Erectile Dysfunction And The Prostate

With the flu season and the H1N1 virus looming, pharmacists are increasingly being called on to take a more active role in public health, from immunizations to disaster planning and management. ASHPs new book, Pharmacy in Public Health Basics and Beyond, provides pharmacists and other health care practitioners with critical information theyll need to play a muchneeded role in public health, for flu season, emergency preparedness, and chronic disease prevention and management.

Pharmacy in Public Health Basics and Beyond is divided into three useful sections, each of which builds on the next. First, the authors introduce practitioners to the fundamentals of public health. Next, the book helps readers build a skill base by presenting necessary tools and measures of public health. Finally, applied models of pharmacy and public health practices detail reallife solutions to issues, such as providing immunizations in a community pharmacy.

Pharmacists and other health care practitioners can ensure theyre prepared for challenges such as

Responding to public health crises such as H1N1 virus
Providing immunizations
Ensuring emergency preparedness
Managing the obesity and diabetes epidemics

Within the book, fully integrated cases and model scenarios provide realworld applications. Learning objectives, figures, tables, and key terms clarify and guide readers through important concepts. Thoughtprovoking discussion questions and suggested readings help readers understand how the concepts and cases can be used in their own communities and practices. The books website, ashp.org/publichealth provides PowerPoint slides, image files, and additional cases for extra material.

“With Pharmacy in Public Health Basics and Beyond, pharmacists can start preparing themselves now for public health issues that lie ahead, and begin making a difference in their communitys H1N1 challenge today,” said coauthor Jean Carter, Ph.D., Pharm.D., associate professor of pharmacy administration at University of Montanas Skaggs School of Pharmacy. Coauthor Marion Slack, Ph.D., professor of pharmacy practice at the University of Arizona, agrees, “Our hope is that readers will use what they have learned to make an impact in public health, whether in their own local community, for national public health initiatives, or for the global community.”

About the Authors

Jean Carter, Ph.D., Pharm.D., is an associate professor of pharmacy administration at University of Montanas Skaggs School of Pharmacy, and an affiliated faculty member of the schools public health program.

Marion Slack, Ph.D., is a professor of pharmacy practice at University of Arizona, where she is Principal Investigator of an interprofessional training program for rural and underserved communities in community health.

There is no strong evidence that the popular smoking cessation drug varenicline increases the risk of self harm or depression compared to other cessation products, according to new research published on bmj.com today.

Varenicline is a recently introduced smoking cessation product of proven effectiveness, but there have been concerns that it may increase the risk of suicidal behaviour and suicide. Despite warnings about the possible increased risks issued by regulatory authorities worldwide, varenicline continues to be used widely.

To provide more evidence, a team of researchers from the University of Bristol and the UKs Medicines and Healthcare products Regulatory Agency (MHRA) compared the risk of self harm among people taking varenicline with the risk of self harm associated with other smoking cessation products bupropion and nicotine replacement therapy (patch, inhaler, gum, tablet or lozenge).

Using data from the General Practice Research Database, 80,660 men and women aged between 18 and 95 years were identified who were prescribed a new course of smoking cessation product between September 2006 and May 2008.

Participants were prescribed either nicotine replacement products for (n=63, 265), varenicline (n=10,973), or bupropion (n=6,422).

All electronic patient records over the period of the prescription and for three months after the date of the last prescription were examined for incidences of fatal and nonfatal selfharm, suicidal thoughts and depression.

After controlling for confounding factors, there was no clear evidence of an increased risk of self harm, suicidal thoughts or depression associated with either varenicline or bupropion.

The authors caution that although they found no strong evidence of an increased risk of self harm linked to varenicline, “the limited power of the study means we cannot rule out either a halving or a twofold increased risk.”

They go on to call for more investigation of vareniclines effect on suicide risk in other databases and secondary analysis of all adverse event reporting in clinical trials.

They conclude by cautioning that any risks must be balanced against the long term health benefits of stopping smoking and the effectiveness of varenicline as a smoking cessation product.

Mayo Clinic has repeatedly been ranked #1 in endocrinology by annual U.S. News and Report medical surveys. One reason is the historical strength and current depth of expertise in diabetes treatment and research, including related areas of obesity and metabolic syndrome.

An excellent story is our work toward finding a means of regenerating insulinproducing tissue through iPSC or induced pluripotent stem cells. For an overview on this research see Discoverys Edge article “Diabetes and Heart Damage an iPS Cell Approach.”

Diabetes Experts

Maria CollazoClavell, M.D.

Clinical study of obesity, weight loss, Diabetyes; Lipid Disorders, Womens Health Issues (Osteoporosis, Hormonal Replacement).

Cheryl Conover, Ph.D.

Insulinlike growth factors (IGFs); how the endocrine system can impact cancer, especially ovarian tumors.

Michael Jensen, M.D.

Diabetes. Research focuses on types of fat and how fat deposits on the body are regulated; fatty acids; how the body burns fat. Codefiner of NEAT (non exercise activity thermogenesis).

Yogish Kudva, M.B.B.S.

Diabetes type 1; conducting research into pancreatic cell transplant and regeneration to restore insulin production.

James Levine, M.D., Ph.D.

Obesity, Anorexia Nervosa, Congenital Leanness. Expert in mobid obesity and burning calories. Innovator in weight loss behavior in the environment. Codefiner of NEAT (non exercise activity thermogenesis).

Jennifer K. Nelson, MS.N. Dir., Clinical Dietetics

Diabetic nutritionist; heads Mayos diabetic nutrition section. Advisor on Mayo cook books.

Robert Rizza, M.D.

Diabetes. Hypoglycemia; Insulin Resistance; Obesity; Lipid Disorders. Former president, American Diabetes Assocation.

Victor Montori, M.D.

Diabetes. Research focuses on evidence based medicine, science of health care delivery.

Steven A. Smith, M.D.

Metabolic and lipid disorders, diabetes.

Adrian Vella, M.D.

Diabetes, prediabetes, genetic metabolism disorders, pituitary and adrenal disorders, polycystic ovarian disorders.. Research focuses on glucose tolerance and factors impacting Type II diabetes.

Source Mayo Clinic

With more than 35 million people worldwide living with Alzheimers disease or a related dementia, the search for answers has never been more critical.

With this in mind, the very best minds in dementia research and care, both in Canada and abroad, will converge on Toronto today at the 5th Canadian Conference on Dementia to share the very latest developments in the field.

“Dementia is a rapidly growing issue for Canadians, an issue that needs immediate attention if we are to mitigate the impact of this illness on our health and social systems,” says Dr. Ron Keren, Conference Chair. “The Canadian Conference on Dementia is an opportunity for the international community of experts to come together and share critical information on the latest in research and care.”

The conference will open with two keynote presentations by Dr. Margaret Lock (McGill University) and Dr. Mary Ganguli (University of Pittsburgh), followed by the presentation of Im Still Here, a powerful researchbased play illustrating the perspective of persons living with dementia and their family partners in care.

The conference will also feature sessions on risk factors, diagnosis, treatments, quality of life, caregiving and the need for a national dementia strategy. This diverse program will explore the challenges of dementia, address the issues facing people with the illness, and present ways to help change the future of the disease.

The Canadian Conference on Dementia will take place October 1 to 3 at the Westin Harbor Castle Hotel in Toronto. To see the full schedule of speakers and topics, please visit ccd2009.ca.

Canadian Conference on Dementia

Unlike other forms of suicide, physician assisted death does not cause substantial regret, or a sense of rejection among surviving family members. In addition, the prevalence and severity of depression and grief among family members whose loved ones received aid in dying is no different than family members whose loved ones did not pursue physician assisted suicide. These findings are the result of a study conducted by researchers at Oregon Health & Science University and published online this week in the Journal of Pain and Symptom Management.

“Grief following the death of a loved one can be persistent, painful and debilitating,” said Linda Ganzini, M.D., a professor of psychiatry and medicine in the OHSU School of Medicine and lead author of the research paper. “Prior studies on suicides indicate high levels of shame, guilt, stigma and sense of rejection in surviving family members. However, until now, little was known about mental health outcomes in the family members of a patient who receives physician aid in dying. Based on our research, we know that family members of loved ones who pursue physician assisted suicide do not have different prevalence and severity of depression and prolonged grief compared to the general population.”

To conduct the study, researchers surveyed 95 family members whose loved ones requested aid in dying through Oregons Death with Dignity Act. This group included 59 family members whose loved one received a lethal prescription and 36 whose loved one died by lethal ingestion. The researchers compared this information with responses received from 63 family members whose loved one had died from cancer or amyotrophic lateral sclerosis (Lou Gehrigs disease) and had not requested aid in dying.

In comparing survey results, the researchers found that the rate of grief and depression between these two groups was nearly identical. However, family members of loved ones who requested a lethal prescription indicated they felt more prepared for and more accepting of the death.

Among family members whose loved one requested but did not receive a lethal prescription, there was greater likelihood that the family members had regrets about how their loved one died. This group also was less likely to confirm that the patients preferences for care were honored, and they gave a lower rating for overall quality of care the last week of life.

“One of the other interesting findings in this research was the fact that families often had shared views when it came to the acceptability of physician aid in dying,” added Ganzini. “When we communicated with the family members of those who received aid in dying, 98 percent said they would consider physician assisted suicide for themselves.”

This research was funded by the Greenwall Foundation.

Source
Jim Newman

What is one of the biggest complaints firefighters have about their job? Its their gloves. While the current gloves are designed to provide protection against extreme temperatures, they are often bulky and inflexible. Through a recent Federal Emergency Management Agency (FEMA) grant, researchers at North Carolina State University will attempt to redesign the traditional firefighter glove to provide fire protection with less bulk and greater hand dexterity.

“Firefighters frequently say that bulky gloves impede their ability to pick up things and turn knobs which can be critical in emergency situations,” says Dr. Roger Barker, professor of textile engineering chemistry and science, director of the Textile Protection and Comfort Center (TPACC), and lead researcher on the study. “There have been improvements in fabrics over the years. What we need now are advances in the functional design of the glove itself, to go along with the advances in glove materials.”

Barker and his team at NC State will begin their research by speaking with firefighters to discuss their needs and wants in a glove. Based on their feedback, the researchers will test a variety of textile materials for thermal protection, grip, breathability, insulation and flexibility among other characteristics and design prototypes of the next generation firefighter glove.

The testing of the glove will be conducted on TPACCs stateoftheart PyroHands Fire Test System a lifesized hand manikin made from a flame resistant composite that provides realistic simulation of a human hands response to intense heat exposures. PyroHands, which was developed through a grant from the U.S. Department of Defense, has 21 sensors 20 in the palm and back of the hands and wrists, and one in the middle finger that provide valuable data about the level of heat exposure and the predicted burns as result of a fire. PyroHands is an extension of the NC States PyroMan, a fully instrumented, lifesized manikin capable of evaluating the performance of thermal protective clothing with 122 individual heat sensors placed throughout the body. The system is part of a sophisticated facility that features computerized, animated analysis of the response of heat sensors to permit the study of garment and body reaction to intense heat and flames.

“By using PyroHands to test glove prototypes, we will be able to measure the distribution of fire protective insulation over the surface of the hands. This should help us develop improved glove designs by showing the locations on the glove where thickness and bulk might be reduced without compromising thermal protective performance,” Barker says.

This project is the latest of several grants NC State has received to support research that benefits the firefighting industry. In 2003, Barker and team received a grant from the U.S. Department of Homeland Security to develop a prototype of new firefighter turnout gear, which offered increased protection against heat and chemical and biological agents while also improving comfort and durability. Earlier in 2009, Barkers team received grants from the National Institute for Occupational Safety and Health and the National Fire Protection Research Foundation to develop a testing apparatus and measurement protocol that allow firefighter suits to be evaluated for their ability to prevent and minimize stored heat burns.

Source
Caroline M. Barnhill

Research published on bmj.com today reports that doctors could forecast a patients risk of receiving a domestic abuse diagnosis years in advance by using electronic medical records as an early warning system.

Dr Ben Reis from the Childrens Hospital Boston Informatics Program and Harvard Medical School is the lead author. Researchers investigated whether the amount of historical electronic data could be used to identify high risk patients.

Reis explains “Doctors typically do not have the time to thoroughly review a patients historical records during the brief clinical encounter. As a result, certain conditions that could otherwise be detected are often missed. One such condition is domestic abuse, which may go unrecognised for years as it is masked by acute complaints that form the basis of clinical encounters.”

In the United States, domestic abuse is the most frequent cause of nonfatal injury to women. Every year it accounts for more than half the murders of women. It affects both men and women and can result in serious injury and death. As a result, the authors state “it is critical that atrisk patients be identified as early as possible.”

There is proof that screening is a valuable tool in detecting domestic abuse. But the authors judge that doctors “may not be taking full advantage of the growing amounts of longitudinal data stored in electronic health information systems.”

An analysis was completed using medical records from over 500,000 nonidentifiable patients over 18 years of age. For these individuals, there was at least four years of data on admissions to hospital and visits to emergency departments. There were over 16 million diagnoses, from which some were identified as cases of abuse according to established recordkeeping codes.

A scoring system was developed by the researchers. It predicted which patients were likely to receive a domestic abuse diagnosis. The system was effective in predicting future diagnoses of abuse an average of 10 to 30 months in advance.

Particular risk factors were strongly linked with a future diagnosis of abuse. The risk was highest after being seen in hospital or the emergency department for these events
For women
• injuries
• alcoholism
• poisoning
For men
• mental health conditions such as depression and psychosis

In addition, researchers developed a prototype riskvisualization environment. It provides clinicians with instant overviews of longitudinal medical histories and related risk profiles at the point of care. The authors explain “In conjunction with alerts for highrisk patients, this could enable clinicians to rapidly review and act on all available historical information by identifying important risk factors and longterm trends.”

Reis claims that these risk profiles could help doctors diagnose domestic abuse much earlier, perhaps many years in advance. He underlines that “With increasing amounts of data becoming available, this work has the potential to bring closer the vision of predictive medicine, where vast quantities of information are used to predict individuals future medical risks in order to improve medical care and diagnosis.”

“Longitudinal histories as predictors of future diagnoses of domestic abuse modelling study”
Ben Y Reis, assistant professor, Isaac S Kohane, professor, Kenneth D Mandl, associate professor
BMJ 2009; 339b3677
doi10.1136/bmj.b3677
bmj.com

Women have a particularly high stake in the health care reform debate because they “interact with the health care system more often” than men, “and so are more vulnerable to a system with soaring costs and with restrictions that hurt women especially,” the Christian Science Monitor reports.

Although more men than women are uninsured 46% to 38%, respectively women face greater hurdles in the existing health care system that reform legislation would address. For example, the House health reform bill (HR 3200) would ban “gender rating,” a practice by which health insurers charge women more than men for the same policies. Under the current system, a 25yearold woman typically pays 6% to 45% more than a man the same age for identical coverage, according to the National Womens Law Center. “The current market doesnt work very well for women,” Rep. Jan Schakowsky (DIll.), cochair of the Congressional Caucus for Womens Issues, said.

The House bill also would require insurers to cover maternity care, which many policies currently exclude or offer as a separate rider. Some insurers also deem a caesarean section a preexisting condition and reject domestic violence survivors for coverage. Both practices would be prohibited under the legislation, which would ban exclusions for preexisting conditions.

Women are more likely than men to become “economically vulnerable” and have difficulty paying medical bills, the Monitor reports. More than half of medical bankruptcies are filed by femaleheaded households, according to a recent study in the American Journal of Medicine. Women ages 55 to 64 are especially vulnerable, as they risk losing coverage as their spouses transition from employerbased coverage to Medicare, according to the Joint Economic Committee. JEC figures show that nearly 1.7 million women have lost health insurance during the recession 71% because of a spouses job loss and 29% because of their own job loss.

Members of the womens caucus are pushing for support of a public health care option as the best way to address these issues. “The public option is the strongest costcontainment piece to put into the bill,” Schakowsky said (Feldmann, Christian Science Monitor, 9/25).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Autism, depression, anxiety. Antipsychotic drug side effects. What are the genetic and environmental factors that underlie and contribute to these complex problems? And how do genes and environment interact to shape them?

To seek answers, the National Human Genome Research Institute and the National Institute of Mental Health has named the University of North Carolina at Chapel Hill a Center of Excellence in Genomic Science and awarded UNC $8.6 million over five years to fund a new Center for Integrated Systems Genetics, or CISGen.

In funding the grant to UNC for the first two years, NIMH will contribute about $6 million through the 2009 American Recovery and Reinvestment Act.

The new center will require “an exceptional diversity of scientific expertise from psychiatry to mouse genetics to computational biology,” says CISGen codirector Fernando PardoManuel de Villena, Ph.D., associate professor of genetics at the Carolina Center for Genome Sciences. “UNC is one of the few places in the US where this sort of project is possible, and the Center of Excellence award recognizes this.”

PardoManuel de Villena says that the crux of the problem is that “the genome is enormous, and there are billions of ways in which the pieces can act together. Its easier to win the PowerBall lottery than to get the right answer in humans.” The centerpiece of the UNC Center of Excellence is to use laboratory mice to screen all the possibilities to find the few that are likely. “We can use the mouse to narrow the search space from billions of possibilities to only hundreds or even dozens. Its like the PowerBall when you know four or five of the six numbers for sure.”

The CISGen team, codirected by Patrick Sullivan, M.D., Ray M. Hayworth and Family Distinguished Professor of Psychiatry in the department of genetics at the UNC School of Medicine, will integrate the study of genetics and neurobehavior using unique strains of laboratory mice derived from a mouse resource housed at UNC known as the Collaborative Cross. Sullivan also is a member of the Carolina Center for Genome Sciences, the Center under which CISGen will operate.

The Collaborative Cross is designed to be a vital mouse reference population for scientists exploring the genetic underpinnings of complex traits. The team will generate novel strains of mice to study relevant behavioral traits. The resulting mouse models will then be used to focus genomic studies of human psychiatric disorders and predicting treatment outcomes.

“We chose the hardest problems out there, the ones that have been most resistant to scientific inquiry in humans,” Sullivan says. “We chose to study mouse versions of psychiatric traits potentially relevant to autism, depression and anxiety, and antipsychotic drug side effects and response to treatment.”

Sullivan says the team also chose the hardest twist on this problem, how the environment interacts with the genome. “We want to understand how genes and environments interact to influence these traits so well that we can predict whether they will occur in mice never before studied. These sorts of studies are straightforward in mouse but exceptionally hard in people.”

Other Carolina Center for Genome Sciences investigators on the project include Daniel Pomp, David Threadgill, Fred Wright, Fei Zou, Wei Sun, Wei Wang, and Leonard McMillan. Other investigators include Lisa Tarantino (Psychiatry), Sheryl Moy (Psychiatry), Gary Churchill (The Jackson Lab), and Elena de la CasaEsperon (UT Arlington). The web site for CISGen is compgen.unc.edu/cisgen.

A scientist at the La Jolla Institute for Allergy & Immunology has received one of the National Institutes of Health (NIH)s top awards the 2009 NIH Directors Pioneer Award. The prestigious prize carries with it funding for total costs of up to $4.7 million over five years, and is designed to support the work of exceptionally creative scientists, whose novel proposals offer the potential to make extraordinary contributions to human health.

Hilde Cheroutre, Ph.D., received the award during the Pioneer Award Symposium at the NIH headquarters in Bethesda, Maryland. NIH Director Francis S. Collins, M.D., Ph.D., announced the winners. Dr. Cheroutre is one of a select group of 18 scientists nationwide chosen for the 2009 prize from among more than 2,300 applicants. The award will fund her innovative research proposal that, if successful, would create a new way of detecting, treating and possibly preventing autoimmune diseases, with the potential for identifying high risk for autoimmunity in newborns.

In announcing the winners, the NIH said the awards are part of its ongoing efforts to encourage highly creative scientists to explore bold ideas that have the potential to catapult fields forward and speed the translation of research into improved health.

“Leaps in knowledge often result from exceptional minds exploring ideas that were considered risky at their inception, especially in the absence of strong supportive data,” said an NIH statement describing the awards. “The changing face of biomedical research calls for support of aggressive risktaking and innovation that will produce tomorrows conceptual and technological breakthroughs.”

Nilabh Shastri, Ph.D., a prominent scientist and immunology professor at UC Berkeley, who previously worked with Dr. Cheroutre, said her selection “justifies the existence of such awards.”

“Dr. Cheroutre possesses a remarkable and rare combination of abilities which have allowed her to make seminal research contributions,” said Dr. Shastri, noting that Dr. Cheroutres previous discoveries have opened up novel avenues of research on the molecular mechanisms of immunological memory, regulatory T cells and autoimmunity. “She not only questions dogmas, but also designs appropriate experiments and has the persistence to carry through until the problems are resolved. She is simply one of the best.”

Dr. Cheroutres proposal focuses on pinpointing specific molecular and genetic events that, she believes, could lay at the basis of susceptibility to autoimmunity. She also will work toward developing innovative treatment, and even more farreaching approaches, that might prevent autoimmunity in those susceptible individuals. Autoimmunity occurs when the bodys white blood cells mistakenly attack normal cells. This leads to a host of disorders such as type 1 diabetes, multiple sclerosis and rheumatoid arthritis. “Normally, the immune system provides us protection against pathogens and the generation of transformed cancer cells,” said Dr. Cheroutre. “But in autoimmunity, the immune system does not seem to be able to distinguish bad from good cells. Its like the body gets caught in friendly fire. It can cause incredible selfdestruction.”

If Dr. Cheroutres premise is correct and she proves that certain cellular defects underlie autoimmunity it could allow for early detection of those individuals at high risk. “If true, it would enable us to detect at birth whether an individual is genetically prone to autoimmunity.”

The second part of her groundbreaking proposal would then come into play through the development of new therapies that could potentially prevent autoimmunity in those people identified as highly susceptible. Theoretically, similar treatments could also be used for those who have already developed autoimmunity.

“If successful, an individual could be treated very early on right after birth to prevent the disease from occurring or they could be closely observed (medically) and the moment they start to show signs of autoimmunity, treatment could begin,” said Dr. Cheroutre. “This would enable treatment before autoimmunity starts up and gets out of hand. It is so important to stop or control these diseases before too much damage has occurred. They are kind of like cancer, in that once it gets too far along, it takes a huge toll.”

Dr. Cheroutres bold proposal is not her first venture into unconventional thinking. In fact, she is a world renowned expert on mucosal immunity, whose findings over the years have frequently bucked conventional wisdom on the immunology of the intestines or broken new ground in immunology in general. Such was her 2007 discovery that retinoic acid, a vitamin A derivative, can play a critical role in controlling inflammation in the body, which is the chief cause of inflammatory bowel disease, rheumatoid arthritis and several other autoimmune diseases. Nature Medicine named it one of the key biomedical research advances of the year. The finding was a departure from current understanding and opened a new frontier in inflammation research.

This, of course, is just the kind of researcher the NIH is looking for with its Pioneer award. The NIH selects the recipients through a special application and evaluation process. Distinguished outside experts identify the most highly competitive applicants. The Advisory Committee to the Director, NIH, performs the second level of review and Dr. Collins makes final decisions based on the outside evaluations and programmatic considerations.

Unlike the predominant form of NIH research grants that require heavy documentation and significant preliminary data, the Pioneer award does not seek preexisting data from applicants, since they are dealing with novel concepts that have not yet been tested. Instead, the selection committee looks for highly creative proposals put forth by exemplary researchers, along with proof of past innovation and a record of success.

Dr. Cheroutre said her proposal is based on logic, reason and previous information she garnered in her studies of the mucosal immune system. “It really is my knowledge from the mucosal immune system, and the mechanisms by which the body chooses to tolerate or attack certain substances, that I used to reason and make this proposal,” she said.

Dr. Cheroutre finds the Pioneer award both exhilarating and challenging. “The NIH is giving recipients the chance to explore our most imaginative concepts. Its a once in a lifetime opportunity. I hope that the opportunity given to me with this award will ultimately lead to innovative and advanced knowledge that can help to prevent autoimmunity from occurring and effectively treat those people who already suffer from autoimmune diseases.”

Source
Bonnie Ward