Painkiller Overdose Deaths Strike New York City’s Middle Class

Drug overdoses are usually thought to afflict mainly the poor and troubled. But it looks like OxyContin and other opioid painkillers are changing the picture.

People in stable, middle-class neighborhoods are also dying from opioid overdoses, a study in New York City finds.

Opioids have become among the most popular drugs of abuse in the past decade, with deaths from overdoses of oxycodone, hydrocodone and codeine eclipsing those from heroin and cocaine combined.

Fatal overdoses from prescription painkillers more than tripled from 1991 to 2007, according to the Centers for Disease Control and Prevention.

To find out what was happening in New York City, researchers at Columbia University’s Mailman School of Public Health mapped the 447 unintentional deaths from opioid painkiller overdoses in its five boroughs from 2000 to 2006. They then compared those deaths to heroin overdoses and accidental deaths from other causes, such as falls and drowning.

The heroin deaths were mostly in low-income neighborhoods where many people struggle with crime, fractured families and untreated mental health problems.

The prescription painkiller deaths were more common in areas where you don’t see much heroin — solid working-class neighborhoods in Staten Island and parts of the Bronx.

“We were very surprised to see these very different patterns for heroin and analgesic,” Magdalena Cerda, an Columbia epidemiologist and lead author of the study, tells Shots.

That may be because people in those neighborhoods are more likely to be prescribed painkillers, Cerda says. “There you see a higher percentage of policemen, firefighters, construction workers,” she says. “They may have a higher percentage of back pain as a result of work-related injuries.”

It’s also easier to get an OxyContin prescription filled at pharmacies or physicians in middle-class neighborhoods, she adds. That’s backed up by earlier studies that found that pharmacies in low-income, minority neighborhoods in the city don’t have enough prescription painkillers to meet legitimate demand.

The findings were published in the American Journal of Public Health.

Cerda and her colleagues are trying to get funding to look more closely at Staten Island and figure out what’s going on there. Are people first prescribed these drugs, and then start using them recreationally? Or do they become addicted while using them as prescribed? “Overdose fatalities are just the tip of the iceberg,” she says.

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A bad fall in the hospital can turn a short visit into a long stay.

Such falls featured in congressional discussions about patient safety, and in a new study in the Journal of Patient Safety about medical errors. Falls are one part of a multi state clash between nurses and hospitals over how to improve the safety of hospitalized patients.

 In Washington state, hospitals are required to report falls that happen on their watch to the state health department.

Some hospitals have installed bed alarms to monitor patients prone to sleepwalking.

Gene White sits on his back porch near a garden fountain. Just walking there from his bedroom was an ordeal for the retired airline pilot. “I did have cancer, and it turned out to be lymphoma,” he says.

But White says it’s not cancer that has left him weak. Six months ago, after he’d recovered from his lymphoma, he went to Swedish Medical Center, Seattle’s largest hospital, for back pain. He was set to go home after an overnight stay.

“Four a.m. came, and I hadn’t slept a bit,” White says, so he called a nurse. “She says, ‘I’ll get you something.’ ”

That something was the sleeping pill Ambien. It’s one of a dozen sleep aids that the Food and Drug Administration says can lead to sleepwalking and even driving while asleep. The Mayo Clinic in Minnesota has found that hospital patients who have taken Ambien are four times more likely to suffer a fall.

“I went to sleep almost immediately, and I got in a dreamlike state,” says White. “I was flying a beautiful wooden-interior airplane about the size of a DC-3. I was having a hell of a good time.”

The next thing White knew, he was crumpled on the floor. “So, I had broken three ribs on my left side, hitting the wash basin,” he says.

Instead of going home that morning, he had to spend two more weeks in the hospital, then months in a nursing facility.

Hospitals in 39 states don’t have to report falls. In Washington state, they do. In 2012, falls injured or killed at least 92 hospital patients there.

Falls occur in a small fraction of the many thousands of hospital visits in Washington each year. But safety experts call bad falls “never events.” They should never happen inside the protective embrace of a hospital.

“Zero falls is certainly our goal,” says June Altaras, chief nursing officer at Swedish Medical Center. She says she can’t discuss White’s case because of privacy concerns.

But she says the hospital carefully assesses each patient’s risk of falling. The hospital considers anyone on sleeping pills to be high risk. They’re supposed to get special attention. That would include a bed alarm that goes off when a patient gets up.

“We wanted something very distinctive so you knew exactly what was going on, and you get there very quickly,” says Altaras. “It rises above the level of all the other noises in the unit.”

The alarm is a beeping rendition of the children’s song “Mary Had a Little Lamb.” It can be pretty annoying.

“We get complaints almost every day, patients begging the nurses to turn it off,” says Altaras. Annoying or not, alarms work at preventing falls, she says.

White says there was no alarm on his bed. At the time, some beds at Swedish had alarms; some didn’t. Last month, Swedish installed a brand-new fleet of hospital beds. All of them have alarms built in.

Nurses say alarms help, but are no substitute for good nursing. “You still need a person to be close enough nearby to be able to respond to the alarm,” says Bernedette Haskins, a nurse at Swedish.

Nurses’ unions say medical mishaps of all kinds often share a root cause: understaffing. “Every nurse has a story about being short-staffed, about working an entire 12-hour shift without a break,” says Haskins.

The unions are pushing state and federal legislation to force hospitals to beef up nursing staffs. Hospitals say they can reduce errors without government-mandated hiring.

The Washington hospital with the most falls in recent years is Auburn Medical Center. Last year, after new owners bought the small hospital, they overhauled its safety procedures and increased staff by more than 100. Hospital management says Auburn’s rate of falls fell by two-thirds in less than a year.

Source: https://www.healthleadersmedia.com

 

Outdoor air pollution: cause of cancer, says UN

The specialized cancer agency of the United Nations World Health Organization (WHO) announced today that outdoor air pollution is a leading environmental cause of cancer deaths.

An evaluation by the International Agency for Research on Cancer (IARC) Monographs Program found there is sufficient evidence that exposure to outdoor air pollution causes lung cancer and increases the risk for bladder cancer.

In a news release, the IARC pointed out that air pollution is already known to increase risks for a wide range of diseases, such as respiratory and heart diseases. Studies indicate that in recent years exposure levels have increased significantly in some parts of the world, particularly in rapidly industrializing countries with large populations.

The most recent data indicate that 223,000 deaths from lung cancer in 2010 resulted from air pollution.

“The air we breathe has become polluted with a mixture of cancer-causing substances,” said Kurt Straif, Head of the IARC Monographs Section. “We now know that outdoor air pollution is not only a major risk to health in general, but also a leading environmental cause of cancer deaths.”

The IARC Monographs Program, dubbed the ‘encyclopedia of carcinogens,’ provides an authoritative source of scientific evidence on cancer-causing substances and exposures. In the past, the Program evaluated many individual chemicals and specific mixtures that occur in outdoor air pollution.

These included diesel engine exhaust, solvents, metals, and dusts. But this is the first time that experts have classified outdoor air pollution as a cause of cancer.

“Our task was to evaluate the air everyone breathes rather than focus on specific air pollutants,” said Dana Loomis, Deputy Head of the Monographs Section. “The results from the reviewed studies point in the same direction: the risk of developing lung cancer is significantly increased in people exposed to air pollution.”

The main sources of outdoor air pollution are transportation, stationary power generation, industrial and agricultural emissions, and residential heating and cooking. Some air pollutants have natural sources, as well.

“Classifying outdoor air pollution as carcinogenic to humans is an important step,” stressed IARC Director Christopher Wild. “There are effective ways to reduce air pollution and, given the scale of the exposure affecting people worldwide, this report should send a strong signal to the international community to take action without further delay.”

Source: http://www.un.org

Poor coping skills linked to kids’ lower quality of life

Kids who dwell on or “catastrophize” chronic stomach pain is likely having lower quality of life than kids with a better attitude.

 However, the study showed that parents can help their children learn to cope, Fox News reported.

Study co-author Claudia Calvano of the University of Potsdam in Germany said that if the kids think, ‘My pain will not stop,’ then this can lead to further impairment and increase psychological strain.

The researchers looked at two types of stomach pain, organic pain- the kind for which doctors can identify a medical cause, and another type was functional pain- with no clear source.

They examined data on 170 kids and teenagers ages 8 to 18 and found that poor coping skills, and not gender, economic status, or type of abdominal pain, was directly tied to lower quality of life scores.

Calvano said that it is very important that a parent acknowledge the pain and not deny it, but he or she then needs to introduce the child to healthy coping strategies.

The researchers also suggested that cognitive behavioral therapy (CBT) is a way to better handle the pain

Source: medindia.com

Elusive Secret of HIV Long-Term Immunity

Discovery offers hope of new, shorter HIV treatment if drugs are started right away

Scientists have discovered a critical new clue about why some people are able to control the HIV virus long term without taking antiviral drugs. The finding may be useful in shortening drug treatment for everyone else with HIV.

These rare individuals who do not require medicine have an extra helping of a certain type of immune protein that blocks HIV from spreading within the body by turning it into an impotent wimp, Northwestern Medicine® scientists report. The new finding comes from analyzing cells from these rare individuals and HIV in the lab.

Scientists have been trying to solve the mystery of why 1 percent of people with HIV — called “controllers” — have enduring control of the virus without medications, in some cases for life. The controllers’ early defense against HIV is quickly extinguished by the virus, so how do they have long-term immunity? The Northwestern discovery represents what scientists have long sought: a second line of defense deep in the immune system backing up the short-lived early defense.

This discovery suggests a novel approach involving much earlier treatment that could potentially make every HIV-infected person into a controller for the long term by protecting the reserves of this defensive immune protein. The goal would be for them to eventually be free from anti-retroviral drugs.

Currently most HIV patients need to take powerful anti-retroviral drugs every single day for life. If the medicines are stopped, the virus quickly reactivates to harmful levels even after years of treatment.

“Preserving and even increasing this defense in cells may make more HIV-infected persons into controllers and prevent HIV from rebounding to high and damaging levels when anti-HIV medications are stopped,” said Richard D’Aquila, M.D., the director of the Northwestern HIV Translational Research Center. He is the senior author of the study, which will be published Oct. 16 in the journal PLOS ONE.

D’Aquila also is the Howard Taylor Ricketts Professor of Medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital.

D’Aquila and colleagues now are working to develop a medicine that would boost this defensive immune protein called APOBEC3G, or A3 for short. 

The Missing Second Defensive Line

Much is known about how the immune system of controllers initially fights the virus. But HIV quickly escapes from that first line of defense by mutating and evading the adaptive immune system. How these individuals control HIV long term without medications to keep from developing AIDS has been under study by many researchers? It seemed there must be a second defensive line in the immune system.

Turning HIV Into a Wimp

In the new study, D’Aquila and his team have found that controllers, long after they have acquired HIV, have a more abundant supply of the critical immune protein A3 in specific white blood cells called resting memory T cells. This is where the virus lies silently in an inactive form and roars back when anti-retroviral drugs are stopped. In controllers, though, their bounty of A3 means that any new HIV made from those cells inherits a helping of A3, which turns the new viruses into harmless wimps that can’t infect other cells.

You Can’t Fool A3

The feisty A3 is a critical part of the newly characterized intrinsic immune system, and it resides in many cells of the immune system including resting T cells. Unlike the adaptive immune system, which fails to recognize the virus once it mutates its pieces, the intrinsic immune system can’t be fooled.

“The intrinsic immune system recognizes the basic guts of the virus — the nucleic acids — that HIV can’t change and then damages those nucleic acids,” D’Aquila said.

D’Aquila theorizes that the controllers’ first line of defense slows down the ability of HIV to destroy all the A3.

“Perhaps starting anti-HIV drugs very soon after HIV is caught, rather than the current practice of waiting until later to start, would work like the controllers’ first line of defense,” D’Aquila suggested. “If we preserve A3, it could minimize HIV’s spread through the body as this protein seems to do in controllers.”

Otherwise, D’Aquila theorizes, all reserves of the protein are wiped out if HIV replicates unchecked for several months.

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Delhi Hospitals Overflow With an Annual Plague of Dengue

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Factory worker Mohammad Awwal is gripped by fever, sweats and the sort of agonising aches that mean his condition is sometimes called “breakbone disease”. It’s an annual plague in India and a hidden epidemic, say experts.

Dengue fever is a mosquito-borne disease with no known cure or vaccination that strikes fear into the citizens of New Delhi when it arrives with the monsoon rains — just as the scorching heat of the summer is subsiding.

Hospital wards are overwhelmed and tales abound of deaths and cases while New Delhi public authorities insist that only 3,500 have fallen sick so far this year — with only five fatalities.

“I took him first to a government hospital. I was shocked to see that it was packed with dengue patients. There was not even a single bed available,” said Awwal’s mother, Mehrunissa, sitting in her one-room shack in east Delhi.

She is now treating him at their home, giving him multi-vitamins, paracetamol and water as he lies on the floor with two pillows and a bedsheet but no mattress.

In a sign that this year’s outbreak could be as bad as record-breaking 2010, the city’s largest public hospital, Hindu Rao, announced earlier this month that it had suspended all routine surgeries to make room for more dengue patients.

The Delhi government has blamed prolonged monsoons for the hike in infections, but says it has added beds at hospitals and increased resources for spraying insecticides to tackle the mosquito menace.

“It’s nothing to worry about, there is no crisis,” Charan Singh, additional director of Delhi health services, told AFP, dismissing allegations that the city of 17 million under-reports the problem.

“It is a lot of hype going on… The government is in action and we report all cases according to international guidelines,” he added.

Fear of a panic?

The virus — first detected in the 1950s in the Philippines and Thailand — affects two million people across the globe annually, with the number of cases up 30 times in the last 50 years, according to the World Health Organisation.

Transmitted to humans by the female Aedes aegypti mosquito, it causes high fever, headaches, itching and joint pains that last about a week. There are four strains, one of which can cause fatal internal bleeding.

In India, cases have increased sharply over the last five years — there have been 38,000 so far in 2013 — but doctors say these numbers only capture part of the problem.

At the All India Institute of Medical Sciences (AIIMS), India’s most prestigious public hospital, doctors are overwhelmed by patients whose beds are squeezed together like Tetris tiles in the emergency ward with saline drips nailed to the walls.

Medics, speaking on condition of anonymity, told AFP that they were seeing 60 new dengue patients a day — an influx they suspected was not reflected in the official figures.

“Maybe it’s because they don’t want to create panic or because they don’t want to be blamed, but if they hide, people won’t know how bad the situation is,” said one doctor.

The former health chief at the Municipal Corporation of Delhi (MCD) said that only positive results from one of the two standard dengue tests — known as ELISA test — was registered.

“There is gross under-reporting of these cases every year. I believe the real numbers are always three times higher than those projected by the MCD,” V.K. Monga told AFP.

Sandeep Budhiraja, internal medicines director at private Max Healthcare hospital in Delhi, blamed city authorities for failing to be prepared and said cases would only decline with the onset of winter next month.

“It’s an epidemic that hits the country every year, yet there is never any preparedness by officials. It just keeps getting worse,” said Budhiraja, adding that Max had opened its fever wards to accommodate dengue patients.

‘No luck’ with treatments

While dengue is painful and debilitating, death is usually rare but patients are vulnerable to other fatal viral infections during or shortly after the time of illness.

There is still no specific treatment, but last year French healthcare giant Sanofi Pasteur said it would begin tests for a dengue vaccine in India before making it available internationally by 2015.

A leading Brazilian biomedical research institute, Butantan, also said last month it was working on a new dengue vaccine that they hoped would be ready by 2018.

British firm Oxitec has also created genetically modified sterile male Aedes mosquitoes – what they call “birth control for insects” – but met with severe criticism for releasing unnatural species into the environment.

The only defence so far is preventive steps, like removing stagnant water near residential areas, spraying insecticide, applying mosquito repellent and wearing long sleeves and trousers.

Many victims in India gulp down papaya-leaf juice believing it to boost blood platelet levels, which are decimated by the virus.

“It is a largely preventive, self-limiting virus, but we still hardly invest in research for treatments,” said Budhiraja from Max Healthcare.

“There are only some vaccines being tried out, but no luck yet.”
Read more: http://newsinfo.inquirer.net/510759/delhi-hospitals-overflow-with-hidden-dengue-epidemic#ixzz2iKXoWyCi

Study Shows How Melanoma can Become Drug Resistant

A process involving the phenotypes of tumor cells could change the appearance of melanoma tumors, say researchers. Identifying the phenotype patients exhibit may help determine which patients are more likely to benefit from existing medications while also providing an opportunity to create new targeted therapies.

Senior correspond author Ashani Weeraratna, Ph.D., Assistant Professor in the Tumor Microenvironment and Metastasis Program of Wistar’s NCI-designated Cancer Center, and her team focus on Wnt5A, a Wnt signaling molecule that has been found in increased levels in metastatic melanomas.

In order for Wnt5A to promote the phenotype switch from early in the tumor’s formation to the time it becomes metastatic, the tyrosine kinase receptor ROR2 is required. When ROR2 is not present, Wnt5A is unable to promote tumor metastasis.

The only other member of the family that has been identified is ROR1, and this research was done to determine what role ROR1 might play in the progression of melanoma.

The researchers were able to determine that ROR1 inhibited the invasion of melanoma cells, and this receptor was targeted for degradation by Wnt5A and ROR2.

When ROR1 was silenced, the researchers observed that there was an increased rate of invasion of melanoma cells both in vitro and in vivo. The researchers also found that hypoxia – areas of low oxygen supply in the tumor – is able to induce a switch from ROR1 to ROR2 and results in an increase in levels of Wnt5A, suggesting the switch from a non-invasive ROR1-positive phenotype to an invasive ROR2-positive phenotype occurs when the tumor is exposed to hypoxic conditions.

The researchers also found that a protein HIF1a is required to increase the Wnt5A expressed. When HIF1a was removed, ROR2 was decreased, indicating that the up regulation of ROR2 via HIF1a requires Wnt5A.

The findings have been published online in the journal Cancer Discovery.

Read more: http://www.medindia.net

Soon, single universal jab to give lifelong protection against all flu strains

A single flu vaccine that would protect against all strains of the virus for life may be coming soon, which could make annual flu jabs that cost the NHS around 100m pound per year a history.

Scientists working on the universal flu jab, known as Flu-v, are in the early stages of development but hope to offer a product to the NHS within three to five years.

The company behind the drug, SEEK, will present the results of a small-scale clinical trial at the Influenza Congress in Washington DC on Tuesday.

Results so far have shown that it can significantly reduce infection rates and also cut the severity of symptoms.

Because flu is so changeable, pregnant women, the elderly and other ‘at risk’ groups are given a new injection every year.

The flu virus regularly mutates its `outer coat`, which is what a vaccine usually targets.

But the team behind Flu-v has managed to isolate a thread common to all strains of flu and by targeting that element, rather than the changing `outer coat`, the vaccine can cater for all requirements.

That means it would protect against strains of bird flu and swine flu, as well as seasonal variants.

`The trial suggest was only need one shot of vaccine,` the Daily Mail quoted Gregory Stoloff, the chief executive of SEEK as telling The Telegraph.Our aim is for the flu vaccine to become more like the mumps and measles – where you only need it once and you get protection for a long time,` he stated.

Source: http://food.sify.com

 

Open-air burning of funeral pyres : a source of carbon aerosols

Smoke from open-air burning of funeral pyres in India and Nepal is a significant source of production of carbon aerosols, a new study has claimed.

Rajan Chakrabarty, Ph.D., an assistant research professor at the Desert Research Institute, began looking into the regional inventories of human-produced sources of carbon aerosol pollution in South Asia, considered to be a climate change hot spot, he knew something was missing.

Chakrabarty said that current emission inventories do not account for cultural burning practices in Asia as aerosol sources.

Teaming up with Shamsh Pervez , Ph.D., a professor of Chemistry at the Pandit Ravishankar Shukla University, India and a 2011 Fulbright fellow to DRI, Chakrabarty designed and executed a comprehensive study to investigate the nature and impact of pollutant particles emitted from the widely-prevalent cultural practice of open-air funeral pyre burning in India and Nepal.

More than seven million pyres, each weighing around 550 kilograms, are burned every year throughout India and Nepal and these pyres consume an estimated 50 to 60 million trees annually.

Chakrabarty and colleagues found to their surprise that funeral pyre emissions contain sunlight-absorbing organic carbon aerosols known as brown carbon.

In the past, numerous studies have identified black carbon aerosols emitted from combustion of fossil fuels and residential biofuels as the dominant light-absorbing aerosol over South Asia.

The researchers estimate the mean light-absorbing organic aerosol mass emitted from funeral pyres to be equivalent of approximately 23 percent of the total carbonaceous aerosol mass produced by anthropogenic burning of fossil fuels, and 10 percent of biofuels in the region.

The study has been published in Environmental Science and Technology Letters.

Source: http://www.aninews.in/

Study shows how Staph toxin disarms the immune system

Researchers at NYU Langone Medical Center have discovered a new mechanism by which the deadly Staphylococcus aureus bacteria attack and kill off immune cells. Findings, published in the journal Cell Host & Microbe, explain a critical survival tactic of pathogen that cause more skin and heart infections than any other microbe and kills more than 100,000 Americans every year.

“What we’ve found is that Staph unleashes a multi-purpose toxin capable of killing different types of immune cells by selectively binding to surface receptors,” says Victor J. Torres, PhD, assistant professor of microbiology, and senior author of the study. “Staph has evolved the clever ability to target the immune system at different stages.”

Scientists have long known that Staph releases an arsenal of toxins to puncture immune cells and clear the way for infection. But only recently have they begun to understand exactly how these toxins work. Earlier this year, Dr. Torres and his team published a paper in Nature explaining how one of those toxins, a protein called LukED, fatally lyses T-cells, macrophages and dendritic cells, all types of white blood cells that help fight off infection. The LukED toxin, they showed, binds to a surface receptor called CCR5 (the same one exploited by HIV). “It attaches to the surface receptor and then triggers pore formation,” says Dr. Torres. But their discovery failed to explain how the bacterial toxin kills other types of white blood cells, such as neutrophils, that lack the CCR5 receptor.

Their most recent work solves this puzzle, showing for the first time how receptors on neutrophils (a common type of white blood cell) also enable binding of the LukED toxin. The researchers found that LukED latches onto surface receptors called CXCR1 and CXCR2, creating the same deadly pores that it does when it latches onto CCR5 receptors. “The mechanism is the same,” says Dr. Torres. “The strategy makes Staph deadlier in mice.”

Neutrophils are the first responders. Upon infection, they race through the bloodstream to kill off the invading pathogen. “They’re like the marines of the immune system,” Dr. Torres says. T-cells, macrophages and dendritic cells rush in later, mounting a secondary attack to help the body clear the pathogen and remember it in the future. “Killing off the first responders completely disarms the immune system,” Dr. Torres says.

LukED is just one piece of the puzzle, and more research is needed to understand other Staph toxins and how they work together to make the microbe deadlier. However, these recent insights hold promise for new medications that target LukED. Better treatments against Staph are desperately needed. In 2005, the Centers for Disease Control and Prevention estimated that more than half of the 478,000 people hospitalized for staph infections were resistant to methicillin, one of the most potent antibiotics available.

One therapeutic strategy is to block CCR5 receptors and spare the secondary immune response. “We know we can block CCR5 receptors without crippling the rest of the immune system. Some people lack CCR5 and they are perfectly healthy and immune to HIV as well,” Dr. Torres says. “But just blocking CCR5 isn’t enough.” Drugs are available to block CXCR1 and CXCR2 receptors, but those will impair neutrophil recruitment and function. “The lesson is to target the toxin itself and prevent it from attaching to any receptors,” Dr. Torres adds. “We have to think globally.”

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