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Childhood brain cancer survivors have ongoing cognitive problems and achieve lower levels of education, employment and income than their siblings and survivors of other types of cancer, a U.S. study has found.

The findings, published by the American Psychological Association in the November issue of Neuropsychology, highlight the importance of programs to support childhood brain cancer survivors’ transition to adulthood, said Leah Ellenberg, a clinical faculty member of the David Geffen School of Medicine at the University of California, Los Angeles.

Ellenberg and colleagues analyzed responses to a questionnaire filled out by 785 childhood brain cancer survivors 16 years after their diagnosis. The same questionnaire was completed by 5,870 survivors of cancers such as leukemia, Hodgkin’s disease and bone tumors, and 379 siblings of childhood brain cancer survivors.

The study found that childhood brain cancer survivors reported significantly greater neurocognitive dysfunction than their siblings or other cancer survivors. All areas of cognitive function were affected in childhood brain cancer survivors, including organization and emotional regulation.

The most commonly reported problems were in memory and efficiency, such as forgetting what they’re doing in the middle of a task and being slower than others at completing work. More than half of childhood brain cancer survivors reported significant difficulty with at least one task efficiency item, a rate three times higher than among their siblings.

The most serious neurocognitive problems were reported by childhood brain cancer survivors with significant motor or sensory problems after treatment, those who were treated with radiation to their brains, and those who had tumors in the brain cortex rather than in lower brain regions, the researchers found.

The neurocognitive issues reported by childhood brain cancer survivors were associated with significantly poorer adaptation to adult life, including lower achievement in education, full-time employment and income. They were also less likely to be married, the study authors noted.

The study “underscores the need for continued attention to mitigating the long-term negative effects of [childhood brain cancers] and their treatment,” the study authors wrote. They added that it’s “important to investigate the benefits of early and consistent use of compensatory strategies, including assistive technology, transitional facilities to promote independent living, and job placement and coaching, to enhance functional outcomes.”

NIH-supported scientists at Seaside Therapeutics in Cambridge, Mass., are beginning a clinical trial of a potential medication designed to correct a central neurochemical defect underlying Fragile X syndrome, the most common inherited cause of intellectual disability. There has to date been no medication that could alter the disorder’s neurologic abnormalities. The study will evaluate safety, tolerability, and optimal dosage in healthy volunteers.

The work is the outcome of basic research that traced how an error in the fragile X mental retardation gene (FMR1) leads to changes in brain connections, called synapses. The changes in turn appear to be the mechanism for learning deficits in Fragile X syndrome. The new trial tests Seaside Therapeutics’ novel compound, STX107, that selectively and potently targets the synaptic defect.

Thomas R. Insel, M.D., director of the National Institute of Mental Health, said, “This project is the culmination of years of fundamental research, first identifying the genetic mutation and later deciphering the biochemical consequences of this mutation. Now, with the initiation of this first clinical study, we move one step closer to understanding how this novel candidate may play a critical role in improving the lives of individuals with Fragile X Syndrome.”

Randall Carpenter, M.D., president and chief executive officer of Seaside Therapeutics, and Mark Bear, Ph.D., Seaside’s scientific founder, are leading the research. Dr. Bear is a Howard Hughes Medical Institute investigator and a professor of neuroscience at the Massachusetts Institute of Technology, Cambridge, Mass.

The National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Institute of Neurological Disorders and Stroke (NINDS) have provided grant support. Private foundations providing funding include the advocacy groups Autism Speaks and FRAXA Research Foundation.

Fragile X syndrome is the most common inherited cause of intellectual disability, affecting an estimated 1 in 4,000 males and 1 in 6,000 females.

The syndrome causes a range of developmental problems, including learning disabilities and cognitive impairment. People with Fragile X syndrome may have anxiety and attention deficit hyperactivity disorder. About one-third of males with Fragile X syndrome also have autism or autistic-like behavior that affects communication and social interaction. Usually, males, who have only a single X chromosome, are more severely affected than females.

People with Fragile X have DNA mutations in the FMR1 gene that, in effect, turn off the gene. Research in recent years by Dr. Bear and colleagues has identified the molecular consequences of this silencing of FMR1. Normally, the protein product of the FMR1 gene acts to dampen the synthesis of proteins at synapses that are stimulated via a specific class of receptors on brain cell — metabotropic glutamate receptors (mGluRs). Without the brake provided by FMR protein, synaptic protein synthesis is excessive and connections do not develop normally.

This basic research provided the basis on which to develop medications that could correct the defect.

The current study will focus on a compound, designated STX107, that selectively inhibits one type of mGluR receptor, mGluR5. Evidence in mice with Fragile X-like symptoms suggests that reducing levels of mGluR5 can restore normal synaptic protein synthesis and improve function.

The length of time a patient has to wait between lung cancer diagnosis and treatment is influenced by a number of health-care system factors, a new U.S. study finds.

Researchers at the University of Texas Southwestern Medical Center analyzed data on 482 patients diagnosed with non-small cell lung cancer.

They found that factors such as type of hospital (private or public), insurance coverage, age and race have a major impact on the time it takes for a patient diagnosed with lung cancer to receive treatment.

For example, 59 percent of patients treated at a public hospital had advanced (stage 3) lung cancer, compared with 37 percent of patients treated at a private hospital. The researchers also found significant differences in patient populations at public and private hospitals in terms of age, race and socioeconomic status.

“This study demonstrates that in a contemporary U.S. health-care system, intervals among suspicion, diagnosis and treatment vary widely and are predominately associated with system variables such as insurance and hospital type,” said study author Dr. David E. Gerber. “An organized and timely approach to subsequent diagnostic and therapeutic measures may benefit these individuals and reduce this health-care disparity.”

The appetite-regulating hormone leptin may contribute to osteoarthritis in obese people, according to a new study that suggests that skeletal wear and tear caused by excess weight isn’t the only cause of the painful and debilitating condition.

Duke University researchers found that extremely obese mice didn’t develop osteoarthritis if their bodies didn’t have leptin. In fact, joints in obese mice without leptin appeared healthier than those in normal mice.

The study appears in the Sept. 29 issue of the journal Arthritis & Rheumatism.

This is the first time that leptin has been identified as a “metabolic link” between obesity and altered cartilage metabolism in joints, according to a university news release.

“Although there was some earlier evidence that leptin might be involved in the arthritis disease process, we didn’t think that there would be no arthritis at all” in the obese mice without leptin, said Farshid Guilak, director of orthopedic research in the Duke Department of Surgery, in the news release.

Leptin influences many osteoarthritis-related factors, such as body weight, inflammation and bone metabolism.

“With obesity and osteoarthritis, there are good similarities between humans and mice,” Guilak said. “If we can find a pathway that links a high-fat diet with arthritis, then we can try to identify and block the inflammatory mediators that are linked with the dietary fat.”

For those middle-aged folks who cringe at the memory of their adolescence, new Swedish research suggests that social standing as a teenager has long-term health consequences.

And in a related study, British scientists have found that children whose mothers work outside the home are more likely to engage in unhealthier lifestyles — including eating less healthy foods and getting less exercise — than kids whose mothers are at home.

Both studies appear online Sept. 29 in the Journal of Epidemiology and Community Health.

“I think that the results highlight the importance of recognizing that school is not only about performance and grades, but equally so about the social interplay between children,” said study author Ylva Almquist, a sociologist at the Centre for Health Equity Studies in Stockholm.

The researchers studied data from 14,000 children who participated in the Stockholm Birth Cohort Study, which tracked the long-term health of Swedes born between 1953 and 2003. Specifically, Almquist and her team examined levels of popularity, power and status reported by study participants who were in sixth grade in 1966.

Using that information as a personality baseline, the team then examined the students’ health records during a 30-year-period from 1973 and 2003, focusing on hospital discharge records. Researchers noted that the students who reported lower levels of social acceptance as young teens tended to have a higher risk of serious health issues as adults; the same was true for males and females.

Specifically, the study found that:
Children who were the least popular and powerful at school were more than four times as likely to require hospital treatment for hormonal, nutritional and metabolic diseases as their most popular and powerful classmates.
They were more than twice as likely to develop mental health and behavioral problems, including suicide attempts and self-harm.
They were more than five times as likely to be admitted for unintentional poisoning.
They were also significantly more likely to develop drug and alcohol dependency problems, and nine times more likely to develop heart disease.

Almquist said she is not sure why low social status has such noticeable and long-term health consequences, but there are theories.

“Most likely it is a combination of various aspects,” she said. “Our hypothesis is that lower peer status is linked to less social support, influence and integration, which could result in a more negative self-image and self-confidence. This could in turn influence the child’s future ambitions, expectations and choices. For example, health behaviors such as smoking may be a relevant explanation as to why peer status influences ischemic heart disease. Stress and coping abilities may also be potentially important aspects.”

Kiti Freier Randall, a pediatric neurodevelopmental psychologist from California, said there is a growing body of evidence pointing to the negative consequences of social isolation.

“Our experience of low power and status affects our self-esteem,” she said. “How you feel about yourself affects your health. In many ways, we are hardwired to connect with others.”

Stress physically harms the body, said Freier Randall, who added that people who feel bad often try to comfort themselves with potentially self-destructive behaviors, such as smoking, over-eating and substance abuse.

Freier Randall was also intrigued with the British study that looked at the behavioral impact of mothers working outside the home. To her, the issue is less about moms, who often have no choice but to work, than about the lack of overall adult supervision of young people, especially after school.

“Kids need to have activities with adults who care,” she said.

Young women who make poor shoe choices risk foot pain later in life, U.S. researchers warn.

The study authors analyzed data from 1,900 women and 1,472 men enrolled in the Framingham Foot Study between 2002 and 2008. The participants were asked about pain, aching, or stiffness in either or both feet. They also provided information about current and past footwear.

Footwear was classified as: good (low-risk shoes, including athletic and casual sneakers); average (mid-risk shoes, such as hard- or rubber-soled shoes, special shoes and work boots); and poor (high-risk shoes that lack support and sound structure, such as high-heeled shoes, sandals and slippers).

The researchers found that one-quarter of participants reported generalized foot pain on most days, with 19 percent of men and 29 percent of women falling into this category.

“In women, we found an increased risk between hindfoot pain and shoewear,” wrote the researchers from Boston University School of Public Health and the Institute for Aging Research at Hebrew SeniorLife.

Less than 2 percent of men wore poor shoes, which means that shoe type wasn’t a major factor in the development of foot pain in men, the researchers noted.

“While more research is needed, young women should make careful choices regarding their shoe type to avoid hindfoot pain later in life, or perform stretching exercises to alleviate the effect of high heels on foot pain,” the researchers recommended.

Heparin, a common blood thinner, can cause skin lesions that are harmless in most cases but could indicate a life-threatening condition induced by the drug, a new study suggests.

Researchers examined 320 people who were given heparin injections at a German hospital. Of those, 7.5 percent developed skin lesions as a result of the treatment. That’s higher than the 2 percent rate the researchers had anticipated.

“During the study, we were surprised by the high number of patients with heparin-induced skin lesions,” the study authors wrote. “For most patients, the diagnosis was made because of our study.”

The researchers found that in most cases, the lesions resulted from an allergic reaction. Women were more likely to have the reaction, and three factors — pregnancy, obesity and long-term heparin use — resulted in a higher likelihood of the condition, the study found.

The authors suggested that doctors be aware that skin lesions might occur and realize that they need to figure out the cause. The lesions could be a sign, they said, of a serious condition called “heparin-induced thrombocytopenia,” in which the number of platelets in the blood decrease.

Paraffin wax candles, used mainly for romantic ambiance, fragrance and light, may also contribute to air pollution inside your home.

The candles, which are made from petroleum, are a source of known human carcinogens and indoor pollution, researchers said in a study to be presented Wednesday at the American Chemical Society’s national meeting in Washington, D.C.

In the study, R. Massoudi and Amid Hamidi found that candles made from beeswax or soy, although more expensive, apparently are safer because they do not release potentially harmful pollutants.

“An occasional paraffin candle and its emissions will not likely affect you,” Hamidi said in a news release. “But lighting many paraffin candles every day for years or lighting them frequently in an unventilated bathroom around a tub, for example, may cause problems.”

Ventilation can help reduce the level of pollutants in closed rooms, the researchers said.

Besides the more serious risks, Hamidi also said that some people who believe they have an indoor allergy or respiratory irritation may actually be reacting to pollutants from burning candles.

The type 2 diabetes drug Avandia (rosiglitazone) increases the risk of heart failure and death more than another drug in the same class, Actos (pioglitazone), new Canadian research contends.

Avandia has been the subject of controversy since 2007, when it was linked to an increased risk for heart attack and death, although those claims have become clouded as other studies have discounted that risk to some degree. But taken together, many believe that the drug should not be used, especially since there appears to be a safer choice.

“It is difficult for making a case for using rosiglitazone in anybody, because we have an alternative,” said lead researcher Dr. David Juurlink, division head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto.

In 2007, Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, published a study that found Avandia showed a 43 percent greater risk of heart attack among diabetes patients, and he remains convinced that the drug should not be used.

“I agree with the authors’ conclusions,” Nissen said. “Rosiglitazone should not be used in patients with diabetes. Pioglitazone is a safer alternative.”

There is increasing evidence that Actos is safer than Avandia, Juurlink said. “Not a single study has suggested that pioglitazone might be less safe than rosiglitazone,” he said. “And rosiglitazone doesn’t have a single advantage — not even a theoretical one.”

Both Avandia and Actos belong to a class of drugs called thiazolidinediones, which are used widely to lower blood sugar in people with type 2 diabetes. In addition to an increased risk for heart failure, both drugs can also cause side effects that include weight gain and fluid retention. Both medications carry a U.S. Food and Drug Administration warning label about the risk of heart failure and heart attack.

The latest report on the safety of these drugs is published online Aug. 19 in the BMJ.

For the study, Juurlink’s team collected data on 39,736 patients treated with Avandia or Actos between April 2002 and March 2008. The researchers compared these data with hospital records of heart failure, heart attack and deaths.

The researchers found that patients taking Avandia were at greater risk of heart failure and death than those taking Actos. There was no significant difference between the drugs for the risk of heart attack, Juurlink’s group noted.

For every 93 patients treated with Avandia instead of Actos, there was one additional cardiovascular event or death per year, the researchers estimated.

“As a clinician, I cannot envision an instance in which I would recommend rosiglitazone,” Juurlink said.

However, Corinne de Vries, a professor of pharmacoepidemiology in the department of pharmacy and pharmacology at the University of Bath, England, and co-author of an accompanying journal editorial, is not convinced that Avandia is less safe than Actos.

“Nobody should stop taking their medication without consulting their doctor, because I don’t think rosiglitazone kills you,” de Vries said.

De Vries said the conclusions of this study are not supported by the data Juurlink’s group used. People taking Avandia were sicker than those taking Actos, so these patients were more likely to develop heart failure, she noted.

“The data presented by Juurlink do not support the suggestion that you should favor one drug over the other,” de Vries said. “There is no reason to believe yet that there is a difference.”

People who have a preexisting heart condition should not be started on either of these drugs, de Vries stressed. Patients who develop heart failure should have the drug discontinued, because the condition is usually reversible, she added.

Another expert, Dr. Carl J. Lavie, medical director for cardiac rehabilitation and prevention director of the Stress Testing Laboratory at the Ochsner Heart and Vascular Institute in New Orleans, thinks the study gives more reasons not to use Avandia.

“I believe that most clinicians have stopped using Avandia — some will use Actos instead or go to another class completely,” Lavie said.

Lavie noted that an ongoing study assessing Avandia and Actos in a head-to-head comparison should provide more answers about these drugs.

“Until then, this current study provides further ammunition against using Avandia or at least for trying Actos first, which is along the same lines as the current American Diabetes Association and European guidelines anyway,” Lavie said. “Most will, and should, avoid either agent in a patient with heart failure or high heart failure risk.”

“Both drugs have a place in treating diabetes, but not if you have a preexisting heart condition,” de Vries said.

One of the first steps toward managing your child’s asthma is to recognize the allergens or irritants that can trigger an attack. Frequently, these may include dust, pet dander, smoke, exercise or polluted air.

The American Academy of Family Physicians offers these suggestions:
During allergy seasons, run the air conditioner and keep the windows in your home and car closed. Regularly replace filters from your home’s cooling system.
Keep bathrooms, kitchens and basements clean and allow them to air out. Run a dehumidifier, if needed, in these areas.
Reduce dust and dust mites by frequently washing bed linens in hot water. Remove any carpets and rugs, if possible.
Keep pets out of your child’s bedroom.
Keep your child away from tobacco smoke.