activation in the early visual cortex that are associated with remembering different stimuli, said John T. Serences, professor of psychology at UC-San Diego. "This algorithm," he said, "can then be used to predict exactly what someone is remembering based on these activation patterns."

Increases in blood flow, as seen with fMRI, are measured in voxels -- small units displayed in a 3-D grid. Different vectors of the grid, corresponding to neurons, respond as subjects view and store their chosen memories. Based on patterns of activity in an individual's visual cortex, located at the rear of the brain, researchers can pinpoint what is being stored and where, Awh said.

The study is similar to one published this month in Nature and led by Vanderbilt University neuroscientist Frank Tong and colleagues, who were able to predict with 80-percent-plus accuracy which patterns individuals held in memory 11 seconds after seeing a stimulus.

"Their paper makes a very similar point to ours," Awh said, "though they did not vary which 'dimension' of the stimulus people chose to remember, and they did not compare the pattern of activity during sensory processing and during memory. They showed that they could look at brain activity to classify which orientation was being stored in memory."

What Awh and colleagues found was that the sensory area of the brain had a pattern of activity that represented only an individual's intentionally stored aspect of the stimulus. This voluntary control in memory selection, Awh said, falls in line with previous research, including that done by Awh and co-author Edward K. Vogel, also of the UO, that there is limited capacity for what can be stored at one time. People choose what is important and relevant to them, Awh said.

"Basically, our study shows that information about the precise feature a person is remembering is represented in the visual cortex," Serences said, "This is important because it demonstrates that people recruit the same neural machinery during memory as they do when they see a stimulus."

Feb 24
Mail And Electronic Reminders May Increase Colon Cancer Screening
In addition, electronic reminders to physicians appear to increase screening among patients with more frequent primary care visits.

"Colorectal cancer is the secondary leading cause of cancer mortality [death] in the United States," according to background information in the article. "Screening programs involving fecal occult blood testing, flexible sigmoidoscopy and colonoscopy lower the incidence of colorectal cancer by removing precancerous adenomas, detect cancers at more curable early stages and reduce colorectal cancer mortality." Although national guidelines suggest that average-risk adults age 50 and older should be screened for colorectal cancer, only 60 percent report up-to-date testing.

Thomas D. Sequist, M.D., M.P.H., of Brigham and Women's Hospital, Harvard Vanguard Medical Associates and Harvard Medical School, Boston, and colleagues studied screening rates and colorectal adenoma (tumor) detection for 21,860 patients (age 50 to 80) of 110 physicians from April 2006 to June 2007. Fifty-five physicians were randomly assigned to receive electronic reminders during office visits with patients overdue for screening. Additionally, 10,930 patients were randomly assigned to receive mailings containing an educational pamphlet, a fecal occult blood test kit and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy. Screening rates and detection of colorectal adenomas (tumors) were noted 15 months after the start of the intervention.

Screening rates for patients who received mailings were higher than for those who did not (44 percent vs. 38.1 percent). The mailings were more effective among older patients - patients age 50 to 59 experienced a 3.7 percent increase, patients age 60 to 69 had a 7.3 percent increase and patients age 70 to 80 experienced a 10.1 percent increase in screening rates. While patients of physicians receiving electronic reminders had screening rates similar to patients of physicians who did not receive reminders (41.9 percent vs. 40.2 percent), electronic reminders tended to increase screening rates among patients with three or more primary care visits (59.5 percent vs. 52.7 percent).

"Detection of adenomas tended to increase with patient mailings (5.7 percent vs. 5.2 percent) and physician reminders (6 percent vs. 4.9 percent)," the authors write, but these increases were not statistically significant.

"Patient mailings produced modest increases in rates of colorectal cancer screening, whereas electronic physician reminders tended to promote screening only among patients who have more frequent primary care visits," they conclude. "These complementary approaches have the potential to promote the overarching goal of widespread screening to reduce the incidence, morbidity and mortality of colorectal cancer."

Feb 24
Calcium Associated With Lower Risk Of Cancer In Women
Women with higher intake of calcium appear to have a lower risk of cancer overall, and both men and women with high calcium intakes have lower risks of colorectal cancer and other cancers of the digestive system.

Calcium is known to benefit bone health, according to background information in the article. Because of this, the Institute of Medicine recommends 1,200 milligrams of calcium for adults age 50 and older, and the 2005 dietary guidelines for Americans recommend 3 cups per day of low-fat or fat-free dairy products. Studies of dairy products, calcium intake and cancer have revealed different results for different cancer sites.

Yikyung Park, Sc.D., of the National Cancer Institute, Bethesda, Md., and colleagues analyzed data from 293,907 men and 198,903 women who participated in the National Institutes of Health-AARP Diet and Health Study. Participants took a food frequency questionnaire when they enrolled in the study between 1995 and 1996, reporting how much and how often they consumed dairy and a wide variety of other foods and whether they took supplements. Their records were then linked with state cancer registries to identify new cases of cancer through 2003.

Over an average of 7 years of follow-up, 36,965 cancer cases were identified in men and 16,605 in women. Calcium intake was not associated with total cancer in men but was in women-the risk decreased in women with intake of up to 1,300 milligrams per day, after which no further risk reduction was observed.

"In both men and women, dairy food and calcium intakes were inversely associated with cancers of the digestive system," the authors write. The one-fifth of men who consumed the most calcium through food and supplements (about 1,530 milligrams per day) had a 16 percent lower risk of these types of cancer than the one-fifth who consumed the least (526 milligrams per day). For women, those in the top one-fifth of calcium consumption (1,881 milligrams per day) had a 23 percent lower risk than those in the bottom one-fifth (494 milligrams per day). The decreased risk was particularly pronounced for colorectal cancer. Calcium and dairy food intake was not associated with prostate cancer, breast cancer or cancer in any other anatomical system besides the digestive system.

"Dairy food, which is relatively high in potentially anticarcinogenic nutrients such as calcium, vitamin D and conjugated linoleic acid, has been postulated to protect against the development of colorectal and breast cancer," the authors write. Calcium has been shown to reduce abnormal growth and induce normal turnover among cells in the gastrointestinal tract and breast. In addition, it binds to bile and fatty acids, potentially reducing damage to the mucous membrane in the large intestine.

Feb 24
Child Abuse Causes Lifelong Changes To DNA Expression And Brain
A study led by researchers in Canada who analysed post mortem brain samples of suicide victims with a history of being abused in childhood found changes in DNA expression that were not present in suicide victims with no childhood abuse history or in people who died of other causes. The affected DNA was in a gene that regulates the way the brain controls the stress response.

The research was the work of scientists from the Douglas Mental Health University Institute and McGill University in Montreal, Quebec, and the Singapore Institute for Clinical Sciences and was published online on 22 February in Nature Neuroscience.

Previous studies have shown that child abuse or neglect changes the hormonal stress response and increases the risk of suicide in the victim. Animal studies show that maternal care can influence the expression of genes that control the stress response.

In this study the researchers looked at samples of the hippocampus from human suicide victims with a history of childhood abuse. The hippocampus is a region of the brain that plays a key role in regulating the stress response.

They found changes in expression of the NC3R1 gene that were not present in suicide victims with no history of being abused in childhood. The changes weren't present in people who had died of other causes either.

For the study the researchers used samples from 36 brains: 12 came from suicide victims who had been abused as children, 12 came from suicide victims who had no such history, and 12 came from people who had died of other causes (the controls).

The researchers found that the child abuse victims had different "epigenetic" markings in a part of the brain that influences the hypothalamic-pituitary-adrenal (HPA) function, a stress-response that increases suicide risk.

This finding builds on an earlier study published in May last year that showed how child abuse can leave "epigenetic" marks on DNA.

Epigenetics studies the way that DNA is expressed: that is when the code behaves in a way that is not exactly what the DNA program says. DNA itself, the fundamental code, is inherited from the person's biological parents and remains fixed through a person's lifetime.

But the genes in the DNA are coated with a layer of chemicals called DNA methylation. These chemicals influence how the DNA is interpreted and they can be affected by changes in the environment, especially in early life such as when the new embryo is made, in the womb, and then later in childhood.

Co-author Dr Gustavo Turecki, associate professor in the Department of Psychiatry at McGill University and who practices at the Douglas Mental Health University Institute, said:

"We know from clinical experience that a difficult childhood can have an impact on the course of a person's life."

"Now we are starting to understand the biological implications of such psychological abuse", added fellow co-investigator Moshe Szyf, a professor in the Department of Pharmacology and Therapeutics at McGill.

The interaction between environment and DNA plays a key role in our ability to resist and deal with stress and this affects the risk of suicide, said the researchers. Epigenetic marks are the product of DNA and environment.

The researchers found that different types of care from the mothers changed the hypothalamic-pituitary-adrenal (HPA) function in rats by altering the receptors in the brain. In earlier studies they showed that simple behaviours such as when mothers licked their baby rats in early life had a significant effect on epigentic markings on specific genes that affected behaviour throughout the offsprings' lives.

But they also found that these epigenetic marks can be changed in adulthood with treatments that change the DNA coating: the treatment is called DNA methylation and it reverses the change to the stress response.

Feb 22
Surprising Behavior Of Teens Shown In New IPod Listening Study
A new study involving iPods and teenagers by the University of Colorado at Boulder and Children's Hospital Boston indicates teenagers who receive pressure from their peers or others to turn down the volume of their iPods instead turn them up higher.

The study also showed that teen boys listen louder than teen girls, and teens who express the most concern about the risk for and severity of hearing loss from iPods actually play their music at higher levels than their peers, said CU-Boulder audiologist and doctoral candidate Cory Portnuff, who headed up the study. Such behaviors put teens at an increased risk of music-induced hearing loss, he said.

The results of the study, conducted by Portnuff and Associate Professor Kathryn Arehart of CU-Boulder's speech, language and hearing sciences department and Brian Fligor, director of diagnostic audiology at Children's Hospital Boston, were presented at the annual Hearing Conservation Conference held in Atlanta last week. Children's Hospital Boston is the teaching hospital of Harvard Medical School.

Other findings from the study indicated teens play their music louder than young adults, and teens may inaccurately perceive how loud they are playing their music. The good news, said Portnuff, is that teens in the study who understand the benefits of listening at a lower volume have less of a risk for hearing loss.

"We really don't a have good explanation for why teens concerned about the hearing loss risk actually play their music louder than others," he said. "But we do know that teens who knew what the benefits were of listening at lower levels had less hearing loss risk, which is why we believe targeted education is the key."

Portnuff said the new study indicated a relatively small percentage of teens -- somewhere between 7 and 24 percent -- listen to their iPods and MP3 players at risky levels. "We don't seem to be at an epidemic level for hearing loss from music players," Portnuff said.

The new findings regarding the sound volumes selected by music-playing teens today are similar to findings 20 years ago when Walkman audio cassette players first came onto the market, Portnuff said. "One of the concerns we have today is that while Walkmans back then operated on AA batteries that usually began to run down after several hours, teenagers today can listen to their iPods for up to 20 hours without recharging them."

A 2006 study by Portnuff and Fligor indicated a typical person can safely listen to an iPod for 4.6 hours per day at 70 percent volume using stock earphones. But listening to music at full volume for more than five minutes a day using stock earphones increased the risk of hearing loss in a typical person, according to the study.

The 2006 study also concluded that individuals can safely listen to iPods for 90 minutes a day with stock earphones if the volume is at 80 percent of maximum levels without greatly increasing the risk of hearing loss, he said.

Loud music can potentially damage delicate hair cells in the inner ear that convert mechanical vibrations, or sound, to electrical signals that the brain interprets as sound, said Portnuff. "Over time, the hair cells can become permanently damaged and no longer work, producing hearing loss."

Feb 22
For The First Time, Doctors Can Predict Which Hepatitis B Patients Have The Highest Chance To Achiev
New data presented showed that, for the first time, doctors can predict which hepatitis B patients treated with Pegasys (peginterferon alfa-2a) have the highest chance to achieve a positive treatment outcome and even a clinical cure1,2. The study results represent an important step forward, as some patients will now be able to feel confident during their Pegasys treatment about the likelihood of beating the disease.

Several studies at the major Asia-Pacific liver disease meeting (APASL) focused on measuring the decline in levels of a viral protein called surface or 's'-antigen, to provide insight into the likelihood of treatment success for patients treated with Pegasys. S-antigen clearance, considered a clinical cure, is associated with greatly reduced liver cancer, cirrhosis and an improved life expectancy3,4,5.

'In treating hepatitis B, we need to change mindsets and raise expectations so that patients and physicians are focused on achieving the best possible outcome clearance of the s-antigen. These new data show that measuring s-antigen decline throughout treatment can help determine success in the long-term. Doctors can now therefore make a strong case to certain patients that Pegasys treatment may provide treatment success or even a clinical cure,' said Dr Patrick Marcellin, Professor of Hepatology at the University of Paris and Head of the Viral Hepatitis Research Unit in Hôpital Beaujon, Clichy, France.

'Unlike anti-viral tablets for hepatitis B, which just reduce the number of viral copies, Pegasys also boosts the body's immune system and mobilises it to fight the disease,' commented William M. Burns, CEO Roche Pharmaceuticals Division. 'Due to these immune-stimulating effects, the number of patients treated with Pegasys who achieve a clinical cure has been shown to continue increasing for years after the end of treatment. This supports its use as a first-line therapy for hepatitis B.' Measuring success with Pegasys in the two types of hepatitis B

There are two types of patients with hepatitis B: those with early disease who still have the envelope or 'e'-antigen in their blood, and those who do not (called 'e-positive' and 'e-negative' disease, respectively). Although some of the treatment endpoints are different, s-antigen clearance is the ultimate goal of therapy in both types of hepatitis B.

All patients start off with e-positive disease. For e-positive patients, loss of the e-antigen after treatment, or 'e-seroconversion', signifies that therapy has worked well, and is a first important indicator of treatment success. In a new study looking at e-positive patients, the results showed that 50% of patients whose s-antigen levels dropped significantly 24 weeks after starting Pegasys treatment were able to achieve 'e-seroconversion', an important treatment endpoint for these patients. Furthermore, approximately 20% of the patients with e-seroconversion went on to achieve s-antigen clearance, a so-called 'clinical cure', six months after treatment had ended.2

In some patients, after many years of infection, the virus mutates and no longer produces the e-antigen; these patients are considered e-negative. In this form of the disease, the virus evades the body's immune system so that the infection and liver damage return.

According to another new study presented at APASL, the number of e-negative hepatitis B patients who achieved a clinical cure continued to increase, even after the end of treatment with Pegasys.1 At year five, 12.2% of Pegasys-treated patients had cleared s-antigen, compared with just 3.5% of lamivudine-treated patients. Whilst modest, the number of patients who achieve s-antigen clearance on Pegasys therapy is a breakthrough because such high rates of s-clearance have never been shown with an oral anti-viral.1 Furthermore, researchers observed that s-antigen decline during treatment was associated with the achievement of a clinical cure.1

Feb 21
Discovery Boosts Cancer Radiation Therapy Effectiveness
Dr. Gino Fallone and his team of medical physicists at the Cross Cancer Institute in Edmonton are the first in the world to successfully take a magnetic resonance (MR) image at the same time radiation therapy is being delivered.

This discovery has the potential to increase the likelihood of tumour control by an estimated 20 to 40 per cent. The discovery also makes radiation therapy more accessible for cancers difficult to treat with radiation because of organ movement, such as liver, stomach and pancreatic cancers.

Fallone, the director of medical physics at the Cross Cancer Institute and professor of oncology at the University of Alberta says: "We were told by some that it couldn't be done." Mutual interferences (magnetic and radio frequency fields) make the linear accelerator (linac) and the MR systems "allergic" to each other, an obstacle previously thought to be insurmountable.

"However, we've now proved our design principle and can proceed to developing a larger (whole body system) prototype and eventually to clinical trials," says Fallone.

Dr. Fallone and his team are the first to develop and build a prototype linac-MR hybrid (head system) that has successfully taken MR images of objects while linac radiation is being delivered. The prototype gives the ability to guide the curative radiation to the tumour at the same time the image is being taken.

Current state-of-the-art equipment allows for a CT snapshot moments before delivering the radiation. Fallone says it is like relying on blurry snapshot that does not capture soft tissue well. The linac-MR prototype provides clear video images, including soft tissue, and allows one to guide radiation in real time to the tumour.

The prototype will also minimize the need to radiate a margin of healthy tissue, currently required to ensure the entire tumour has been treated and will allow for a higher dose of radiation.

Feb 21
New Laparoscopic Technique Uses Only One Incision
The umbilical cord is the gateway for nourishment to babies in the womb. Now the remnants of that gateway can serve as a convenient exit ramp for unwanted tumors and organs.

S. Duke Herrell, M.D., associate professor of Urologic Surgery, has performed Vanderbilt Medical Center's first kidney removal through a single laparoscopic incision in a patient's navel.

The patient, who has renal failure and needs a kidney transplant, had a cancerous tumor in one kidney. The kidney had to be removed to make the patient eligible for a transplant.

"We were able to go in through a single 5 cm (approximately two inches) incision around the umbilicus and take her kidney out intact," said Herrell, who is director of Minimally Invasive Urologic Surgery and Robotics. "Five centimeters sounds like a big incision but there is a lot of skin in the umbilicus, so you can hide the incision in those folds."

This new form of belly button surgery is also known as LESS, or laparoendoscopic single-site surgery. What makes this approach unique is that the camera and all of the laparoscopic instruments go through a single small incision.

This feature is simultaneously responsible for the increased benefit to the patient and increased challenge for the surgeon. In addition to a single small scar, patients may also experience faster recovery times. Herrell's patient went home the next day.

"We have been working on the idea of trying to make the entry into the body less invasive for quicker healing and less scarring," Herrell explained. "We have gone from big open incisions to smaller incisions, including laparoscopy and robotics, and now to this single port access through the navel. The progression of that is where it gets interesting."

In normal laparoscopic surgery, three to five small incisions are made around the abdomen and tubes or trocars are placed in the incisions.

Then the laparoscopic instruments, including a camera, are inserted through the tubes and the surgeon triangulates the instruments to cut and suture tissue. But putting the same instruments into a single small space around the navel is much trickier.

"You're bringing all of these instruments through access points that are close together so they tend to clash," said Herrell. "As a surgeon, you need a lot of experience in laparoscopic surgery and you must be able to think three-dimensionally so you can manipulate things without clashing and still perform the procedure safely."

Ted Anderson, M.D., Ph.D., director of the Division of Gynecology, just performed his first LESS procedure on a patient with a 9 cm endometrioma, a benign cystic mass of the ovary.

Anderson removed the patient's entire right ovary through a single 2.5 cm incision in the navel.

"Another surgeon proposed making a midline incision from her belly button down to her pubic bone," said Anderson. "But she was facing a monthlong recovery."

Instead, Anderson's patient opted for a single incision in the navel for a chance at a faster recovery.

Feb 19
Chronic Bronchitis Among Non-Smokers In China
A vast study on over 20,000 people in China demonstrates the significant role of so-called indoor air pollution, particularly smoke from coal or wood fires in kitchens. Its results are published today in the online edition of the ERJ, the scientific publication of the European Respiratory Society (ERS).

COPD (Chronic Obstructive Pulmonary Disease), which includes chronic bronchitis and emphysema, represents a major global public health problem. While this severe respiratory condition is known to be caused mainly by smoking, which is very widespread in China, it is far from rare among non-smokers. Indeed, as shown by this study in the European Respiratory Journal (ERJ), over a third of Chinese COPD patients (38.6%) have never touched a cigarette!

The prevalence of COPD among non-smokers varies widely from one country to another: from only about 6% in Mexico City, it rises to 9% in the USA and nearly 16% in Santiago de Chile. This range points clearly to important differences in lifestyle, behaviour and exposure to various toxic substances.

It was precisely in order to identify COPD risk factors among non-smokers in China that Pixin Ran (University Hospital of Guangzhou, Guangdong, China) decided to undertake, with his team, a vast study on the basis of a known cohort of Chinese COPD sufferers. The cohort (known as CESCOPD), established between 2002 and 2004, was recruited in seven Chinese provinces with a total population of over 230 million people in rural and urban areas.

From 20,245 subjects aged over 40, interviewed and examined by spirometry, the team analysed the data of 12,471 non-smokers and 1,024 smokers with COPD. The selected volunteers completed a detailed questionnaire on their smoking habits, personal and familial antecedents of respiratory disease, and the presence of respiratory symptoms, especially chronic cough. They were also questioned about their lifestyle, especially exposure to smoke from solid fuels (mainly wood and coal, but also grass and dung) used for heating and cooking. The COPD diagnosis was duly established using spirometry with bronchodilation tests.

Kitchen smoke a major suspect

The groundbreaking results published in the ERJ will shed new light on the characteristics of COPD in China. Pixin Ran shows, firstly, that a third of COPD cases (38.6%) are unconnected with tobacco, and 5.2% of affected non-smokers have COPD. Importantly, though, the respiratory disease was found to have a very different profile among the non-smokers. By adjusting all of the variables, Pixin Ran and his team are able to conclude that exposure to various types of smoke in the home (coal, biomass etcŠ), is a leading cause of COPD in non-smokers. Passive smoking naturally plays a part, but on a comparable level to inadequate ventilation of the kitchen.

The Chinese study shows that almost half of the non-smokers (44.6%) had been exposed, for at least one year, to smoke from the burning of biomass for cooking, and 73.2% had been exposed to smoke from coal used for heating or cooking. Poor kitchen ventilation was an aggravating factor in four out of ten cases. This is a matter of no small importance: the researchers found that not only women are harmed by cooking smoke. Men, who had been exposed to it, also pay a heavy price. Furthermore, the authors of the ERJ article report that nearly four-fifths of the Chinese non-smokers (78.2%) had lived with tobacco fumes. While it is already common knowledge that children of smoking parents are more likely to suffer from respiratory disease when they reach adulthood, the problem seems particularly acute in China, where nearly 40% of adults smoke, a much higher proportion than in many European countries.

Prevention is possible

This original Chinese study also reveals other important factors. Pixin Ran and his colleagues emphasise, for example, that COPD is commoner among older men and those with lower educational attainment, or with family or personal antecedents of respiratory disease. A low body mass index (BMI) is also statistically associated with COPD. However, occupational exposure to fumes or dust was not identified as an independent risk factor among non-smokers. The relative significance of the different parameters also varied slightly according to the stage of development of the respiratory condition.

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