Psychological and social issues associated with tooth loss

Expert shares ways to cope with the impact of losing teeth

ORLANDO (July 16, 2008)—Are feelings of depression overwhelming you? Is your self-esteem an issue? Having problems advancing in life or your career? Maybe you feel nervous or self conscious in social settings? Do you avoid social settings all together? Check your smile; tooth loss could be the culprit and you're not alone. Nearly 20 million teeth are extracted each year leaving scores of people to deal with the psychological affects of a less than perfect smile. However, during the Academy of General Dentistry's (AGD) 56th Annual Meeting & Exhibits in Orlando, Fla., July 16-20, H. Asuman Kiyak, PhD, will address the psychological issues affecting people who must deal with the loss of a tooth, as well as explain how this loss can affect the quality of life.

In Dr. Kiyak's course, "Enhancing the Oral Health and Quality of Life for Partially Edentulous or Fully Edentulous Patients: The Importance of Communication," she will reveal the post traumatic effects a patient endures after the loss of a tooth and will also pinpoint ways a doctor can communicate with a patient to help them cope with and understand their options for restoring their smile.

"The major impact of tooth loss is on the appearance and social relations component of quality of life because people cannot change their appearance with missing teeth," says Dr. Kiyak.

In fact, recent results from a survey distributed to nearly 20,000 AGD members revealed that more than 86 percent of general dentists reported social embarrassment is one of the greatest problems associated with tooth loss and more than half of these patients avoid social interaction because of it.

Yet, Dr. Kiyak noted that there are ways that patients can learn how to cope with the loss of a tooth. Dr. Kiyak encourages patients to:

• Weigh their options with the pros and cons for replacement teeth or even endodontic treatment to save a "hopeless" tooth.

• Review videos or still photos of others who have lost teeth and their current teeth status with removable or implant-supported dentures.

• Read testimonials of others who have undergone single, multiple, total tooth loss and replacement of these teeth with removable or implant-supported dentures, how they have coped with each stage and how they are functioning orally, systemically and psychologically with these dentures.

"A smile serves as an individual's most powerful tool," says AGD spokesperson Laura Murcko, DMD. "A great smile can make a great lasting impression, boost a person's self-esteem and confidence as well as improve their overall health."

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Dr. Kiyak will be one of more than 100 speakers that will present the latest developments in oral health and technology during the AGD's Annual Meeting & Exhibits. Dr. Kiyak's course will be held on Thursday, July 17 from 1:00 p.m. to 4:00 p.m. EDT.

About the AGD

The AGD is a professional association of more than 35,000 general dentists dedicated to staying up-to-date in the profession through continuing education. Founded in 1952, the AGD has grown to become the world's second largest dental association, which is the only association that exclusively represents the needs and interests of general dentists.

More than 786,000 persons are employed directly in the field of dentistry. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management, and overall coordination of the general dentist through financial support of scientific, educational services related to a patient's oral health.

For more information about the AGD, please visit www.agd.org.

Dentists will be available for interviews about this topic, and/or other oral health topics, prior to and during the Annual Meeting which takes place July 16-July 20, 2008. Please contact Joshauna Walker at 312.440.4974 or media@agd.org.

European Space Agency research : Even the Antarctic winter cannot protect Wilkins Ice Shelf

Even the Antarctic winter cannot protect Wilkins Ice Shelf


13 June 2008Wilkins Ice Shelf has experienced further break-up with an area of about 160 km² breaking off from 30 May to 31 May 2008. ESA’s Envisat satellite captured the event – the first ever-documented episode to occur in winter. Wilkins Ice Shelf, a broad plate of floating ice south of South America on the Antarctic Peninsula, is connected to two islands, Charcot and Latady. In February 2008, an area of about 400 km² broke off from the ice shelf, narrowing the connection down to a 6 km strip; this latest event in May has further reduced the strip to just 2.7 km.
This animation, comprised of images acquired by Envisat’s Advanced Synthetic Aperture Radar (ASAR) between 30 May and 9 June, highlights the rapidly dwindling strip of ice that is protecting thousands of kilometres of the ice shelf from further break-up.
According to Dr Matthias Braun from the Center for Remote Sensing of Land Surfaces, Bonn University, and Dr Angelika Humbert from the Institute of Geophysics, Münster University, who have been investigating the dynamics of Wilkins Ice Shelf for months, this break-up has not yet finished. "The remaining plate has an arched fracture at its narrowest position, making it very likely that the connection will break completely in the coming days," Braun and Humbert said.
Braun and Humbert are monitoring the ice sheet daily via Envisat acquisitions as part of their contribution to the International Polar Year (IPY) 2007-2008, a large worldwide science programme focused on the Arctic and Antarctic.

Previous break-up of Wilkins Ice ShelfThe ASAR images used to compile these animations were acquired as part of ESA’s support to IPY. ESA is helping scientists during IPY to collect an increasing amount of satellite information, particularly to understand recent and current distributions and variations in snow and ice and changes in the global ice sheets.
ESA is also co-leading a large IPY project – the Global Interagency IPY Polar Snapshot Year (GIIPSY) – with the Byrd Polar Research Centre. The goal of GIIPSY is to make the most efficient use of Earth-observing satellites to capture essential snapshots that will serve as benchmarks for gauging past and future changes in the environment of the polar regions.
ASAR is extremely useful for tracking changes in ice sheets because it is able to see through clouds and darkness – conditions often found in polar regions. Long-term satellite monitoring over Antarctica is important because it provides authoritative evidence of trends and allows scientists to make predictions. Ice shelves on the Antarctic Peninsula are important indicators for on-going climate change because they are sandwiched by extraordinarily raising surface air temperatures and a warming ocean.
The Antarctic Peninsula has experienced extraordinary warming in the past 50 years of 2.5°C, Braun and Humbert explained. In the past 20 years, seven ice shelves along the peninsula have retreated or disintegrated, including the most spectacular break-up of the Larsen B Ice Shelf in 2002, which Envisat captured within days of its launch.

Teenage Cancer Trust :Experts highlight gaps in knowledge on caring for survivors of teenage and young adult cancers

London, UK: Over 95% of patients with testicular cancer are cured nowadays, but this success has produced a new problem for cancer survivors, the medical profession and national governments, a cancer expert will tell Teenage Cancer Trust's Fifth International Conference on Teenage and Young Adult Cancer Medicine, which is meeting in London on Monday and Tuesday (June 9 and 10).
Dr Craig Nichols, director of program development and director of the germ cell tumor and lymphoma program at the Providence Cancer Center (Oregon, USA) will tell the conference: "Patients with testicular cancer, and, indeed, several other of the more treatable cancers, have great expectations of a cure, but this also imparts an additional responsibility of ensuring that the medical and social consequences of the disease and the cure have a minimum impact.
"We are returning an extra 50-60 years of life to teenagers and young adults who have been treated successfully for cancer. This shifts the emphasis from 'can we cure this disease?' to 'can we retain this near perfect cure rate as well as reducing the short and long term side effects of treatment, minimising the fertility consequences of therapy, reducing the long term risk of a second cancer and metabolic syndrome, and developing pre-emptive strategies for managing psychosocial consequences of cancer and cancer treatment at a young age?'.
"The medical profession and national governments need to develop strategies for meeting this challenge. They need to recognise that care cannot just stop when the patient is cured of the cancer, and that there is a huge cost still to be faced in terms of long-term care and support and in terms of collateral damage. Maximising the chances for good health for the next 50 years of life has very calculable social benefits, and people are beginning to realise this now. This is a fundamental shift."
Nearly three-quarters of children with cancer survive into adulthood, but a north American study has shown that, 30 years after diagnosis, 42% are affected by severe disease or a life-threatening condition, or have died. In the UK, there are approximately 30,000 survivors of cancer diagnosed before the age of 15, and given that cancer is more common between the ages of 15-24 than in childhood and assuming cure rates are similar to those for children, there are probably over 30,000 survivors of cancer diagnosed when they were aged between 15-24.
Dr Nichols will explain that cancer patients face a double whammy: "There are two aspects: the burden of the disease and the burden of treatment. Each makes a long-term contribution to the patient's quality of life."
Problems for cancer survivors include: the increased risk of a second cancer arising either from the first cancer or from its treatment, infertility caused by chemotherapy and radiotherapy, hypertension, kidney problems, the metabolic syndrome (a collection of disorders such as obesity, high cholesterol levels, high blood pressure and insulin resistance) and hormonal disorders. Survivors of testicular cancer may have life-long problems with low sperm counts, low testosterone levels and poor semen quality. Patients who have survived cancer as children, teenagers or young adults often have psychosocial problems as well.
"We are beginning to learn more about the psychosocial consequences such as body image, employment and sexual health," says Dr Nichols. "There's a higher incidence of lower performance in life generally among cancer survivors. They have undergone a big life disruption at a formative time in their lives. There needs to be recognition of this so that we can try to identify problems and risks early on and be pre-emptive in our use of psychosocial interventions and use of medications."
Traditionally, paediatricians have tended to drive initiatives on caring for cancer survivors because they recognised the problem some time ago. In the USA, the challenge is being met by the establishment of Adolescent and Young Adult Clinics and Specialised Survivorship Clinics under the auspices of the National Cancer Institute. In the UK, the government's recently published Cancer Reform Strategy announced the setting up of a new National Cancer Survivorship Initiative to consider a range of approaches to caring for cancer survivors.
Simon Davies, chief executive of Teenage Cancer Trust, says: "We know that this is a major issue that affects a lot of our patients and is increasingly going up the national agenda. I have just been invited to join the National Health Improvement Agency's working group on improving services to survivors of childhood cancers. I am also a member of the National Cancer Research Institute's Teenage and Young Adult Clinical Studies Development Group. One of their three strands of work is survivorship led by Professor Mike Hawkins."
Speaking before the conference started, Prof Mike Hawkins, director of the Centre for Childhood Cancer Survivor Studies at the University of Birmingham (UK) agrees that survivorship following cancer in childhood, teenage or young adult years is becoming an increasingly important area in the UK and it has been highlighted by the cancer czar, Professor Mike Richards. Prof Hawkins and his colleagues plan to follow-up approximately 25,000 survivors of cancer diagnosed between the ages of 15-24 between 1970-2000 in order to discover the specific problems this age group face.
He identifies three key areas where there need to be improvements:
the establishment of standardised guidelines for following up TYA cancer survivors;
extending the evidence base for guidelines on long-term follow-up;
providing every survivor with a "patient passport" on their discharge from hospital, which would contain a summary of all their treatments and the implications for any future medical treatments.
Some of these things are happening already, but in a fragmented way, with some guidelines in existence and some centres issuing patient passports. But Prof Hawkins believes it needs to happen in a much more organised and standardised way, and, at present, there is a big gap in knowledge about the 15-24-year-old age group.
"For teenagers and young adults we really need to extend the evidence base. There's still a huge area of ignorance in relation to the consequences of treatment in the late teenage and young adult years. We hope to address this through the NCRI group that I chair.
"In the interim, we have got to use what we know from survivors of childhood cancers. However, we are much more ahead of the game for children up to the age of 15 than we are for the generality of cancer survivors," he concludes.
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Note:
See the press release on Dan Savage for an account of what it is like to be a cancer survivor.

Research Australia : QBI neuroscientists make Alzheimer's disease advance

Queensland Brain Institute (QBI) neuroscientists at UQ have discovered a new way to reduce neuronal loss in the brain of a person with Alzheimer's disease.
Memory loss in people with Alzheimer's disease can be attributed to several factors.
These include a build-up of the neuro-toxin Amyloid beta – the major component of amyloid plaques found in patients with Alzheimer's – and corresponding degeneration of a specific population of nerve cells in the basal forebrain.
QBI neuroscientist Dr Elizabeth Coulson's research was recently published in the Journal of Neuroscience.
She said the research had established that the molecule known as p75 neurotrophin receptor was necessary for the Amyloid beta to cause nerve cell degeneration in the basal forebrain.
During her research, Dr Coulson's team found – both in cultured cells and in an animal model of Alzheimer's disease – that it was possible to completely prevent Amyloid beta toxicity by removing the p75 cell death receptor.
"Discovering how Amyloid beta triggers neuronal degeneration has been a question bugging neuroscientists for decades, and we have identified an important piece of the puzzle," Dr Coulson said.
These results provide a novel mechanism to explain the early and characteristic loss of brain cells that occurs in Alzheimer's disease – which are known to be important for memory formation.
Dr Coulson already has patented molecules that can block p75 and is ready to begin testing them in animal models of Alzheimer's disease.
"If such therapy is successful, it probably wouldn't cure this multifaceted disease," Dr Coulson said.
"But it would be a significant improvement on what is currently available for Alzheimer's disease patients."
The World Health Organisation predicts that by 2040, neurodegenerative conditions will become the world's leading cause of death, overtaking cancer.
Alzheimer's disease is the most common dementia affecting 10 per cent of people over 65 and 40 per cent over 80 years of age.
Significant advances in determining the molecular regulation of nerve cell function and survival have major impact on our understanding of more complex areas such as behaviour, cognition, aging and neurological diseases.
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Established in 2003, QBI is dedicated to understanding the molecular basis of brain function and applying this knowledge to the development of new therapeutics to treat brain and mental health disorders.
QBI was formed as part of the Queensland Government's Smart State Initiative with the generous support of the Atlantic Philanthropies.
An abstract of the Dr Coulson's scientific paper "Beta-amyloid(1-42) induces neuronal death through the p75 neurotrophin receptor" is available.

American Academy of Sleep Medicine : Poor sleep a problem in long-term breast cancer survivors

WESTCHESTER, Ill. – A research abstract that will be presented on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS), finds that poor sleep is a problem in long-term breast cancer survivors.
The study, authored by Julie L. Elam, of Indiana University, was based on 246 breast cancer survivors with an average age of 48 years. Seventy-six percent of the participants were Caucasian, 73 percent employed, 73 percent married or partnered, 70 percent postmenopausal, 58 percent with a college education, and 43 percent with at least one concurrent medical problem. The women were an average of 5.62 years post-treatment.
According to the results, 65 percent of breast cancer survivors scored at or above the cut-off for poor sleep. Breast cancer survivors in the minority, those with hot flashes, with high physical functioning, and high depressive symptoms were more likely to have poor scores on the Pittsburgh Sleep Quality Index, self-rated questionnaire that assesses sleep quality and disturbances over a one-month time interval.
“This study provided new information about predictors of poor sleep in long-term breast cancer survivors,” said Elam. “The purpose of the study was to examine a comprehensive list of physiological, psychological, and environmental factors that contribute to poor sleep for this population. The findings indicated that sleep disturbances were problematic in long-term survivors with physiological and psychological predictors of poor sleep.”
Sleep plays a vital role in promoting a woman’s health and well being. Getting the required amount of sleep is likely to enhance a woman’s overall quality of life. Yet, women face many potential barriers – such as life events, depression, illness, and medication use – that can disrupt and disturb her sleep. Overcoming these challenges can help her enjoy the daily benefits of feeling alert and well rested.
It is recommended that women get between seven and eight hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers the following tips for women on how to get a good night’s sleep:
Follow a consistent bedtime routine.
Establish a relaxing setting at bedtime.
Get a full night’s sleep every night.
Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
Do not bring your worries to bed with you.
Do not go to bed hungry, but don’t eat a big meal before bedtime either.
Avoid any rigorous exercise within six hours of your bedtime.
Make your bedroom quiet, dark and a little bit cool.
Get up at the same time every morning.
Those who suspect that they might be suffering from a sleep disorder are encouraged to consult with their primary care physician or a sleep specialist.
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The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

American Cancer Society research find Family history and screening for colorectal cancer

A new study indicates that African Americans with a family history of colorectal cancer are less likely to be screened than African Americans at average risk for the disease. There is also some evidence to indicate that AA with a family history are less likely to be screened than their white counterparts. The study is published in the July 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
African Americans have the highest colorectal cancer (CRC) incidence and death rates of all racial groups in the United States. The reason for this is thought to be multifactorial but remains poorly understood. Overall, African Americans have low rates of colorectal cancer screening compared to most other racial groups. Early detection is especially important for those with family histories of CRC who are at higher risk of developing the disease. Factors associated with CRC screening are not well understood for African Americans, both those with and without family histories of CRC.
To investigate the factors associated with risk-appropriate CRC screening, Kathleen Griffith, Ph.D., CRNP, of the Johns Hopkins University School of Nursing and colleagues at the University of Maryland Baltimore analyzed data from the 2002 Maryland Cancer Survey, a telephone survey of more than 5,000 Maryland residents, performed under the Maryland Cigarette Restitution Fund Program, to identify predictors of screening among African Americans.
The researchers' analyses revealed that for African Americans, regardless of family history, a health care provider's recommendation for colorectal cancer screening was strongly correlated with a higher likelihood of screening. Furthermore, individuals who were more physically active were also more likely to have been screened for colorectal cancer. Surprisingly, though, having a family history of colorectal cancer did not predict a higher likelihood of screening. In fact, the researchers found that African Americans with a family history were less likely to have received risk-appropriate screening than those without a family history. Family history of colorectal cancer is often associated with increased rates of screening in whites.
The authors say it is difficult to explain why a perception of increased risk, which is significantly higher in African Americans with a family history of CRC than in those without, did not translate into screening. Their findings suggest that other unknown or unmeasured factors may play a role is screening decisions. Additional studies to determine what those factors might be could lead to culturally tailored interventions designed to increase screening rates, which in turn could ultimately improve early detection and reduce colorectal cancer deaths in African Americans. "This study suggests that African Americans would benefit from a primary care approach that evaluates their risk factors for colorectal cancer, and provides corresponding recommendations for appropriate screening tests," the authors write.
Regular colorectal cancer screening is one of the most powerful weapons in preventing colorectal cancer. It can, in many cases, prevent colorectal cancer altogether. Experts estimate adherence to national screening guidelines could prevent up to eight in ten deaths from the disease. The American Cancer Society recommends that people at average risk begin screening for colorectal cancer at age 50. Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, as well as the third leading cause of cancer-related death among both men and women in the United States.
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Article: "Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans." Kathleen A. Griffith, Deborah B. McGuire, Renee Royak-Schaler, Keith O. Plowden, and Eileen K. Steinberger. CANCER; Published Online: June 9, 2008 (DOI: 10.1002/cncr.23550); Print Issue Date: July 15, 2008.
Contact: Lynn Schultz-Writsel, Johns Hopkins University School of Nursing. 410-955-7552 or lwritsel@jhmi.edu.

American Academy of Sleep Medicine : Children with high risk for a sleep-related breathing disorder are more likely to have anxiety

WESTCHESTER, Ill. – Children with high risk for a sleep-related breathing disorder (SRBD) are more likely to have anxiety, according to a research abstract that will be presented on Monday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
The study, authored by Shalini Paruthi, MD, of the University of Michigan, focused on 341 families with a child in second through fifth grade, who were surveyed about SRBD symptoms as well as behavior. Parents completed two well-validated instruments: the SRBD subscale of the Pediatric Sleep Questionnaire and the Conners’ Parent Rating Scale.
According to the results, children with a high risk for an SRBD, compared to those without, were more likely to have anxiety. This relationship was independent of hyperactivity, which is known to be associated with both SRBD and anxiety.
“SRBD is a common condition in children, and is frequently associated with cognitive and behavioral morbidities such as hyperactivity,” said Dr. Paruthi. “Anxiety in children is often multifactorial and can be associated with other disorders, including ADHD. As ADHD has been associated with SRBD, our results showed that treatment of an SRBD has been shown to improve behavior and cognitive function in children diagnosed with ADHD, and may translate into treatment options for school age children with anxiety. More research is needed to further explore this relationship between SRBD and anxiety.”
The most common category of SRBD is obstructive sleep apnea (OSA), which causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs.
OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in preschoolers. OSA often occurs between the ages of three and six years when the tonsils and adenoids are large compared to the throat. OSA appears to occur at the same rate in young boys and girls. How often it occurs in infants and teens is unknown. OSA also is common in children who are obese.
OSA is more likely to occur in a child who has a family member with OSA.
Most children with OSA have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath. Sometimes the snoring involves a continuous, partial obstruction without any obvious pauses or arousals. The child’s body may move in response to the pauses in breathing.
Symptoms of OSA tend to appear in the first few years of life. But OSA often remains undiagnosed until many years later. In early childhood OSA can slow a child’s growth rate. Following treatment for OSA children tend to show gains in both height and weight. Untreated OSA also can lead to high blood pressure.
It is recommended that school-aged children get between 10-11 hours of nightly sleep.
The American Academy of Sleep Medicine (AASM) offers some tips to help your child sleep better:
Follow a consistent bedtime routine. Set aside 10 to 30 minutes to get your child ready to go to sleep each night.
Establish a relaxing setting at bedtime.
Interact with your child at bedtime. Don’t let the TV, computer or video games take your place.
Keep your children from TV programs, movies, and video games that are not right for their age.
Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.
At bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas. Try not to give him or her any medicine that has a stimulant at bedtime. This includes cough medicines and decongestants.
It is important to make sure that your child gets enough sleep and sleeps well. The value of sleep can be measured by your child’s smiling face, happy nature and natural energy. A tired child may have development or behavior problems. A child’s sleep problems can also cause unnecessary stress for you and the other members of your family.
Parents who suspect that their child might be suffering from a sleep disorder are encouraged to consult with their child’s pediatrician or a sleep specialist.
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The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.
More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.
SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

University of California : Moores UCSD Cancer Center study links vitamin D, type 1 diabetes

Global view supports concept of using vitamin D in reducing disease risks
Sun exposure and vitamin D levels may play a strong role in risk of type 1 diabetes in children, according to new findings by researchers at the Moores Cancer Center at University of California, San Diego (UCSD) and the Department of Family and Preventive Medicine. This association comes on the heels of similar research findings by this same group regarding vitamin D levels and several major cancers.
In this new study, the researchers found that populations living at or near the equator, where there is abundant sunshine (and ultraviolet B irradiance) have low incidence rates of type 1 diabetes. Conversely, populations at higher latitudes, where available sunlight is scarcer, have higher incidence rates. These findings add new support to the concept of a role of vitamin D in reducing risk of this disease.
Ultraviolet B (UVB) exposure triggers photosynthesis of vitamin D3 in the skin. This form of vitamin D also is available through diet and supplements.
"This is the first study, to our knowledge, to show that higher serum levels of vitamin D are associated with reduced incidence rates of type 1 diabetes worldwide," said Cedric F. Garland, Dr. P.H., professor of Family and Preventive Medicine in the UCSD School of Medicine, and member of the Moores UCSD Cancer Center.
The study is published June 5 in the online version of the scientific journal Diabetologia.
Type 1 diabetes is the second most common chronic disease in children, second only to asthma. Every day, 1.5 million Americans deal with type 1 diabetes and its complications. About 15,000 new cases are diagnosed in the United States each year, where this disease is the main cause of blindness in young and middle-aged adults and is among the top reasons for kidney failure and transplants in youth and midlife.
"This research suggests that childhood type 1 diabetes may be preventable with a modest intake of vitamin D3 (1000 IU/day) for children, ideally with 5 to 10 minutes of sunlight around noontime, when good weather allows," said Garland. "Infants less than a year old should not be given more than 400 IU per day without consulting a doctor. Hats and dark glasses are a good idea to wear when in the sun at any age, and can be used if the child will tolerate them."
The association of UVB irradiance to incidence of type 1 diabetes remained strong even after the researchers accounted for per capita healthcare expenditure. This was an important consideration because regions located near the equator tend to have lower per capita healthcare expenditures, which could result in under-reporting of type 1 diabetes.
The researchers created a graph with a vertical axis for diabetes incidence rates, and a horizontal axis for latitude. The latitudes range from -60 for the southern hemisphere, to zero for the equator, to +70 for the northern hemisphere. They then plotted incidence rates for 51 regions according to latitude. The resulting chart was a parabolic curve that looks like a smile.
In the paper the researchers call for public health action to address widespread vitamin D inadequacy in U.S. children.
"This study presents strong epidemiological evidence to suggest that we may be able to prevent new cases of type 1 diabetes," said Garland. "By preventing this disease, we would prevent its many devastating consequences."
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This is the fifth environmental paper from this research team to show a strong association between vitamin D and various major diseases using global incidence data. The previous four were related to cancer incidence, the first of which illuminated a similar pattern for kidney cancer, published Sept. 15, 2006, in the International Journal of Cancer. The second, on ovarian cancer, was published Oct. 31, 2006, in the American Journal of Preventive Medicine. The third, on endometrial cancer, was published Sept. 16, 2007, in Preventive Medicine. The fourth, on breast cancer, was published in the May-June 2008 issue of The Breast Journal.
Authors on the diabetes study are Sharif B. Mohr, M.P.H., Cedric F. Garland, Dr. P.H., Frank C. Garland, Ph.D., and Edward D. Gorham, Ph.D. of the UCSD Department of Family and Preventive Medicine and Moores UCSD Cancer Center.

Journal of Clinical Investigation : Finding the source: Cells that initiate a common infant tumor identified

Infantile hemangiomas, exemplified by the strawberry-like patches that appear on the skin of infants soon after birth, are benign tumors that develop in 5%-10% of Caucasian infants and usually disappear by the age of 9 without treatment. Joyce Bischoff and colleagues, at Children's Hospital Boston, have now identified the cells that give rise to these tumors and used them to develop a new mouse model of this disease.
Cells expressing the protein CD133 were isolated from infantile hemangioma tissue and individual cells were grown separately in culture. After each cell had been grown long enough for it to have given rise to a large population of cells, the cells were transplanted into immunodeficient mice, where they generated human blood vessels. Overtime, the number of blood vessels decreased and fat cells became evident. As these observations recapitulate those made in individuals with infantile hemangioma — where blood vessels form and then disappear leaving behind fat cells — the authors conclude that a single cell can give rise to infantile hemangioma and that their new model of these tumors will help identify therapeutic targets.
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TITLE: Multipotential stem cells recapitulate human infantile hemangioma in immunodeficient mice
AUTHOR CONTACT: Joyce Bischoff Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. Phone: (617) 919-2192; Fax: (617) 730-0231; E-mail: joyce.bischoff@childrens.harvard.edu.

University of Cambridge : New research explores role of serotonin

Findings provide insight into clinical disorders characterised by low serotonin level, such as depression, obsessive compulsive disorder and severe anxiety
New research by scientists at the University of Cambridge suggests that the neurotransmitter serotonin, which acts as a chemical messenger between nerve cells, plays a critical role in regulating emotions such as aggression during social decision-making.
Serotonin has long been associated with social behaviour, but its precise involvement in impulsive aggression has been controversial. Though many have hypothesised the link between serotonin and impulsivity, this is one of the first studies to show a causal link between the two.
Their findings highlight why some of us may become combative or aggressive when we haven't eaten. The essential amino acid necessary for the body to create serotonin can only be obtained through diet. Therefore, our serotonin levels naturally decline when we don't eat, an effect the researchers took advantage of in their experimental technique.
The research also provides insight into clinical disorders characterised by low serotonin levels, such as depression and obsessive compulsive disorder (OCD), and may help explain some of the social difficulties associated with these disorders.
This research, funded by the Wellcome Trust and the Medical Research Council, suggests that patients with depression and anxiety disorders may benefit from therapies that teach them strategies for regulating emotions during decision making, particularly in social scenarios.
The researchers were able reduce brain serotonin levels in healthy volunteers for a short time by manipulating their diet. They used a situation known as the 'Ultimatum Game' to investigate how individuals with low serotonin react to what they perceive as unfair behaviour. In this game one player proposes a way to split a sum of money with a partner. If the partner accepts, both players are paid accordingly. But if he rejects the offer, neither player is paid.
Normally, people tend to reject about half of all offers less than 20-30% of the total stake, despite the fact that this means they receive nothing - but rejection rates increased to more than 80% after serotonin reductions. Other measures showed that the volunteers with serotonin depletion were not simply depressed or hypersensitive to lost rewards.
PhD student Molly Crockett, a Gates Scholar at the University of Cambridge Behavioural and Clinical Neuroscience Institute, said: "Our results suggest that serotonin plays a critical role in social decision-making by normally keeping aggressive social responses in check. Changes in diet and stress cause our serotonin levels to fluctuate naturally, so it's important to understand how this might affect our everyday decision-making."
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1. The article 'Serotonin Modulates Behavioural Reactions to Unfairness' will appear in Science Express on 06 June 2008.
2. Authors of the paper include: M.J. Crockett; L. Clark; T.W. Robbins; University of Cambridge, G. Tabibnia; M.D. Lieberman; University of California, Los Angeles.
3. Serotonin: The only way to get the raw material for serotonin (tryptophan) is through the diet. Therefore, serotonin levels are lower when you haven't eaten, an effect that the researchers take advantage of in their experimental technique. Eating tryptophan rich foods like poultry (chicken soup) and chocolate can boost serotonin levels - some have speculated that this is why these are "feel good" foods.
4. The Wellcome Trust is the largest charity in the UK. It funds innovative biomedical research, in the UK and internationally, spending around £500 million each year to support the brightest scientists with the best ideas. The Wellcome Trust supports public debate about biomedical research and its impact on health and wellbeing. http://www.wellcome.ac.uk
5. The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public's needs. The results have led to some of the most significant discoveries in medical science and benefited the health and wealth of millions of people in the UK and around the world. http://www.mrc.ac.uk

BMJ-British Medical Journal : Simplistic NHS reforms are inadvertently damaging patient care

Simplistic and unpiloted NHS reforms are inadvertently damaging patient care in general practice, according to a group of academics writing in this week's BMJ.
Professor Howie, from the University of Edinburgh, writing with colleagues, criticises recent reforms in general practice and says if they "continue unchallenged [it] will result in the dismemberment of a primary care system that has been the envy of other countries."
They argue that the holistic care patients have always received from their GP, and which has worked in the individual patient's favour, is in danger of being harmed by recent changes.
The most serious of which is the way "tinkering" reforms will change the successful model of general practice which provides continuity of care by a known GP, to one in which patients are seen by a variety of healthcare workers in different sites who treat episodes of illness rather than the whole person. They argue that "the best of the past is in danger of being lost without sufficient proven benefit in return."
They point out that the government's insistence of using general practice to implement a public health agenda has had the knock-on effect of patients not being treated as individuals, because priority in consultations may be given to the public health agenda over the reasons the individual went to the GP in the first place.
In addition, they criticise "perverse incentives" such as the Quality and Outcomes Framework, which financially rewards GPs for hitting targets, and claim that it provides poor value for patients. "Ticking boxes," they say, may distract doctors from dealing with important topics during a consultation.
Both these factors have created extra work for family doctors, which in turn has led to it becoming increasingly difficult for patients to get timely access to care from their first choice of GP.
These reforms, they conclude, if allowed to continue will mean that "patients will lose holistic care, doctors will lose job satisfaction and the NHS will lose effectiveness and inefficiency."

Public Library of Science : Protein found to promote antibiotic resistance in a common food-borne pathogen

Researchers from Iowa State University have identified a novel factor that promotes the development of antibiotic resistance in a bacterial pathogen. The study, published June 6th in the open-access journal PLoS Pathogens, explains that Mfd, a protein involved in DNA transcription and repair, plays an important role in the development of fluoroquinolone resistance in Campylobacter, a bacterial pathogen commonly associated with food poisoning in humans.
Development of antibiotic resistance in Campylobacter, especially to fluoroquinolone (a broad-spectrum antimicrobial), compromises clinical therapy and poses a public health threat. Previous studies have revealed that Campylobacter is highly mutable to antibiotic treatment and the number of fluoroquinolone-resistant Campylobacter is greatly increased in many regions of the world. But it has not been clear why Campylobacter is able to mutate at such a high frequency.
Using various molecular tools, the research team from the College of Veterinary Medicine, led by Dr. Qijing Zhang, has found that Campylobacter increases the production of Mfd in the presence of a fluoroquinolone antibiotic. Elimination of Mfd from Campylobacter resulted in 100-fold reduction in the rate of emergence of mutants resistant to fluoroquinolones. Without Mfd, the development of fluoroquinolone-resistant Campylobacter under antibiotic treatment is significantly reduced.
These findings have uncovered a previously unrecognized role of Mfd in promoting mutations conferring antibiotic resistance. Despite its importance, Mfd is not the only factor influencing the mutation frequency and future studies will be needed to determine how Mfd increases the emergence of antibiotic-resistant mutants.
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PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://www.plospathogens.org/doi/ppat.1000083 (link will go live on Friday, June 6)
CITATION: Han J, Sahin O, Barton Y-W, Zhang Q (2008) Key Role of Mfd in the Development of Fluoroquinolone Resistance in Campylobacter jejuni. PLoS Pathog 4(6): e1000083. doi:10.1371/journal.ppat.1000083
CONTACT:
Dr. Qijing Zhang College of Veterinary Medicine Iowa State University zhang123@iastate.edu
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Tufts University : Tufts researcher leads revision of osteoporosis guidelines

Tufts University researcher Bess Dawson-Hughes, M.D., chaired the committee that recently updated the National Osteoporosis Foundation (NOF) Clinician's Guide to Prevention and Treatment of Osteoporosis. The new Clinician's Guide incorporates the World Health Organization (WHO) absolute fracture prediction algorithm (FRAX®), a computer-based tool expected to increase the identification of patients at risk for osteoporosis.
"The introduction of the WHO's fracture prediction algorithm necessitated the revision of the Clinician's Guide," says Dawson-Hughes, director of the Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. "The algorithm tells clinicians how likely a patient is to fracture a bone due to osteoporosis or low bone mass in the 10 years following examination, also known as 10-year fracture risk. This can help clinicians decide whether a patient needs to be treated or simply monitored."
Writing in the April 2008 issue of the journal Osteoporosis International, corresponding author Dawson-Hughes and colleagues describe how to apply FRAX® in the United States. Clinicians estimate a patient's 10-year fracture risk using a computer program that considers bone mineral density (BMD) score, or T-score, and nine clinical risk factors including personal fracture history, family fracture history, weight, race and gender. Notably, FRAX® and the new Clinician's Guide now apply to men over 50 and post-menopausal non-Caucasian women, including African-Americans, Asians and Latinas. Previous versions applied only to post-menopausal Caucasian women, the group at highest-risk for osteoporosis.
In their analysis, Dawson-Hughes and colleagues highlight the inclusion of men in the guide. "Post menopausal women remain the most vulnerable to osteoporotic fractures, yet clinicians should not overlook men because their fracture risk may be lower," says Dawson-Hughes, who is also a professor at Tufts University School of Medicine. "The new U.S.-adapted FRAX® will help identify high-risk subgroups of men and non-Caucasian women and, we hope, a wider population of patients at risk for osteoporosis will be treated. Use of FRAX® in men and non-Caucasian women will require adjustments in their T-scores that currently appear on bone density reports. "
Additionally, FRAX® and the new Clinician's Guide address the cost-effectiveness of prescribing medication to patients with low bone mass, but not osteoporosis. Dawson-Hughes and colleagues performed an economic analysis that calls for treating patients with a 10-year hip fracture risk of 3 percent or greater or a major fracture risk of 20 percent or greater. That would include; patients with fragility fractures or osteoporosis, older patients at risk for osteoporosis and younger patients presenting additional clinical risk factors for fracture. FRAX® is applicable to men and women over age 50, but not to younger people.
"The ability to estimate 10-year fracture risk is a crucial development in osteoporosis care, but it is still important for clinicians to review patient cases on an individual basis," says Dawson-Hughes. "Ten-year fracture risk should be used as a guideline."
The following are some recommendations from the new Clinician's Guide:
BMD testing for women age 65 and older and men age 70 and older and in post-menopausal women age 50-70 who present with certain risk factors.
Treatment in postmenopausal women and in men age 50 and older with low bone mass at the femoral neck, total hip or spine and 10-year hip fracture probability of 3 percent or more, or, a 10-year major fracture risk of 20 percent or more based on the US-adapted WHO absolute fracture risk model.
Regular weight-bearing and muscle-strengthening exercise to reduce the risk of falls and fractures.
Advise on adequate amounts of calcium (at least 1200 mg per day, including supplements (if necessary) and vitamin D (800 to 1000 IU per day of vitamin D for individuals at risk of insufficiency).
"We continue to stress the importance of taking calcium and vitamin D for optimal bone health," says Dawson-Hughes, who has published several papers on the subject. "Previous studies suggest these nutrients help strengthen bones which is beneficial for all adults, even those who show no signs of osteoporosis."
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Dawson-Hughes, B, Tosteson, ANA, Melton, LJ III, Baim, S, Favus MJ, Khosla, S, Lindsay RL. Osteoporosis International. 2008 (April); 19: 449-458.
*Select information in this news release was provided by the National Osteoporosis Foundation, which also funded a portion of the study.
If you are a member of the media interested in learning more about this topic, or speaking with another Tufts health sciences researcher, please contact Andrea Grossman at 617-636-3728 or Christine Fennelly at 617-636-3707.
About Tufts University School of Medicine
Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. The Sackler School undertakes research that is consistently rated among the highest in the nation for its impact on the advancement of medical science. For two decades, the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University has studied the relationship between good nutrition and good health in aging populations. Tufts research scientists work with federal agencies to establish the USDA Dietary Guidelines, the Dietary Reference Intakes, and other significant public policies.