• Health Policy
• Diseases and Conditions

• Mental Health
• Depression

• Public Health
• Social Issues

• Prison
• Athletic training
• Service dog
• Pediatrics

Yet historically, incarcerated populations have been mostly excluded from university-based health research, leaving critical questions related specifically to inmate populations largely unstudied and unanswered. This concern takes added urgency since the vast majority of incarcerated persons in the United States eventually return home, impacting the health of their communities.

"Excluding incarcerated patient populations from university-based research is increasingly viewed as thwarting needed advancements in public health," writes Newton E. Kendig, MD, assistant director, health services division, Federal Bureau of Prisons, in an introduction to the issue.

The first Academic and Health Policy Conference on Correctional Health, hosted by UMass Medical School, sought to bridge the gap between correctional health care and academic medicine. It linked academic researchers with correctional health care administrators and clinicians and with the broader public health community.

The three main articles summarize the work of three task forces from the Conference that focused on, respectively, primary care, infectious disease and mental health. The articles are Infectious Disease in Correctional Health Care: Pursuing a Research Agenda, Correctional Mental Health Research: Opportunities and Barriers, and Correctional Health Primary Care: Research and Educational Opportunities. The articles address the status quo in each area, identify areas in which research and education are especially needed, and highlight challenges.

"We hope this special section will inspire collaborations between academia and corrections to further the scope of research that is so vitally needed to improve health outcomes," said JCHC editor John Miles, MPA. "Such efforts promise great benefits not only for thousands of inmates but also for the health of the public as a whole."

Journal reference:

1. Kendig, Newton E. Introduction. Journal of Correctional Health Care, 2008 14: 260-262 DOI: 10.1177/1078345808322735

• Stem Cells
• Brain Tumor
• Immune System
• Lymphoma
• Lung Cancer
• Cancer

• Peripheral vision
• Inflammation
• Axon
• Natural killer cell

Patrick T. Caswell and colleagues report their findings in the latest issue of the Journal of Cell Biology.

On 2D surfaces, cells may migrate randomly, or be strongly unidirectional. Integrins, which link the cell to the extracellular matrix, are known to influence the mode of migration, but exactly how has been unclear. Recent work has suggested that an integrin called a5b1 drives random movement, while an integrin called avb3 has been associated with unidirectional migration—the balance of activity between the two determining the type of movement.

To further explore the contribution of a5b1 to random migration, the authors thus blocked avb3.

The treated cells changed their mode of migration from unidirectional to random, and their ability to invade 3D gels increased. The changed behavior correlated with an increase in trafficking of a5b1 from intracellular compartments to anterior membrane protrusions. But this increase in trafficking did not significantly alter a5b1's contribution to cell adhesion—the ease with which cells were dislodged from a spinning disk increased as the amount of avb3 was reduced, but was not correlated with any change in a5b1. This suggested that the cells' increased invasive ability was due to alteration in some other property. That property turned out to be activation of a proinvasive pathway headed by a kinase called Akt.

In avb3-blocked cells, a5b1 became associated with epidermal growth factor receptor 1 (EGFR1), which increased EGFR1's abundance at the membrane protrusions, as well as its autophosphorylation. Because EGFR1 is an activator of the Akt pathway, hey presto, the cells took on some new moves.

Journal reference:

1. Patrick T. Caswell, May Chan, Andrew J. Lindsay, Mary W. McCaffrey, David Boettiger, and Jim C. Norman. Rab-coupling protein coordinates recycling of %u03B15%u03B21 integrin and EGFR1 to promote cell migration in 3D microenvironments. J. Cell Biol., 2008; 183: 143-155 DOI: 10.1083/jcb.200804140

• Colon Cancer
• Genes
• Prostate Cancer
• Human Biology
• Breast Cancer
• Cancer

• Pap smear
• Colorectal cancer
• Mammography
• Irritable bowel syndrome

"But the concerns we identified with stool DNA testing are all solvable," says David Ahlquist, M.D., lead researcher in the study that included 4,482 participants and 22 academic medical centers. Researchers have hoped that stool DNA testing could be the user-friendly and accurate screening tool that would increase screening numbers.

More than half of adults in the United States have never been screened for colorectal cancer, the second-leading cause of cancer deaths. While available screening tools work, the most effective tests involve time, effort and costs. For example, colonoscopy requires fasting, bowel cleansing, a physician visit, sedation, an invasive procedure and lost work time -- factors that contribute to low screening participation.

This blinded study, conducted from 2001 to 2007, compared screening effectiveness of two widely used fecal blood tests (Hemoccult and HemoccultSensa) with a stool DNA test in average-risk patients, ages 50 to 80. The DNA test used was the prototype for PreGenPlus, the first commercially-used stool DNA test, and was performed on samples sent to EXACT Sciences in Marlborough, Mass. All participants underwent a colonoscopy, the gold standard in current screening. Researchers used colonoscopy as the benchmark to detect cancer or precancerous polyps.

In the fecal blood screening, lab technicians searched for unseen traces of blood from stool that patients smeared onto a card. The presence of blood might indicate colorectal cancer. However, tumors bleed intermittently, which limits the test's accuracy for cancer detection. Three stool samples were tested for blood for each participant, the typical approach for fecal blood screening.

In DNA testing, researchers used sensitive laboratory tools to identify DNA from cells shed from cancer and precancerous polyps in stool samples. Only one sample was required because DNA shedding is believed to be continuous.

At about the study's halfway point, when 2,497 patients had been tested, researchers compiled an interim analysis. "All stool tests performed suboptimally," says Dr. Ahlquist. "The stool DNA test detected 20 percent of cancer and precancerous polyps, compared to 11 percent by Hemoccult and 20 percent by HemoccultSensa."

"We didn't think that stool DNA test performance was good enough to justify continuing without some changes," he says. Dr. Ahlquist and colleagues switched to a second-generation DNA test with improvements including a better method to capture DNA from stool and a more accurate panel of DNA markers.

With those changes, the stool DNA test performed significantly better than either of the fecal blood tests. "The new DNA test detected half of all the cancers and large polyps," says Dr. Ahlquist. In comparison, Hemoccult detected only one-sixth of cancers and large polyps, and HemoccultSensa found one-fourth of cancers and large polyps.

Importantly, the second-generation DNA test detected 46 percent of the precancerous polyps, compared to 10 percent detected by Hemoccult and 17 percent by HemoccultSensa. "If the premalignant polyps are not detected, cancer cannot be prevented. So, this result was most encouraging," says Dr. Ahlquist.

Dr. Ahlquist noted that the study, funded by the National Cancer Institute, honed in on weaknesses in the stool DNA screening that can be fixed to make it a more practical, accurate screening tool.

Sample degradation: Study participants were provided kits to collect and mail stool samples. When the samples arrived at Mayo Clinic's laboratory two to three days after collection, much of the DNA in samples had degraded and was not usable. "We have learned that adding a preservative at the time of collection eliminates DNA breakdown and can boost tumor detection rates further," says Dr. Ahlquist. That step will be important in future patient screening, should the test become widely available.

DNA markers: Markers used in the first-generation DNA test missed many polyps and cancers — evident in the low detection rate in the interim results. "The second-generation screen, with a broader assay, improved results," says Dr. Ahlquist. "We will be able to select even more accurate marker combinations for future tests."

DNA detection: Detecting the minute amounts of tumor DNA in stool is very challenging. Tumor DNA may account for less than one-millionth of total stool DNA. The instruments used to measure DNA for the interim results could not always detect the DNA. Since then, Mayo Clinic and others have improved the sensitivity of the measurement tools using digital polymerase chain reaction (PCR), a technique to duplicate DNA, and other analytical techniques.

"To prevent colorectal cancer deaths, we need an easy-to-use screening tool that consistently finds precancerous polyps," says Dr. Ahlquist. "Stool DNA testing is evolving quickly and may soon fill that need."

Earlier this year, the American Cancer Society endorsed stool DNA testing to detect colorectal cancer. Dr. Ahlquist advises that current hurdles to its use are that it is not widely available, has not been approved by the U.S. Food and Drug Administration, and is not covered by most insurers.

• Pregnancy and Childbirth
• Genes
• Birth Defects
• Down's Syndrome
• Hypertension
• Diseases and Conditions

• Stillbirth
• Miscarriage
• Somatic cell
• Pregnancy

But a new prenatal test could make this dilemma obsolete. The new method, developed by scientists at Stanford University, the Howard Hughes Medical Institute and Lucile Packard Children's Hospital, requires only a maternal blood sample to spot chromosomal disorders such as Down syndrome.

"Right now, people are risking their pregnancies to get this information," said Yair Blumenfeld, MD, a postdoctoral medical fellow in obstetrics and gynecology and co-author of a paper describing the technique. Current prenatal gene tests, such as amniocentesis and chorionic villus sampling, require inserting a needle in the uterus and carry a miscarriage risk of around half a percent.

"Non-invasive testing will be much safer than current approaches," said Stephen Quake, PhD, professor of bioengineering and the study's senior author. The new technique, which takes advantage of fragments of fetal DNA in the woman's blood, will be published online the week of Oct. 6 in the Proceedings of the National Academy of Sciences. Safety may not be the only gain. Quake hopes the test will spot genetic problems much earlier in gestation than the other methods.

The new method scans for fetal aneuploidy, an abnormality in the number of fetal chromosomes. Humans typically inherit 46 chromosomes, half from each parent. Errors in chromosome number cause serious problems in physical and mental development. Down syndrome, for example, arises from an extra copy of chromosome 21.

The Stanford/Packard team developed a way to count chromosomes using bits of fetal DNA in a pregnant woman's blood. Other scientists had struggled to tease these tiny genetic clues apart from a mom's DNA, said Quake, who is also an HHMI investigator. His team made an ingenious simplification: their new method has no need to distinguish between maternal and fetal DNA.

First, using samples from 12 women with aneuploid pregnancies and six with normal pregnancies, the researchers separated maternal blood into cells and plasma. They discarded the blood cells, focusing on the liquid plasma's DNA fragments, which come from both the mom and the fetus. They counted the number of DNA fragments and used DNA sequencing to read each one.

"You randomly sequence whatever is there," explained Christina Fan, a doctoral student in bioengineering who was the study's lead author. The DNA fragments are 25-30 base pairs long, she said, long enough to match each fragment to a specific chromosome. The researchers tallied how many gene fragments originated from each chromosome. Women with Down syndrome pregnancies had more chromosome-21 fragments in their blood than women with normal pregnancies. Other forms of aneuploidy could be detected, too.

Because fetal DNA shows up in maternal blood quite early in pregnancy, the team says their technique could provide a much earlier diagnosis for fetal aneuploidy than is now available.

"The earlier you know you've got a fetus with Down syndrome, the better able you are to prepare," Quake said, noting that the benefit holds both for women who keep and those who terminate such pregnancies.

The next step, the scientists say, is to repeat their study in a larger number of women. If their technique holds up in further research, they expect that it would be simple and inexpensive to use in clinical settings, especially as other forms of genetic testing also become popular. Quake expects it will take the new test two to three years to reach the clinic, assuming that the larger trial is successful.

"This technique is on the leading edge of a flood of different ways that rapid DNA sequencing will be used in medicine," Quake said.

Stanford is filing a patent application for the new technique, and Quake consults for two potential licensees. In addition to Fan and Blumenfeld, Quake's team included Usha Chitkara, MD, professor of obstetrics and gynecology at Stanford and Packard Children's, and Louanne Hudgins, MD, director of perinatal genetics at Packard Children's and professor of pediatrics. The study was funded by the Wallace H. Coulter Foundation and the NIH Director's Pioneer Award.

Regional health authorities, which were disbanded in May in favour of one "superboard," have already spent the money they were given to cover retirement benefits for health executives, said auditor Fred Dunn.

'Fiscal management was not one of their strong points.' —Scott Hennig

The money for supplementary retirement plans (SRPs) wasn't put into accounts to earn interest. Instead, the cash went into general revenues and was spent by the health regions.

"The government was paying the health regions for the executive compensation, these SRPs, but the money wasn't being set aside. So there's a danger and I believe it's happening right now, of paying for it twice."

Scott Hennig, a spokesman with the Canadian Taxpayers Federation, calls it mismanagement and says Albertans should be outraged.

"It was pretty clear, at least from our standpoint, watching all of the various health boards run deficits, that fiscal management was not one of their strong points."

The new Alberta Health Services Board isn't commenting. The full cost will be made public later this week in a report.

Earlier this year, it was estimated that the supplementary retirement benefits for just one health executive, former Calgary Health Region CEO Jack Davis, will be more than $4 million.

The province spent $80 million merging Alberta's health regions, and an additional $97 million to cover the deficits of the regional health authorities.

Related

Internal Links

$550K paycheque for interim CEO of health superboard

$80M allocated for health superboard startup costs

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The pneumonia vaccine not only prevents the bacterial infection but the shot also seems to dramatically lower the risk of heart attacks in adults, a new Canadian study suggests.

Policy change delayed alarm signal over listeria, inspectors say

Inspectors with the Canadian Food Inspection Agency say their hands-on role at meat plants changed with a CFIA policy introduced three months before the listeriosis outbreak.

Fans may help prevent SIDS

Using a fan or opening a window could reduce the risk of sudden infant death syndrome by improving ventilation, researchers suggest.

Calgary study links appendicitis with air quality

New research from the University of Calgary suggests high levels of air pollution may increase the risk of appendicitis.

Traumatic brain injury common among homeless, study finds

More than half of the people who are homeless in Toronto are suffering from a traumatic brain injury, according to a new study that suggests early diagnosis and treatment may help stem the number of homeless people in major cities.

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• Colitis
• Pain Control
• Children's Health
• Joint Pain
• Fibromyalgia
• Obesity

• Appendicitis
• Diarrhea
• Gastroenteritis
• Inflammation

The scenario is not uncommon, experts say, because children with appendicitis don't usually have the classic symptoms of the condition, but pediatricians at the Johns Hopkins Children's Center say there are ways for doctors and parents to tell the difference early on between a potentially deadly burst appendix — which can kill in a matter of days, even hours — and a stomach bug.

Past research has found that half of appendicitis cases are misdiagnosed when they first present at the emergency room or the doctor's office and that up to 80 percent of appendicitis cases in children younger than 4 years of age end up in rupture.

Says emergency room pediatrician Jennifer Anders, M.D., of Hopkins Children's, who has seen her fair share of burst appendixes, "appendicitis should always be near the top of the list of potential culprits when a child has any abdominal pain, vomiting, and malaise," keeping in mind that many children don't have fever or lose appetite the way adults might.

Doctors recommend that children with prolonged or severe abdominal symptoms that do not go away or improve should be evaluated for ruptured appendix. Consider the following questions:

• Do blood tests indicate elevated white cell count?
• Does the child have diarrhea? Diarrhea, which can be a marker of bowel inflammation resulting from the infection caused by the burst appendix, often distracts doctors and puts them on a different track. Diarrhea may not be a classic sign of appendicitis, but it may signal a ruptured appendix.
• Did the child have vomiting, which later stopped?
• Was there sharp pain in the lower right portion of the abdomen, which later subsided and became dull and spread across the abdominal area? Paradoxically, as appendicitis worsens and the appendix ruptures, the acute pain is alleviated and transformed into more diffuse abdominal pain.

"It's counter-intuitive, but if that sharp pain improves or subsides and becomes more generalized, it's actually a bad sign," Anders says.

The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix before they reach the OR.

• Forensics
• Diseases and Conditions

• Public Health
• Educational Policy
• Justice

• Sports medicine
• Evidence-based medicine
• Athletic training
• Double blind

In their Essay, Neal Young (National Institutes of Health, USA), John Ioannidis (Tufts University School of Medicine, USA and University of Ioannina School of Medicine, Greece), and Omar Al-Ubaydli (George Mason University, USA) apply principles from the field of economics to present evidence consistent with a distortion.

There is an "extreme imbalance," they say, between the abundance of supply (the output of basic science laboratories and clinical investigations) and the increasingly limited venues for publication (journals with sufficiently high impact).

The result is that only a small proportion of all research results are eventually chosen for publication, and these results are unrepresentative of scientists' repeated samplings of the real world.

The authors argue that there is a moral imperative to reconsider how scientific data are judged and disseminated.

Journal reference:

1. Young et al. Why Current Publication Practices May Distort Science. PLoS Medicine, 2008; 5 (10): e201 DOI: 10.1371/journal.pmed.0050201

• Gastrointestinal Problems
• Breast Cancer
• Cancer

• Bacteria
• Microbes and More
• Mice

• Peptic ulcer
• Stomach cancer
• Heartburn
• Tumor suppressor gene

The review, published in the October issue of Cancer Prevention Research, a journal of the American Association for Cancer Research, found that people who had H. pylori strains carrying a gene called CagA were almost half as likely to get adenocarcinoma of the esophagus, a cancer that develops in the tube that passes food from the throat to the stomach.

"CagA- positive strains of H. pylori may decrease the risk of adenocarcinoma by reducing acid production in the stomach and, therefore, reducing acid reflux to the esophagus," said study co-author Farin Kamangar, M.D., Ph.D., a research fellow at the National Cancer Institute. "It may also work by decreasing the production of the hormone ghrelin, which is secreted from the stomach to stimulate appetite. A reduction in the level of ghrelin may lead to lower rates of obesity, an important risk factor for adenocarcinoma."

H. pylori, estimated to be present in about half the world's population, is a known cause of stomach cancer and ulcers. Advancements in sanitation and antibiotics have made H. pylori less common and have consequently lowered the incidence stomach cancer and ulcers. However, as H. pylori, including CagA-positive H. pylori, has become less common, esophageal adenocarcinomas have increased. The study suggests that the declining rates of H. pylori in developed populations may be partly responsible for this increase. Once a rare cancer, esophageal adenocarcinomas now constitute approximately half of all esophageal cancers cases in Western Countries like the U.S. and United Kingdom.

Although H. pylori was first discovered in the early 1980s, Kamangar says humans already had been living with the bacteria for 60,000 years. The bacteria were once present in the stomachs of just about everyone. Despite its potential for causing stomach cancer and ulcers, H. pylori's long history of co-existence with humans suggests it also may have some beneficial effects, including possible roles in reducing diarrheal diseases and asthma, Kamangar said.

For the study, Kamangar and co-author Farhad Islami of the University of Tehran in Iran analyzed results from 19 published studies examining the associations of H. pylori with esophageal adenocarcinoma and esophageal squamous cell carcinoma, another type of esophageal cancer.

• Children's Health
• Attention Deficit Disorder
• Infant's Health

• Child Psychology
• Child Development
• ADD and ADHD

• Burn (injury)
• Wound
• Scar
• Pediatrics

Severe scalds can be devastating for children because they can leave scars and wounds that can restrict movement. The study recommends extra protections, such as locking mechanisms and stepped-up warning campaigns, to reduce accidental injuries to children when they remove food from the microwave.

"Aside from efforts to set hot water heaters at or below 120 degrees, there have been few scald prevention efforts that have been effective," said Kyran Quinlan, MD, MPH, a study author and associate professor of pediatrics at the Medical Center.

Study author Lawrence Gottlieb, MD, professor of surgery and director of the Medical Center's Complex Wound Center, added that burns have long-lasting effects on appearance and physical function. "It is far better to prevent these injuries than to treat painful burns and try to fix the resultant scars," he said.

The researchers suggest that microwave ovens include a locking mechanism to make it difficult for young children to open a microwave after food or drinks have been heated. Many current models have an option to lock the oven which requires the user to hold the start or stop/clear button for three to four seconds before it will operate. However, this does not stop a child from opening the oven after something has been heated, the study noted.

The study focused on 104 patients less than 5 years old who were admitted to the Medical Center's Burn Unit between Jan. 1, 2002, and Dec. 31, 2004, for unintentional injuries, but not for tap water scalds. Researchers found that 90 percent of the 104 children were scalded by hot food or liquids.

Two unexpected patterns led up to the injuries. In the first, children between 18 months and 4 years were burned after they opened the microwave and removed hot foods or liquids themselves.

In the second, older children, ages 7 to 14, inadvertently burned younger children in their care. The incidents occurred when the older child accidentally spilled hot food on the young child, or when the younger child was being supervised by the older child.

Burn injuries were most frequent in children between 10 and 21 months old. Most injuries occurred while children were at home being cared for by their family or primary caregiver.

Treatment for children in the study involved skin grafts and an average hospital stay of eight days. Forty-five children suffered burns to more than 10 percent of their bodies. In some of the more severe cases, children endured prolonged intubation and tracheostomy, and developed wound infections. Seven children required inpatient rehabilitation.

"Microwaved foods and drinks can cause serious scald injuries to young children," study author Gina Lowell, MD, said. "While parents may well recognize the stove as a danger area in the kitchen, they may not realize that their toddlers can open the microwave, remove what was heated, and scald themselves."

The study added that major sources of safety information from parenting books, in addition to child and home safety organizations, inadequately address the threat posed by food heated in microwaves.

For youngsters, microwaves can be a playful attraction that leads to trouble. Children open and close it to imitate their parents' actions and may think of the microwave as toy.

Kyran Quinlan, Gina Lowell, and Lawrence Gottlieb are the authors of this study. Lowell was a pediatric resident at the University of Chicago Medical Center at the time of the study and is now with Rush University Medical Center.

• Psychology Research
• Nervous System
• Today's Healthcare

• Anxiety
• Psychology
• Social Psychology

• Phobia
• Fear
• General anxiety disorder
• Panic attack

"Generalized social phobia is characterized by fear/avoidance of social situations and fear of being judged negatively by others," the authors write as background information in the article. "It is the most common anxiety disorder in the general population, with the lifetime prevalence estimated at 13.3 percent, and it is associated with a high risk for depression, alcohol and drug abuse and suicide." Previous studies have found differences in the way brains of affected individuals respond to facial expressions, suggesting that the condition involves increased responsiveness to social stimuli in areas linked to emotion.

Karina Blair, Ph.D., and colleagues at the National Institute of Mental Health, Bethesda, Md., compared functional MRI (fMRI) scans of 17 unmedicated individuals with generalized social phobia to those of 17 controls who were the same age and sex and had the same IQ but did not have the disorder. "During fMRI scans, individuals read positive (e.g., You are beautiful), negative (e.g., You are ugly) and neutral (e.g., You are human) comments that could be either about the self or about somebody else (e.g., He is beautiful)," the authors write.

The patients with generalized social phobia showed increased blood flow in their medial prefrontal cortex and amygdala—areas of the brain linked to concepts of self as well as fear, emotion and stress response—when reading negative statements about themselves. However, there were no differences between the two groups in response to negative comments referring to others or neutral or positive comments referring to either self or others.

"Given that medial prefrontal cortex regions are involved in representations of the self, it might be suggested that these regions, together with the amygdala, play a primary role in the development and maintenance of generalized social phobia and that the pathology in the disorder at least partly reflects a negative attitude toward the self, particularly in response to social stimuli—that in generalized social phobia what engages the mind is others' criticism," the authors conclude. "This highly context-dependent response in generalized social phobia helps constrain existing models of the disorder and may thus guide future therapeutic formulations in the treatment of the disorder."

Journal reference:

1. Blair et al. Neural Response to Self- and Other Referential Praise and Criticism in Generalized Social Phobia. Arch Gen Psychiatry, 2008; 65 (10): 1176-1184 [link]