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A widely used psychological test has the potential to gauge how people feel about suicide, possibly giving mental-health workers more insight into what their patients are thinking, a new study suggests.

The Implicit Association Test is used to show whether people automatically associate things with each other. Test takers are shown pairs of words, and the quickness of their reactions to them is thought to show whether they unconsciously link them.

Harvard University psychology student Matthew Nock and colleagues gave a version of the test to people seeking psychiatric treatment at an emergency room. The test version was designed to detect if patients connected death to themselves.

In the study, published in the journal Psychological Science, researchers found that patients who’d previously tried to commit suicide were more likely to strongly link death and self than other patients. They were also more likely to try to kill themselves within the next three months compared to those who made stronger connections between life and self.

“These results are really exciting because they address a long-standing scientific and clinical dilemma by identifying a method of measuring how people are thinking about death and suicide that does not rely on their self-report,” Nock said in a statement.

“We are hopeful that this line of research ultimately will provide scientists and clinicians with new tools for measuring how people think about sensitive clinical behaviors that they may be unwilling or unable to report on verbally,” he said.

SOURCE: Association for Psychological Science, news release.

The chance that a corneal transplant will fail is not affected by the age of the donor, the length of time that the transplanted cornea was preserved or the method of preservation, according to a new study.

The finding came from a study that included 388 people who were followed for up to 20 years after a corneal transplant. During that time, 83 of the grafts failed, including 26 because of late endothelial failure — an increasing thickness and loss of clarity of the cornea.

During the follow-up period, endothelial cell density of transplanted corneas decreased an average of 74 percent. The study found no additional cell loss between 15 and 20 years of follow-up. And, the risk for graft failure was lower in people diagnosed with keratoconus (a degenerative disorder in which the cornea becomes cone-shaped) than in those with endothelial dysfunction (a decrease in the number or performance of endothelial cells), said Dr. Sanjay V. Patel, of the Mayo Clinic in Rochester, Minn., and his colleagues.

Donor corneas with lower endothelial cell density before transplant and higher endothelial cell loss two months after transplant were associated with late endothelial failure among people with endothelial dysfunction but not keratoconus.

The time between donor death and corneal transplant was not found to affect risk, nor was the way donor corneas were preserved.

“The findings in our study provide additional evidence that increased death-to-transplant time has no effect on graft failure, which is important information for surgeons who import donor tissue or accept donor tissue with extended preservation times,” the researchers wrote.

The study is published in the issue of the Archives of Ophthalmology.

Blacks are hit the hardest when it comes to both developing and dying from lung cancer.

A new report from the American Lung Association paints a grim picture of how environmental factors, biological factors, cultural attitudes and biases in the health-care system conspire to make this deadly disease even deadlier among members of this minority group.

“Despite lower smoking rates, African-Americans are more likely to develop and die from lung cancer than whites. African-Americans are more likely to be diagnosed later when the cancer is more advanced. Also, African-Americans are more likely to wait longer after the diagnosis to receive treatment or perhaps to refuse treatment and to die in the hospital after surgery,” Dr. William J. Hicks, professor of clinical medicine at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, said during a Monday news conference.

Black men bear an even more disproportionate share of the burden, being 37 percent more likely to be diagnosed with lung cancer and 22 percent more likely to die of the disease than white men.

Only 12 percent of blacks will be alive five years after their lung cancer diagnosis, compared with 16 percent of whites, the ALA report notes.

The report points to a number of factors that could explain the disparity, including differences in socioeconomic status, big business behavior and environmental exposure.

For instance, thanks to concerted marketing efforts by the tobacco industry, blacks have higher rates of smoking menthol cigarettes than other groups. Smokers of menthol cigarettes tend to have higher blood levels of cotinine, an indicator of how much nicotine a person is absorbing. The U.S. Food and Drug Administration is expected to issue a report on the public health impact of menthol cigarettes in March of 2011.

Education and income levels also play a role. Not only do these factors impact lifestyle choices and access to health care, including health insurance, but they largely determine where blacks are likely to work and live.

According to one study, predominantly black neighborhoods have noticeably higher levels of air pollution than other communities.

And a greater proportion of blacks work in the transportation industry, where they are exposed to diesel fumes, known to contribute to lung cancer risk.

Meanwhile, blacks are less likely to have a gene variant that is targeted by a widely used cancer drug.

The good news is that if individuals, regardless of race, receive equal treatment for lung cancer, their outcomes are likely to be similar.

However, as Hicks pointed out, “the sad truth is that not all patients receive equal treatment and for those who do not, their health outcomes are poorer.”

Blacks are also less likely to be seen by experienced or credentialed doctors and hospitals, less likely to have their disease staged, less likely to have surgery and less likely to undergo chemotherapy.

These problems have to do with both patient and provider attitudes.

“We’re looking not just at system failures but also at issues that are deeply rooted in the history, culture and beliefs of African-Americans,” Hicks said. “This is not post-racial America. For people of color in the United States, race and discrimination are facts of everyday life, and clearly take a toll both mentally and with regard to one’s physical health.”

There is, first of all, the legacy of the Tuskegee (syphilis) and other medical experiments of the past, in which blacks were exploited by the U.S. health-care establishment. That’s made trust in the medical establishment an ongoing issue, the experts said.

And while doctors appear less likely to funnel black patients to the right kind of specialists, blacks are more likely to refuse gold-standard treatment even when it is offered and available, they added.

“This is not an issue that can be solved overnight,” said Chuck D. Connor, president and CEO of the American Lung Association. “We’ve made progress in reducing smoking rates and exposure to secondhand smoke, but there is still much work that needs to be done.”

Hicks said he hoped experts and community members could arrive at a new approach that will “hopefully render this very preventable form of cancer to its state of 125 years ago, when it was a very rarely encountered medical issue, primarily before the advent of widespread cigarette smoking.”

SOURCES: 2010, teleconference with: William J. Hicks, M.D., professor, clinical medicine, Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus; Chuck D. Connor, president and CEO, American Lung Association; Too Many Cases, Too Many Deaths: Lung Cancer in African-Americans

Involuntary crying or laughing can be a common symptom in patients with certain neurological disorders, such as Alzheimer’s, multiple sclerosis or amyotrophic lateral sclerosis (ALS).

However, a combination of drugs could be the first effective long-term treatment for the problem, researchers say.

The new treatment for curbing these unwanted crying/laughing episodes — known to doctors as “pseudobulbar affect” or PBA — uses two drugs, dextromethorphan and low-dose quinidine.

Early indications are that the two drugs do reduce the incidence and severity of PBA episodes and improve quality of life.

“There’s no FDA-approved therapy for pseudobulbar affect,” noted study lead author Dr. Erik P. Pioro, director of the section for ALS and related disorders at the Cleveland Clinic in Ohio, and a member of the American Academy of Neurology (AAN). “The off-label medications that are being used have their own set of side effects and problems. So from a medical and patient care point of view, it would be very worthwhile to have an approved medication that is both safe and effective,” he said.

Pioro presented the findings at a press conference held earlier this week at the AAN’s annual meeting in Toronto.

The study authors note that PBA typically manifests in patients with an underlying neurological illness, including those with multiple sclerosis (MS), ALS (also known as Lou Gehrig’s disease) or Alzheimer’s, as well as patients suffering from other dementias and/or brain infections and injuries.

Pioro said that conservative estimates put the number of Americans with PBA at close to 2 million, although he said the figure might actually be as high as 6 million to 7 million.

Dextromethorphan is a common medication and a principle ingredient of standard cough syrup, according to Dr. Lily K. Jung, medical director of the neurology clinic and chief of neurology at the Swedish Medical Center in Seattle. The drug has previously been shown to have a “significant” effect upon parts of the brain responsible for behavioral control, she said at the press briefing.

Jung, who did not take part in the study, noted that quinidine is sometimes used to treat heart rhythm abnormalities. When combined at very low doses with dextromethorphan, it appears to help prolong that drug’s usefulness.

In the study, Pioro and his colleagues enlisted 283 patients with PBA in an initial drug trial, during which some patients received one of two dosage levels of the two medications, while others received placebos.

After a two-week break, this was followed by a second phase involving 253 of the original study participants.

During the study’s second part, patients were exposed to daily doses of the two-drug regimen for 12 weeks.

Pioro and his colleagues observed “significant improvement” among all the patients — particularly among those who had not been exposed to the drug combo until the second part of the study.

Overall, Pioro noted that “there was an improvement of probably about 30 to 40 percent of symptoms” on average.

“Hopefully, we will soon have a very effective approved therapy to help these patients, which is important because this problem is probably much wider and more prevalent than we realize,” he said.

“Very often patients who have this can be mistaken for having depression,” Pioro explained. “But they’re not depressed. Pseudobulbar affect is actually incongruent usually to the inner mood that the person has. So it can generate a lot of misconceptions. And patients will often be stigmatized, if you will, as a result.”

Jung agreed. “This is exciting,” she said, “because pseudobulbar affect can be so significantly socially disabling.”

Still, further investigation into the drug combo’s potential is warranted, since Pioro’s study was relatively small. “Obviously more studies need to be done in larger groups of patients,” Jung cautioned. “And testing for benefit should be done with other validated measures.”

SOURCES: Erik P. Pioro, M.D., Ph.D., director, section of ALS and related disorders, Cleveland Clinic, Cleveland, Ohio, and member American Academy of Neurology; Lily K. Jung, M.D., medical director, neurology clinic, and chief of neurology, Swedish Medical Center, Seattle; American Academy of Neurology meeting, Toronto.

A new study suggests that the brain’s reward system, which makes us feel good when we get things we want and need, could hold insight into why some people are psychopaths.

Researchers from Vanderbilt University in Nashville, Tenn., used brain scans to find evidence that the brain reward system is hypersensitive in people who show more latent signs of psychopathic personality disorder.

“By linking traits that suggest impulsivity and the potential for antisocial behavior to an overreactive dopamine system, this study helps explain why aggression may be as rewarding for some people as drugs are for others,” Dr. Nora Volkow, director of the U.S. National Institute on Drug Abuse, which funded the study, said in a statement.

Psychopaths are defined as charming, manipulative and sensation-seeking people who lack empathy. Many people who fit into this category become criminals.

In the study, researchers studied the brain’s reward system as subjects received low doses of amphetamine and played a game.

The researchers think it’s possible that people with hypersensitive reward systems “may become focused on a chance to get a reward, and less able to shift their attention until they get what they’re after,” said Joshua Buckholtz, doctoral candidate in neuroscience and the lead author of the study, in a statement. “This pattern, along with other traits, could develop into psychopathic personality disorder.”

An intense focus on a particular goal could cause psychopathic individuals to shed the fear that often accompanies negative behavior, the team said. They may also have less sensitivity to other’s emotions and a reduced capacity to learn from their own mistakes.

The study is published in the March issue of the journal Nature Neuroscience.

Palliative care services, which help people who are seriously ill relieve symptoms such as pain, are now found at most U.S. cancer centers, but many programs don’t interact with patients until it’s too late, study findings show.

Dr. David Hui, of the University of Texas M.D. Anderson Cancer Center in Houston, and his colleagues surveyed 71 U.S. National Cancer Institute-designated cancer centers and randomly surveyed 71 other cancer centers. They received responses from 71 percent of 142 executives and 82 percent of 120 program leaders.

The researchers also found that the NCI cancer centers were more likely to have palliative care programs and physicians. A report on the survey was published in the March 17 issue of the Journal of the American Medical Association.

“Palliative care outpatient clinics, inpatient consultation teams, palliative care units and hospices all play an integral role providing symptom control, psychosocial support and transition of care for patients with cancer and their families along the cancer care continuum,” the study authors wrote. “Based on this understanding, multiple national and international organizations support early incorporation of palliative care into oncology practice.”

However, the researchers found that “palliative care patients were referred too late in the disease trajectory, a marker of limited access and integration.”

“Although most cancer centers now have a palliative care program, significant gaps and delays in the delivery of care remain,” Hui’s team concluded.

Older colon cancer patients are less likely than younger ones to receive potentially life-prolonging chemotherapy following surgery for their illness, a new study reveals.

The research indicates that those with advanced colon cancer who are over the age of 75 are both less likely to receive chemotherapy and more likely to receive less chemotherapy even when they are given the treatment.

Yet, prior research has indicated that surgery coupled with postoperative chemotherapy appears to reduce the risk of dying from the disease or experiencing a recurrence.

“So, we have to wonder why one of two older patients are not getting chemotherapy when the trials say they benefit from it,” said study author Dr. Katherine L. Kahn, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

“One reason is that there aren’t that many older patients enrolled in study trials, and so doctors aren’t comfortable with the research findings regarding the elderly,” Kahn noted. “And there also isn’t much written about how you manage those patients. But we studied what happens, and we find that the half that gets treated do great, just as well as younger patients who get chemotherapy.”

Kahn, who is also a member of UCLA’s Jonsson Comprehensive Cancer Center, and colleagues report their findings in the March 17 issue of the Journal of the American Medical Association.

According to American Cancer Society estimates, more than 106,000 Americans were newly diagnosed with colon cancer, and nearly 50,000 men and women died from the disease, last year alone.

Previous research has indicated that, regardless of age, patients who receive chemotherapy following surgery are 24 percent less likely to die and 32 percent less likely to experience the return of their cancer.

To gain insight into the age differential, Kahn’s team analyzed data concerning 675 stage 3 colon cancer patients. All had undergone surgery after having been diagnosed between 2003 and 2005. Just over 200 of the patients were over 75.

The authors reviewed both patient surveys and medical records covering a period of three months before diagnosis, and up to 15 months after that.

Kahn and her team found that, overall, three-quarters of the patients received chemotherapy following surgery.

However, when breaking it down by age they noted that while 87 percent of patients under the age of 75 underwent chemotherapy, that figure dropped to just 50 percent among patients over the age of 75.

And despite the fact that older patients who did receive chemotherapy were less likely to have additional disease than their peers who did not get chemo, the older group was more likely to receive lower than the standard recommended dosage for their chemotherapy regimen.

The age bias was also apparent when looking at the length of chemotherapy treatment. While just 25 percent of younger patients had discontinued their treatment by the 150-day mark, that figure rose to 40 percent among those over the age of 65.

Patients over the age of 75 were more likely to experience negative side effects early into their chemotherapy. However, side effects that manifested well into the chemotherapy process actually occurred less frequently among patients 75 and older than among younger patients.

The researchers did find significant evidence of adverse side effects overall. They observed that 24 percent of the patients experienced at least one negative side effect by the end of the study period, and that side effects were twice as likely to occur among those who received chemotherapy as among those who had surgery alone.

However, the authors concluded that, as a whole, older colon cancer patients were not more likely to experience chemotherapy side effects than younger patients.

“But this finding doesn’t override what doctors are fearful about,” Kahn cautioned. “We don’t know whether we can generalize our results to all older people, because we still have limited information,” she explained.

“For example, maybe all older people on chemotherapy will do as well as the younger patients,” Kahn said. “Or maybe the older ones who got it in our study were selected out by their doctors as the ones most likely to do best. We don’t know yet. We need more data.”

Meanwhile, Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn., suggests that age is just one of many variables to consider when deciding which treatment to offer cancer patients.

“I think it’s important to say that there’s no data presented in this study [on] recurrence or survival among any of the patients,” he noted. “So, there’s no comment the researchers can provide here on what the benefit of chemotherapy actually is among either older or younger patients,” Sinicrope said.

“But the overriding message here is that we need to move beyond making treatment decisions purely on the basis of age. We need to think more about the performance status of the patient and their overall medical condition, and consider offering these patients treatment if appropriate,” Sinicrope said. “And, yes, certainly I think more research and studies specifically looking at elderly populations would be beneficial to have.”

SOURCES: Katherine L. Kahn, M.D., professor, medicine, division of general internal medicine and health services research, department of medicine, David Geffen School of Medicine, University of California, Los Angeles, and senior natural scientist, Rand Corp., Santa Monica, Calif.; Frank A. Sinicrope, M.D., professor, medicine and oncology, Mayo Clinic, Rochester, Minn.

In a trial comparing two anti-clotting drugs, patients given Brilinta before cardiac bypass surgery were less likely to die than those given Plavix, researchers found.

Both drugs prevent platelets from clumping and forming clots, but Plavix, the more popular drug, has been linked to potentially dangerous side effects in cancer patients. In addition, some people don’t metabolize it well, making it less effective.

“We did see about a 50 percent reduction in mortality in these patients [who took Brilinta], but without any increase in bleeding complications,” Dr. Claes Held, an associate professor of cardiology at the Uppsala Clinical Research Center at Uppsala University in Sweden and the study’s lead researcher, said during an afternoon press conference Tuesday.

“Ticagrelor (Brilinta) in this setting, with acute coronary syndrome patients with the potential need for bypass surgery, is more effective than clopidogrel (Plavix) in preventing cardiovascular and total mortality without increasing the risk of bleeding,” he said.

A danger with any anti-platelet drug is the risk of uncontrolled bleeding, which is why these drugs are stopped before patients undergo surgery.

Held was scheduled to present the results Tuesday at the American College of Cardiology’s annual meeting in Atlanta.

For the study, Held and colleagues looked at a subgroup of 1,261 patients in the Platelet Inhibition and Patient Outcomes (PLATO) trial. The researchers found that 10.5 percent of the patients given Brilinta plus aspirin before surgery had a heart attack, stroke or died from heart disease within a week after surgery. Among patients given Plavix plus aspirin, 12.6 percent had the same adverse outcomes.

Patients taking Brilinta had a total death rate of 4.6 percent, compared with 9.2 percent for patients taking Plavix. In addition, the cardiovascular death rates were 4 percent among patients taking Brilinta and 7.5 percent among those taking Plavix.

When Held’s team looked at each group individually, they found no statistically significant difference for heart attack and stroke and no significant difference in major bleeding from the bypass operation itself.

The two drugs work in different ways.

Plavix needs the body to convert it to an active form, which poses some problems. Last week, the U.S. Food and Drug Administration required Bristol-Myers Squibb and Sanofi Aventis, the makers of Plavix, to add a “black box” warning to the drug’s label, alerting doctors and patients that some patients cannot fully convert the drug, so it may be less effective for them.

Brilinta, which is in a different class of drugs, does not rely on metabolic conversion, so it acts faster and clears the body faster than Plavix. This enables quicker recovery of normal platelet function, the researchers say.

But Held can’t explain the difference in the rate of death. “That’s the billion dollar question,” he said.

“Right now we don’t understand the mechanism. We see the difference in mortality, but we cannot explain it in differences in bleeding so there has to be some other effect explaining the difference,” Held said.

The PLATO study was funded by AstraZeneca, the maker of Brilinta.

Results of another study presented at the meeting Tuesday found that the drug Tekturna (aliskiren) given to patients after a heart attack did not improve heart function as researchers had hoped. In that trial — called the Aliskiren Study in Post-MI Patients to Reduce Remodeling (ASPIRE) — Tekturna, which blocks the hormone renin, was given to patients along with common blood pressure-lowering drugs. But the researchers found it provided no additional benefit in heart function and only served to raise potassium levels and cause low blood pressure.

“Morbidity and mortality remain high in patients following heart attack, with a substantial number of patients subsequently developing heart failure,” Dr. Scott D. Solomon, director of noninvasive cardiology at the Brigham and Women’s Hospital, Harvard Medical School in Boston and lead researcher, said in a statement.

“We hoped that this study would generate the information needed to plan a major morbidity and mortality trial. However, our results show that the addition of aliskiren to standard therapy in high-risk post-MI patients does not affect left ventricular size or function. These findings suggest the need for caution when treating post-heart attack patients,” he added.

SOURCES: teleconference with: Claes Held, M.D., Ph.D., associate professor of cardiology, Uppsala Clinical Research Center and Department of Cardiology, Uppsala University, Sweden; presentation, American College of Cardiology’s annual meeting, Atlanta