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Mar 05
Only Exercise Prevents Low-Back Problems: Clinical Trials' Review
Low-back pain continues to impose a huge burden on industrialized societies, in terms of symptoms, medical costs, productivity, and work absence. Annual costs related to back pain in the United States alone may run as high as $100 billion per year.

But a systematic review of the literature for high-quality scientific trials published in the February issue of The Spine Journal finds exercise in workplace and community settings effective in preventing new episodes of low-back problems. "Strong and consistent evidence finds many popular prevention methods to fail while exercise has a significant impact, both in terms of preventing symptoms and reducing back pain-related work loss," said Dr. Stanley J. Bigos, University of Washington professor emeritus of orthopaedic surgery and environmental health.

Bigos and his colleagues assessed methodological quality and potential for bias of clinical trials in preventing episodes of back problems. The researchers found 20 controlled trials to be high-quality according to Cochrane Collaboration Back Review Group criteria. Seven of the eight high-quality trials promoting various exercise programs were found effective, but other common and popular methods failed including: reduced lifting programs, back or ergonomic educational interventions, lumbar supports, shoe inserts and stress management.

"Passive interventions such as lumbar belts and shoe inserts do not appear to work," Bigos said. "And eight trials found ergonomic interventions, of either reducing lifting, or back or ergonomic training sessions to be ineffective in preventing back problems."

The new review does not, however, discredit popular ergonomic innovations, said Dr. John Holland, a co-author and UW clinical professor of environmental and occupational health sciences. "Ergonomic interventions may increase productivity, product quality, and work comfort. There are many reasons why such research should continue," said Holland.

The authors suggest that due to the varied and unreliable results of lower quality studies, resources for prevention of back problems should be devoted to interventions already found to be effective in high-quality trials, or to support well-designed research to investigate promising new approaches.

"The new review also supports one additional important conclusion. Ten years ago, some critics suggested we rely upon lower level studies. They maintained that it was not possible to perform high-quality clinical trials on preventive interventions for low-back problems in the workplace. However, our review demonstrates the viability of the growing number of high-quality trials providing more reliable evidence to guide back problem prevention efforts," said Bigos.

Bigos chaired the Acute Low Problems in Adults, the world's first major set of evidence-based clinical guidelines on the management of low-back problems, published by the U.S. Department of Health and Human Services' Agency for Healthcare Policy and Research, now known as the Agency for Healthcare Research and Quality.

Mar 05
Fertility Doctor Withdraws Designer Baby Offer
After the uproar caused by his offer to let parents choose traits like eye and hair colour when selecting embryos for implanting, fertility specialist Dr Jeff Steinberg said on Tuesday that his clinics will only be offering parents the facility to screen embryos on medical grounds, such as genetic diseases.

Steinberg, who has clinics in Los Angeles and Manhattan, said that a story published on Monday in the New York (NY) Daily News about his plan to let parents choose physical traits, even for cosmetic reasons, led to a flood of calls. He is now saying they are not going to do that and will be focusing on families with a history of genetic diseases like albinism and colour blindness instead.

Until Monday, his clinic's website showed an announcement that they were planning to offer "predictive genomics" that would allow parents to have embryos screened for "eye color, hair color, cancer tendency and more", said the NY Daily News.

Steinberg pioneered IVF in the 1970s, and predicts that a trait-selected baby will be born next year, said a BBC News report.

His clinics already offer sex selection, and a mother who underwent treatment at the NYU Fertility Center to select the gender of her third baby defended the service. She told the NY Daily News on Tuesday that:

"When you have two of the same, it's awesome and amazing, but when you have one of the other, too, it's just different."

Some experts are annoyed that the controversy over this issue will distract people from how the same science, called preimplantation genetic diagnosis or PGD, can be used to prevent inherited diseases from being passed on.

PDG takes a cell from the embryo before it is implanted in the womb and screens it for so called "rogue" genes. The same procedure can be used to screen for cosmetically desirable traits such as eye and hair colour. An embryo with the desirable traits is then selected for implantation while those that don't have them are discarded.

Steinberg told the media that he did not think this was a dangerous road but rather an uncharted one.

Josephine Quintavalle of Comment on Reproductive Ethics told the BBC that:

"This is the inevitable slippery slope of a fertility process which results in many more embryos being created than can be implanted."

Steinberg said the technology has been around for years and it was "time for everyone to pull their heads out of the sand".

Another UK fertility expert, Dr Gillian Lockwood who sits on the ethics committee of the Royal College of Obstetricians and Gynaecologists cautioned that offering such services will turn babies into "commodities that you buy off the shelf".

"If it gets to the point where we can decide which gene or combination of genes are responsible for blue eyes or blonde hair, what are you going to do with all those other embryos that turn out like me to be ginger with green eyes?" she said to the BBC.

Mar 05
HIV Rates Surprisingly High In The Over 50s
A new report suggests that HIV infection and prevalence rates are surprisingly high among older people, who seem to have been completely ignored by research and surveillance, perhaps because we don't assume they are at risk. However this also means that many cases of HIV among the over 50s go undiagnosed. The authors said more research is needed to identify the risk factors for HIV infection among older people.

These are the conclusions of scientists working for and on behalf of the World Health Organization (WHO) whose findings were published in the Bulletin of the World Health Organization earlier this week.

There is little data on how many people over the age of 50 are infected with HIV (ie prevalence), as this age group is rarely included in health surveys.

Data on HIV incidence rates among older people is also scarce (incidence is new cases per year whereas prevalence is how many people have a disease).

While developing countries have limited case reporting systems, the authors wrote that as far as identifying HIV rates in older people, industrialized countries aren't much better. However, what data there is suggests incidence of HIV in older people is rising, mostly from information gathered in the US.

To start shining some light in this rather dark corner of our public health awareness, the authors calculated incidence and prevalence of HIV among older people using what information they could get hold of.

For example, using the UNAIDS estimate of HIV cases and population numbers by country, they found a consistent pattern: HIV prevalence in people aged 50 and over was between 25 and 33 per cent of that among people aged 15 to 49.

The authors wrote that after some debate, most of them decided this was a surprising finding.

Figures from Africa show that in many regions, a second peak of HIV incidence appears in the older age group.

When the authors looked in the literature for explanations of how older people become infected with HIV they found only one small study.

We know very little about the sexual habits of older people in the developing world. There is some evidence that many older people throughout the world are sexually active, although interest and frequency of vaginal intercourse does wane with age, wrote the authors.

Much research shows that older people are less likely to practise safe sex compared to younger age groups, and there is some evidence from industrialized countries that use of erectile dysfunction drugs is linked to risky sexual behaviour, and there have been debates about whether men who are HIV-positive should be given these drugs.

If the scant data is to be believed, and the main cause of HIV infection in older people is sex, but they are not having intercourse as frequently, then this suggests older people are more vulnerable to the virus: their chance of becoming infected each time they have sex is much higher than for their younger couterparts.

One biological reason could be that the wall of the vagina gets thinner as women get older, making it easier for the virus to get into the bloodstream.

However, the authors emphasized that while sexual activity was probably the most likely way, more research was needed to find out the relative risks of the different ways older people acquire HIV.

There is however, a consistent failure among health professionals to consider HIV as a cause of illness among older patients, said the researchers.

Older people diagnosed with HIV progress to AIDS much faster, and this could be partly because of age but also because they are not diagnosed as early as their younger counterparts, who are also more likely to be screened for the virus.

Mar 05
People Drink More Alcohol When They See It On TV
A new Dutch and Canadian study of young men's drinking behaviour while watching an hour of TV (a movie clip with advert breaks) found that, compared to those who did not see much alcohol portrayed on screen, those who saw alcohol portrayed frequently, on average consumed 1.5 more 200 ml bottles of alcoholic beverage.

The study was the work of scientists from the Behavioural Science Institute at Radboud University Nijmegen and the Research Centre for Adolescent Development in Utrecht University, both in The Netherlands, and colleagues from the Department of Psychology at Queen's University in Kingston, Ontario. It was published for online access on 4 March in the Oxford University Press journal Alcohol and Alcoholism.

First author Rutger Engels, professor in developmental psychopathology at the Behavioural Science Institute, Radboud University Nijmegen said that:

"This is the first experimental study to show a direct effect of exposure to alcohol portrayals on TV on viewers' immediate drinking behaviour."

In their background information the researchers described how movies and adverts generally put alcohol in a positive light and the assumption is that this encourages young people to drink it. So they decided to set up an experiment to test it.

They designed a naturalistic setting (which they described as a "bar lab") where friendship pairs of young men could watch a movie "home cinema" style for 1 hour, including 2 commerical breaks. While they did this they had access to a fridge filled with alcoholic and soft drinks. The idea was to replicate an observable version home-based TV viewing.

The researchers recruited 80 male university students aged from 18 to 29 and randomly assigned them to one of four groups (20 in each group), characterized by the frequency with which alcohol was portrayed in the movie and the commercial breaks:

1. Movie and adverts with many positive portrayals of alcohol. The film was American Pie, and the participants saw 18 instances of characters drinking alcohol and 23 other instances where alcoholic drinks were shown. The commercial break also included adverts for alcoholic drinks.

2. Movie with many and adverts with no positive portrayals of alcohol. The film for this group was also American Pie with the same exposure as in group 1, but the commercial breaks showed no adverts for alcohol.

3. Movie with few and adverts with many positive portrayals of alcohol. The film was 40 Days and 40 Nights during which the participants only saw characters consume alcohol in 3 instances and there were 15 other instances when alcoholic drinks were shown. The commercial break also included adverts for alcohol.

4. Movie with few and adverts with no positive portrayals of alcohol. The film for this group was also 40 Days and 40 Nights and the commercial break had no adverts for alcohol.

The results showed that:

* Over the period of an hour, the young men in group 1, who watched the film with many positive portrayals of alcohol, together with commerical breaks containing adverts for alcohol, consumed an average of nearly three 200 ml bottles of alcoholic beverage.

* The young men in group 4, who watched a film with few positive portrayals of alcohol and saw no adverts for alcohol only drank an average of 1.5 bottles of alcoholic beverages in an hour.

* The most alcohol anyone consumed was 4 bottles and the least was none.

The researchers concluded that this study is the first to show that there is a "causal link between exposure to drinking models and alcohol commercials on acute alcohol consumption".

Engels said the study clearly showed that portraying alcohol in films and adverts not only influenced people's attitudes about drinking within a culture or society, but might also have a direct effect on behaviour, such as triggering a craving in people who already consume alcohol.

"While watching an ad for a particular brand of beer, you are not only more prone to buy that brand next time you are in the supermarket, but also that you might go immediately to the fridge to take a beer," Engels suggested.

The researchers said if their findings are replicated in other studies this should be a wake up call for policymakers, inasmuch as:

"If moderation of alcohol consumption in certain groups is strived for, it may be sensible to cut down on the portrayal of alcohol in programmes aimed at these groups and the commercials shown in between."

Another implication, they wrote, may be that:

"In situations in which this is possible (eg cinemas), availability of alcohol should be reduced when movies and commercials contain alcohol portrayal and individuals in a group at risk for problematic drinking are present."

Mar 02
Socioeconomic Inequities In Lung Cancer Incidence Partially Explained By Smoking Behavior
Europeans with the least education have a higher incidence of lung cancer compared with those with the highest education. However, smoking history accounts for approximately half of this risk, according to a study in the February 24 online issue of the Journal of the National Cancer Institute.

Previous studies showed that individuals with a lower socioeconomic status have a higher risk for developing lung cancer. Some studies have also suggested that some of the excess risk of lung cancer is due to smoking.

To further investigate the contribution of smoking to the discrepancy in lung cancer incidence, Gwenn Menvielle, Ph.D., and colleagues examined the association of smoking, diet, education, and lung cancer in 391,251 individuals in the European Prospective Investigation into Cancer and Nutrition study. Menvielle, who conducted the research in The Netherlands at the National Institute for Public Health and the Environment, Bilthoven, and the department of public health of the Erasmus MC, Rotterdam, is now at the Institut National de la Santé et de la Recherche Médicale in Villejuif, France.

The researchers used participants' highest level of education achieved as an indicator of socioeconomic status and had smoking and diet information from questionnaires completed at study entry.

With a mean follow-up time of 8.4 years, 939 men and 692 women were diagnosed with lung cancer. Men with the lowest education had a 3.62-fold increased risk of lung cancer compared with men with the highest education. Women with the lowest education had a 2.39-fold increased risk compared with women with the highest education. The association between education and cancer risk was greatest in Northern Europe and Germany. When the researchers adjusted the risk models to account for smoking, the excess risk dropped by approximately half. Diet did not appear to contribute to the inequity in lung cancer risk between participants with lowest and highest education.

The authors state that while their model shows that smoking accounts for some of the discrepancy in lung cancer risk, they may not have yet accounted for the full impact of smoking. Therefore, some of the residual inequity in lung cancer risk associated with socioeconomic status may still be due to smoking behavior. Nonetheless, the new data suggest that other factors contribute to the inequality. "In future studies, other risk factors should be considered, perhaps in relation with smoking," the authors write. "However, we also observed that removing smoking would reduce the population health burden that is associated with social inequality in lung can¬cer considerably, in terms of number of cancers avoided. Therefore, public health policies aiming at reducing smoking rates, especially among persons with low education, are still strongly needed."

Mar 02
More Effort Needed To Prevent Mental, Emotional, And Behavioral Disorders In Young People
The federal government should make preventing mental, emotional, and behavioral disorders and promoting mental health in young people a national priority, says a new report from the National Research Council and Institute of Medicine. These disorders -- which include depression, anxiety, conduct disorder, and substance abuse -- are about as common as fractured limbs in children and adolescents. Collectively, they take a tremendous toll on the well-being of young people and their families, costing the U.S. an estimated $247 billion annually, the report says.

Research has shown that a number of programs are effective at preventing these problems and promoting mental health, the report says. Such programs could be implemented more broadly, but currently there is no clear federal presence to lead these efforts. The White House should create an entity that can coordinate agency initiatives in this area, set public goals for prevention, and provide needed research and funding to achieve them, said the committee that wrote the report.

"There is a substantial gap between what is known about preventing mental, emotional, and behavioral disorders and what is actually being done," said Kenneth E. Warner, committee chair and dean of the University of Michigan School of Public Health. "It is no longer accurate to argue that these disorders can never be prevented. Many can. The nation is well-positioned to equip young people with the skills and habits needed to live healthy, happy, and productive lives in caring relationships. But we need to develop the systems to deliver effective prevention programs to a far wider group of children and adolescents."

Most mental, emotional, and behavioral disorders have their roots in childhood and adolescence, the report notes. Among adults who have experienced these disorders, more than half report the onset as occurring in childhood or early adolescence. In any given year, an estimated 14 percent to 20 percent of young people have one of these disorders.

First symptoms typically occur two to four years before the onset of a full-blown disorder - creating a window of opportunity when preventive programs might make a difference, the report says. And some programs have shown effectiveness at preventing specific disorders in at-risk groups. For example, the Clarke Cognitive-Behavioral Prevention Intervention, which focuses on helping adolescents at risk for depression learn to cope with stress, has prevented episodes of major depression in several controlled experiments.

Other programs have demonstrated broader preventive effects in general populations of young people, the report says. Programs that can be offered in family or educational settings show particular promise in promoting mental health and addressing major risk factors.

One example of an effective school-based program is the Good Behavior Game, which divides elementary school classes into teams and reinforces desirable behaviors with rewards such as extra free time and other privileges. Studies have shown that the program significantly reduces aggressive and disruptive behavior during first grade. The one-year intervention also has benefits over the long term, lowering the students' risk of alcohol and drug abuse, as well as rates of suicidal thoughts and attempts. And it significantly reduces the likelihood that highly aggressive boys will be diagnosed with antisocial personality disorder as adults. Research has shown that programs that focus on enhancing social and emotional skills can also improve students' academic performance, the report notes.

Still other programs improve children's mental health and behavior by enhancing parenting skills, the report says. The Positive Parenting Program, for example, uses a range of approaches, from a television series on how to handle common child-rearing problems to in-person skills training for parents struggling to handle children's aggressiveness or lack of cooperation. These methods have been shown to lower kids' disruptive behaviors, a positive change that persisted one year later.

The report recommends that the White House create an entity to lead a broad implementation of evidence-based prevention approaches and to direct research on interventions. The new leadership body should set public goals for preventing specific disorders and promoting mental health and provide the funding to achieve them. The departments of Education, Justice, and Health and Human Services should align their resources and programs with this strategy. These agencies should also fund state, county, and community efforts to implement and improve evidence-based programs. At the same time, the report cautions, federal and state agencies should not support programs that lack empirical evidence, even if they have community endorsement.

The committee also urged continued research to build understanding of what interventions work for whom and when, and how best to implement them. The National Institutes of Health should develop a comprehensive 10-year plan to research ways to promote mental health and prevent mental, emotional, and behavioral disorders in young people. In addition, agencies and foundations should establish equality in research funding between ways to prevent mental and behavioral disorders and ways to treat these problems, the report says; currently, the balance is weighted toward research on treatment

Mar 02
Indoor Air Pollution Increases Asthma Symptoms
A study by researchers at Johns Hopkins University found an association between increasing levels of indoor particulate matter pollution and the severity of asthma symptoms among children. The study, which followed a group of asthmatic children in Baltimore, Md., is among the first to examine the effects of indoor particulate matter pollution. The results are published in the February 2009 edition of the journal Environmental Health Perspectives.

Particulate matter is an airborne mixture of solid particles and liquid droplets. The solid particles come in numerous shapes and sizes and may be composed of different chemical components. Fine particles measure 2.5 microns or less in size (approximately 1/30th the diameter of a human hair) and can penetrate deep into the body's respiratory system. Coarse particles fall between 2.5 and 10 microns in diameter. These larger particles can also enter the respiratory system and can be produced indoors through activities such as cooking and dusting. The U.S. Environmental Protection Agency (EPA) regulates outdoor levels of fine particle pollution, but does not have a standard for coarse particle pollution. There are no regulations for indoor pollution.

For the study, researchers from the Center for Childhood Asthma in the Urban Environment a joint center of the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins School of Medicine followed 150 asthmatic children, ages 2 to 6, for six months. Environmental monitoring equipment was used to measure the air in the child's bedroom for over three three-day intervals. Air measurements were taken at the beginning of the study, after 3 months and again after 6 months. Ninety-one percent of the children who participated in the study were African-American, from lower socioeconomic backgrounds, and spent most of their time indoors.

"We found that substantial increases in asthma symptoms were associated both with higher indoor concentrations of fine particles and with higher indoor concentrations of coarse particles," said Meredith C. McCormack, MD, MHS, lead author of the study and an instructor with the Johns Hopkins School of Medicine.

For every 10 micrograms per cubic meter of air (ug/m3) increase in indoor coarse particle concentration, there was a 6 percent increase in the number of days of cough, wheeze, or chest tightness, after adjusting for a number of factors. For every 10 ug/m3 increase in fine particles measured indoors, there was a 7 percent increase in days of wheezing severe enough to limit speech and after adjusting for various factors, a 4 percent increase in days on which rescue medication was needed. In many cases, the level of indoor fine particle pollution measured was twice as high as the accepted standard for outdoor pollution established by the EPA.

"Children spend nearly 80 percent of their time indoors, which makes understanding the effects of indoor air very important," said co-author, Gregory B. Diette, MD, an associate professor in the School of Medicine and co-director of the Center for Childhood Asthma in the Urban Environment.

"Improving indoor air quality and lowering indoor particulate matter concentrations may provide additional means of improving asthma health, especially for children living in inner cities," added co-author, Patrick Breysse, PhD, a professor in the Johns Hopkins Bloomberg School of Public Health and co-director of the Center for Childhood Asthma in the Urban Environment.

Mar 02
Research Shows Doodling Can Help Memory Recall
Doodling while listening can help with remembering details, rather than implying that the mind is wandering as is the common perception. According to a study published in the journal Applied Cognitive Psychology, subjects given a doodling task while listening to a dull phone message had a 29% improved recall compared to their non-doodling counterparts.

40 members of the research panel of the Medical Research Council's Cognition and Brain Sciences Unit in Cambridge were asked to listen to a two and a half minute tape giving several names of people and places, and were told to write down only the names of people going to a party. 20 of the participants were asked to shade in shapes on a piece of paper at the same time, but paying no attention to neatness. Participants were not asked to doodle naturally so that they would not become self-conscious. None of the participants were told it was a memory test.

After the tape had finished, all participants in the study were asked to recall the eight names of the party-goers which they were asked to write down, as well as eight additional place names which were included as incidental information. The doodlers recalled on average 7.5 names of people and places compared to only 5.8 by the non-doodlers.

"If someone is doing a boring task, like listening to a dull telephone conversation, they may start to daydream," said study researcher Professor Jackie Andrade, Ph.D., of the School of Psychology, University of Plymouth. "Daydreaming distracts them from the task, resulting in poorer performance. A simple task, like doodling, may be sufficient to stop daydreaming without affecting performance on the main task."

"In psychology, tests of memory or attention will often use a second task to selectively block a particular mental process. If that process is important for the main cognitive task then performance will be impaired. My research shows that beneficial effects of secondary tasks, such as doodling, on concentration may offset the effects of selective blockade," added Andrade. "This study suggests that in everyday life doodling may be something we do because it helps to keep us on track with a boring task, rather than being an unnecessary distraction that we should try to resist doing."

Mar 02
Researchers Solve Mystery Of Why Hair Turns Gray
A team of European scientists from the Universities of Bradford, Mainz and Luebeck have finally solved a mystery that has perplexed humans throughout the ages: why we turn gray.

Despite the notion that gray hair is a sign of wisdom, these researchers show in a research report published online in The FASEB Journal that wisdom has nothing to do with it. Going gray is caused by a massive build up of hydrogen peroxide due to wear and tear of our hair follicles. The hydrogen peroxide ends up blocking the normal production of melanin, our hair's natural pigment. Melanin is the pigment responsible for hair color, as well as skin color, and eye colour.

The researchers made this discovery by examining native hair and cells isolated from human hair follicles. They found that the reduction in melanin production was the result of a complex series of events involving four different enzymes in the hair follicle cells.

Firstly, the build up of hydrogen peroxide in the hair was caused by a reduction in an enzyme (called catalase) that normally breaks up hydrogen peroxide into water and oxygen and gets rid of it. They also discovered that because of low levels of other enzymes (called repair enzymes A and B) the hair follicles could not repair the damage caused by the build up of hydrogen peroxide. Further complicating matters, the build up of hydrogen peroxide together with the low levels of the repair enzymes, disrupted the production of yet another enzyme (called tyrosinase). As tyrosinase is responsible for producing melanin the production of melanin in hair follicles was very much reduced.

The researchers speculate that a similar loss of melanin could be the root cause of vitiligo, a condition where white (de-pigmented) patches begin to appear on the skin.

Lead researcher, Karin Schallreuter, said: "This discovery is a major breakthrough in the understanding of hair greying and opens up some novel ideas to combat this scenario. These are being followed up at the current time in our laboratory."

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