Children who are enrolled in a daycare center as infants are less likely than their peers to develop asthma symptoms by age 5, according to a study published in the Journal of Allergy and Clinical Immunology.

The study followed more than 900 children from birth through age 5. Among other variables, researchers compared the children's historic childcare arrangements to rates of current wheeze at age 5 - considered a symptom of, or precursor to, asthma.

The British study, led by Nicolaos Nicolaou, MD, found that all children enrolled in daycare were 35 percent less likely to develop asthma symptoms, but the greatest protective effect was observed among those enrolled between age 6 months and 12 months - with a 75-percent reduction in risk.

The findings add evidence to support the hygiene hypothesis, which proposes that decreased exposure to infections and germs early in life is responsible for recent drastic increases in asthma and allergies, especially in the developed world. Exposing young children to the pathogens in a daycare environment may help boost immune defenses against allergic diseases.

About 2.4 million tobacco-related cancers were diagnosed in the U.S. from 1999 to 2004, according to a new study by the Centers for Disease Control and Prevention. Lung and bronchial cancer accounted for almost half of those diagnoses.

"Tobacco use is the leading preventable cause of disease and premature death in the United States and the most prominent cause of cancer," said Matthew McKenna, MD, director of CDC's Office on Smoking and Health.

 "The tobacco-use epidemic causes a third of the cancers in America. If proven strategies were fully implemented to decrease tobacco use, much of the suffering and death that cancer inflicts on families and communities could be prevented."

 The estimates are based on data from the CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology and Results Program.

Oct. 3, 2008

The Food and Drug Administration has approved a new test to diagnose human flu infections, including the H5N1 virus that scientists fear could cause a pandemic.

The device uses genetic material from a patient's nose or throat to detect flu virus and differentiate between seasonal and novel influenza. Results can be available within four hours and the system can test multiple samples at once. The test will be available to CDC-qualified laboratories for diagnosing influenza this fall.

"The test allows us to better support laboratories on the front line of influenza testing in the United States and abroad," said Health and Human Services Secretary Mike Leavitt. "The application of the test to detect an emergent influenza virus would be especially important in the early stages of a pandemic."

The H5N1 virus circulates widely in birds in Asia, Africa and Europe, where it has caused human illness and death. Scientists are concerned it could acquire the properties needed to quickly spread between people.

Oct. 1, 2008

Researchers have discovered a gene variant that boosts susceptibility to narcolepsy, according to a study published online Sunday in the Journal of Nature Genetics.

Japanese scientists used 500K SNP microarrays to conduct a genome-wide association study of 222 Japanese subjects with narcolepsy and 389 without. They conducted the same research in 424 Koreans, 184 African Americans and 785 people of European descent.

The study linked rs5770917, a SNP located between CPT1B and CHKB, with narcolepsy in all subjects. PCR assays of white blood cells indicate that a genetic variant of either CPT1B or CHKB could cause narcolepsy.

View the study, Variant between CPT1B and CHKB associated with susceptibility to narcolepsy.

The Agency for Healthcare Research and Quality has released a guide to help quality improvement leaders prevent blood clots in hospital patients.

Prepared by the Society of Hospital Medicine, the guide offers a framework for improving performance based on preventive practices at the University of California, San Diego Medical Center and Emory University Hospitals.

Pulmonary embolism resulting from deep vein thrombosis, or venous thrombo-embolism, is the most common preventable cause of hospital death.

Sept. 30, 2008

Use of inhaled anti-cholinergic agents by patients with chronic obstructive pulmonary disease (COPD) is associated with a significantly increased risk of heart attack, stroke, and cardiovascular death, according to a meta-analysis published in September 24's Journal of the American Medical Association.

Sonal Singh, MD, MPH, of Wake Forest University School of Medicine, Winston-Salem, NC, et al., analyzed 17 randomized trials enrolling 14,783 COPD patients. They found that inhaled anti-cholinergics significantly increased the risk of cardiovascular death, heart attack, or stroke (1.8 percent vs. 1.2 percent for controls).

Inhaled anticholinergics significantly increased the risk of heart attack by 53 percent (1.2 percent vs. 0.8 percent for controls) and significantly increased (by 80 percent) the risk of cardiovascular death (0.9 percent vs. 0.5 percent for controls).

Clinicians and patients "should carefully consider" the potential long-term cardiovascular risks of inhaled anti-cholinergics and "decide whether these risks are an acceptable trade-off in return for their symptomatic benefits," the authors wrote.

Sept. 29, 2008

Researchers at Temple University School of Medicine and Hospital have developed a belt-like device designed to reduce positional sleep apnea episodes.

The Zzoma device, which is not yet approved by the Food and Drug Administration, is worn around the chest and keeps patients from moving their backs.

Positional sleep apnea occurs when patients sleep on their backs. Abnormal breathing in these patients usually stops when they sleep on their sides. Half of patients with mild sleep apnea and 20 percent of people with moderate sleep apnea have positional sleep apnea, according to the developers of the device.

The developers say the Zzoma is an alternative to continuous positive airway pressure.

Sept. 24, 2008

People taking inhaled anticholinergic agents face a significantly increased risk of heart attack, stroke and cardiovascular death, according to a study published in today's issue of the Journal of the American Medication Association.

Wake Forest University School of Medicine researchers conducted a meta-analysis of 103 articles and 17 randomized trials ranging from 6 months to 5 years with 14,785 subjects. The review indicated that anticholinergic agents increased total risk by 58 percent, with a 53 percent increased risk of heart attack and an 80 percent increased risk of cardiovascular death.

When the analysis was restricted to trials longer than 6 months, there was a 73 percent increased risk of cardiovascular death, heart attack or stroke.

"Clinicians and patients should carefully consider these potential long-term cardiovascular risks of inhaled anticholinergics in the treatment of COPD, and decide whether these risks are an acceptable trade-off in return for their symptomatic benefits," the authors said in a news release.

View the complete study here.

Sept. 24, 2008

The American Association of Sleep Medicine has accredited the first A-STEP provider in Connecticut.

The ECHN Sleep Disorders Center at Manchester Memorial Hospital will begin offering the Accredited Sleep Technologists Education Program (A-STEP) introductory course January 5, 2009.

ECHN Sleep Disorders Center joins 54 other programs nationwide that provide the A-STEP introductory course. All candidates for the registered polysomnographic technologist certification exam must complete this course, along with 14 web-based self study modules, prior to sitting the exam.

View more information on the course at ECHN Sleep Disorders Center here. View other A-STEP providers nationwide here.

Aug. 25, 2008

Of all ethnic groups in the U.S., Puerto Ricans have the highest rates of morbidity from asthma. Childhood abuse is a potential contributor to the high asthma burden in this population, according to a study to be published in the September issue of the American Journal of Respiratory and Critical Care Medicine.

Researchers studied 1,213 children and their primary caretakers in the San Juan and Caguas areas of Puerto Rico. The prevalence of physician-diagnosed asthma was 39.6 percent. Fourteen percent of children witness an act of violence within the year prior to the study; 7 percent had been victims of violence; and 6 percent had been victims of physical or sexual abuse.

Stressful life events and exposure to neighborhood violence were not associated with asthma. But a history of physical or sexual abuse doubled the risk of current asthma, researchers found.

The study underlines the importance of screening for asthma among victims of childhood abuse and to be aware of the possibility of physical or sexual abuse among children with asthma.

Creatine, a popular nutritional supplement renowned for enhancing athletic performance and muscle strength, does not improve exercise outcomes in patients with chronic obstructive pulmonary disease (COPD), according to a new study.

The randomized, placebo-controlled, double-blind study provided the most powerful evidence to date that the effect of creatine (Cr) supplementation was negligible at best among these patients.

"We have evidence to suggest Cr uptake into muscles [in COPD patients] but are unable to explain why an increase in muscle Cr did not enhance training," wrote the study's lead author, Sarah Deacon, MD, specialist registrar at the Institute for Lung Health at Glenfield Hospital in Leicester, England, in August's American Journal of Respiratory and Critical Care Medicine.

Cr supplementation has been shown to improve short-burst, high-intensity exercise function in athletes. To determine whether Cr supplementation could similarly enhance the physical condition of COPD patients, Deacon et al. recruited 100 patients with COPD to either receive Cr or a placebo over the course of a 7-week pulmonary rehab program.

Patients enrolled in both the control and Cr groups showed statistically significant improvements in functional and muscular performance during the loading phase, but no differences were seen between the groups. The Cr group also showed a greater, but non-significant percentage of improvement in the incremental shuttle walking test with loading and after pulmonary rehabilitation, but additional analysis still showed no overall effect between it and the placebo group.

"The most likely explanation is that any benefits of creatine have been submerged by the large training effect of physical training alone," wrote Dr. Deacon.

The standard regimens to treat tuberculosis are inadequate in countries with high rates of multi-drug resistant (MDR) TB, where patients are nearly twice as likely to fail their initial treatment as those in countries with low rates, according to a new analysis of World Health Organization (WHO) data.

This finding, published in August's American Journal of Respiratory and Critical Care Medicine, suggests strongly that current TB treatment regimens need to updated and revised to address the shifting landscape of public health in the face of MDR-TB.

"In countries with low prevalence of initial multi-drug resistance, the standardized treatment regimens for new case appear to be adequate," wrote Dick Menzies, MD, lead author of the study and director of the respiratory division at McGill University.

"However, in countries where the prevalence of initial drug resistance exceeds three percent, we believe it is urgent to strengthen capacity to perform drug sensitivity testing, or to reevaluate these standard treatment regimens, given the unacceptably high rates of failure and relapse."

Menzies and co-investigators reviewed the WHO's data from 2003 and 2004 for a total of 155 countries, 121 of which reported at least 250 cases annually. They assessed dropout, failure, relapse and death rates with initial treatment, as well as dropout, failure and death rates for retreatment.

Rates of failed treatment were dramatically higher with increasing prevalence of MDR-TB (p<0.0001). After accounting for age, HIV prevalence, per capita income and treatment regimen, for every one-percent increase in MDR TB prevalence, they saw a 0.30 percent rise in treatment failure among new cases, a 1.1 percent increase in failure rate among RE-treatment cases, and a one percent increase in relapse.

"This is striking evidence that MDR-TB is directly linked to the increased failure rates of our current treatment regimens," said Dr. Menzies.

Aug. 4, 2008

Preventable medical errors during or after surgery cost employers $1.5 billion per year, according to estimates by the U.S. Department of Health and Human Services' Agency for Health Research and Quality.

AHRQ researchers William E. Encinosa, Ph.D., and Fred J. Hellinger, P.D., found insurers paid an additional $28,218 for patients who experienced acute respiratory failure and $19,480 for patients with post-operative infections. These represent a 52 percent and 48 percent cost increase, respectively, over patients who do not experience either problem.

The authors also identified added costs in patients who experienced the following medical errors compared with those who did not:

• Nursing care associated with medical errors, including pressure ulcers and hip fractures - $12,196 (33 percent more)

• Metabolic problems associated with medical errors, including kidney failure or uncontrolled blood sugar - $11,797 (32 percent more)

• Blood clots or other vascular or pulmonary problems associated with medical errors - $7,838 (25 percent more)

• Wound opening associated with medical errors - $1,426 (6 percent more)

The authors found that one of every 10 patients who died within three months of surgery did so because of a preventable error. One-third of the deaths occurred after the initial hospital discharge.

The study, which was published in the July 28 issue of the journal Health Services Research, was based on a nationwide sample of more than 161,000 patients age 18 to 64 in employer-based health plans who underwent surgery between 2001 and 2002.

The number of working-age adults with chronic health conditions grew 25 percent between 1997 and 2006 to 58 million, according to a study published online by Health Affairs.

More than one-third of uninsured adults with a chronic condition did not have a usual source of care in 2006, up from 29 percent a decade earlier; 26 percent had not seen a health professional all year, up from 21 percent in 1997.

Both insured and uninsured adults with chronic conditions were more likely to report unmet medical needs due to cost in 2006 than in 1997.

The study, by the Kaiser Commission on Medicaid and the Uninsured, examined access to care for working-age adults with heart disease, hypertension, stroke, diabetes, asthma, emphysema or cancer based on responses to the National Health Interview Survey.

Children's Hospitals & Clinics of Minnesota in St. Paul and Minneapolis, Children's Hospital of Philadelphia, and Haven Hospice in Gainesville, FL, each will receive the Circle of Life Award July 25 at the AHA and Health Forum Leadership Summit in San Diego.

"The Circle of Life award recognizes organizations that are focused on expanding the frontiers of palliative and end-of-life care, in terms of access and quality," said American Hospital Association President and CEO Rich Umbdenstock.

"These programs are striving to be there for patients and families every step of the way, with expertise, compassion and assistance. A focus on choice and dignity help distinguish these programs and help serve as a model to others."

Citations of Honor were awarded to Kaiser Permanente, Oakland, CA; LifePath Hospice and Palliative Care, Tampa, FL; Providence Hospital, Washington, DC; Rice Hospice, Willmar, MN; Sentara Healthcare, Norfolk, VA; and the UAB Center for Palliative Care and Birmingham VA Medical Center's Joint Palliative Care Programs, Birmingham, AL.

Two members of the U.S. House of Representatives have introduced a bill to create a national patient registry for pulmonary fibrosis (PF) and to call on the National Institutes of Health (NIH) to expand and intensify PF research efforts.

PF is a progressive and ultimately fatal lung disease that claims the lives of 40,000 Americans each year and kills an estimated two-thirds of patients within their first five years of diagnosis. There is no known cause, no FDA-approved treatment and no cure.  For more information on PF, visit www.coalitionforpf.org. 

Congressmen Brian Baird (WA-03) and Mike Castle (DE-at large) introduced the Pulmonary Fibrosis Research Enhancement of 2008 after working closely with the Coalition for Pulmonary Fibrosis (CPF) since early 2007 to author legislation that is the first of its kind to improve research and awareness of this deadly disease.

"I am pleased to have worked with my colleague and the CPF to bring about this important legislation," said Rep. Castle. "PF is an ultimately debilitating and fatal disease, and one that has taken people close to me. I remain dedicated to supporting research efforts to eradicate this disease."

The U.S. Senate and House of Representatives overturned a veto by President Bush and passed a bill known as the Medicare package that contains several important provisions relating to respiratory care, according to the American Association for Respiratory Care (AARC).

The bill adds a specific pulmonary rehabilitation (PR) benefit in the Medicare statute, thereby ensuring access to PR for all Medicare beneficiaries. State-by-state coverage of PR, which is often inconsistent or, in some cases, non-existent, will now end.

The "rent-to-own provision" that would have required home care patients to take ownership of their home oxygen equipment after 36 months of continuous use was repealed. AARC and its sister organizations had lobbied Congress to rescind this provision since it was enacted into law two years ago.

The DME competitive bidding program that began in ten parts of the country on July 1st will now be delayed for 18 months and "reforms to the program must be made," the AARC reported.

For more information