Chest X-Ray Screening Does Not Reduce Lung Cancer Mortality

October 26, 2011 (Honolulu, Hawaii) — The largest study yet to examine the issue shows that screening with chest radiographs does not reduce mortality from lung cancer, researchers reported here at CHEST 2011: American College of Chest Physicians Annual Meeting.

The results, which were also published online October 26 in JAMA, confirmed earlier research on the issue but still came as a disappointment. "We were hopeful the chest X-rays we did would make a difference," coauthor Paul A. Kvale, MD, told Medscape Medical News.

Putting these findings together with a those of study published in August in the New England Journal of Medicine, health policy groups are likely to recommend screening with low-dose computed tomography (CT), but not chest X-ray, and only for patients at high risk for lung cancer, said Dr. Kvale, a pulmonologist at Henry Ford Hospital in Detroit, Michigan.

For the current study, part of the Prostate, Lung, Colorectal and Ovarian Cancer Cancer Screening Trial, researchers enrolled 154,901 participants aged 55 through 74 years. "This was the biggest study of its kind ever done," said Dr. Kvale.

The investigators randomly assigned 77,445 of the patients to receive annual screenings with chest X-rays, and 77,456 to receive usual care, at 1 of 10 centers across the United States between November 1993 and July 2001.

They offered participants in the screening group annual posterio-anterior view chest radiographs for 4 years. The participants in the usual care group were not offered screenings as part of the study, although 11% undertook chest X-rays independent of the study.

Between 79% and 87% of the participants in the screening group got the X-rays offered each year.

Researchers followed-up the patients for a maximum of 13 years until December 31, 2009.

They tallied a lung cancer incidence of 20.1 per 10,000 person-years in the screening group and 19.2 per 10,000 person-years in the usual care group, for a rate ratio (RR) of 1.05 (95% confidence interval, 0.98 - 1.12).

They counted 1213 deaths from lung cancer in the screening group compared with 1230 in the usual care group, for an RR of 0.99 (95% confidence interval, 0.87 - 1.22).

The study avoided problems of previous studies, such as a large number of screenings in the control group, but still came up with the same bottom line, said Dr. Kvale.

Another important aspect of the study was its analysis of a subgroup of patients who were at high risk for lung cancer because of their age, smoking, and other factors. Just as in the study as a whole, researchers randomly assigned 15,183 members of this subgroup to screening, and the same number to usual care.

After 6 years of follow-up, 518 members of the high-risk screening group got lung cancer, and 316 died of the disease. In the high-risk usual care group, 520 got lung cancer and 334 died of it, for an RR of 0.94 (95% confidence interval, 0.81 - 1.10).

The high-risk group was intentionally selected to match a high-risk group in the National Lung Screening Trial, published in the New England Journal of Medicine. In that study, researchers compared high-risk participants screened with chest X-rays with high-risk patients screened with low-dose CT. They concluded that the low-dose CT screening reduced the mortality rate of these patients by 20%.

If low-dose CT screening is 20% better than X-ray screening, and X-ray screening is the same as usual care, then it would be logical to assume that CT screening is 20% better than usual care. However, more statistical analysis should be done before reaching that conclusion, writes Harold C. Sox, MD, from Dartmouth Medical School in West Lebanon, New Hampshire, in an editorial published along with the study in JAMA. New studies should directly compare usual care to low-dose CT-screening, Dr. Sox writes.

Still, the findings are already being taken into consideration by a coalition of groups working on new guidelines for lung cancer screening, said Frank C. Deterrbeck, MD, chief of thoracic surgery at Yale University, New Haven, Connecticut, and cochair of the coalition.

The coalition, made up of the American College of Chest Physicians, the American Cancer Society, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and to a lesser extent, the American Thoracic Society, will publish new guidelines within a few months, Dr. Deterrbeck told Medscape Medical News.

However, he would not confirm that the guidelines will call for low-dose CT screening for everyone who is at high risk for lung cancer. "I think there is a potential benefit, as well as a potential harm," he said. "Selection of the appropriate population is something we have to pay careful attention to."

Although low-dose CT poses a low risk from radiation, it often leads to other diagnostic procedures, some of which may not be necessary. "Low-dose CT picks up a lot of stuff that's nothing," he said.

On the basis of the low-dose scans, patients may be referred for regular CT, with its higher doses of radiation, and for biopsies, which can cause complications.

The cost questions are complicated, too, Dr. Deterrbeck said, as the expense of the screening must be weighed against the costs that are saved in treatment costs if cancer is caught earlier.

However, the short-term implications of the study are clear, he said. "We have not employed X-rays as a screening tool for lung cancer, and I guess we won't."

Dr. Kvale and Dr. Detterrbeck have disclosed no relevant financial relationships. Dr. Sox has disclosed that he is an unpaid member of advisory boards for the Southwest Oncology Group and the Fred Hutchinson University of Washington Cancer Consortium.

JAMA. Published online October 26, 2011. Full text, Editorial

CHEST 2011: American College of Chest Physicians Annual Meeting: Session 7225. Presented October 26, 2011.

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Risk for Suicide High for All Major Psychiatric Disorders

October 13, 2011 — Patients with any major psychiatric disorder are at significant risk for suicide after their first hospital visit, according to new research.

In a Danish registry study of more than 175,000 individuals who were followed-up for up to 36 years, investigators found that among men, those with bipolar disorder or unipolar affective disorder had the highest absolute risk for suicide. Schizophrenia, followed closely by bipolar disorder, represented the highest risks for women.

Comorbidities were also significant risk factors for both sexes, and the cooccurrence of deliberate self-harm increased the risk by 2-fold.

"The steepest increase in suicide incidence occurs during the first years after first contact," write lead author Merete Nordentoft, MD, from the Psychiatric Center Copenhagen and Copenhagen University in Denmark, and colleagues.

The investigators note that the absolute risk for suicide varied between 2% and 8% for the different psychiatric disorders studied.

"Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders," the authors write.

The study appears in the October issue of the Archives of General Psychiatry.

Questionable Estimates

The researchers report that a frequently cited study published in 1977 by Charles P. Miles, MD, and colleagues estimated that among individuals with unipolar affective disorder, alcoholism, and schizophrenia, suicide rates would be 15%, 15%, and 10%, respectively.

However, that review "was based on rather small studies with selected samples and a rather short follow-up, and several authors later concluded that, for different reasons, Miles' estimates were most likely too high," write the investigators, noting that several recent studies have found much smaller estimates.

For the current study, investigators evaluated data on 176,347 people from the Danish Civil Registration System who were born between 1955 and 1991 and had their first contact with a mental health professional after the age of 15 years. All participants were followed-up until death, emigration, or the end of 2006, for a maximum of 36 years.

In addition, 5 healthy control patients from the registry with no diagnosis of psychiatric illness were matched for each participant.

The registry was linked with the Danish Registers of Causes of Death to glean suicide information, as well as with the Danish Psychiatric Central Register.

The participants were separated into subgroups based on classifications from the International Statistical Classification of Diseases, 8th or 10th Revision: schizophrenia, schizophrenia psychoses, bipolar affective disorder, unipolar affective disorder, substance abuse, and anorectic disorder.

They were also examined for comorbidities and for whether or not they participated in deliberate self-harming actions.

Mandatory Prevention

Results showed that the absolute risk for suicide was highest for bipolar disorder (7.77%), unipolar affective disorder (6.67%), and schizophrenia (6.55%) for the men.

Among the women, schizophrenia (4.91%), bipolar disorder (4.78%), and schizophrenia-like disorders (4.07%) were the highest risk factors.

Comorbid unipolar affective disorder significantly increased the risk for suicide for all diagnostic groups, as did comorbid substance abuse, except for the men with schizophrenia.

The cooccurrence of deliberate self-harm across all the groups doubled the risk for suicide, and the most at-risk of all the groups were men with bipolar disorder who also deliberately self-harmed themselves (17.08%).

In the nonpsychiatric/healthy controls, the risk for suicide was 0.72% for men and 0.26% for women.

"[I]t is beyond doubt that the risk of suicide is high in all the investigated mental disorders, and suicide preventive measures should be a mandatory part of treatment programs," write the investigators.

"The fact that the steepest increase in suicide risk occurs during the initial years after first contact with mental health services can serve as an argument for intensive early-intervention services," they add.

Direct Measure of Risk

"This is a really important study because there's been a lot of debate and a lot of numbers thrown out in terms of what percent of people with psychiatric disorders go on to die by suicide," Eric D. Caine, MD, chair of the Department of Psychiatry at the University of Rochester Medical Center, New York, and codirector of the Center for the Study and Prevention of Suicide, told Medscape Medical News.

"We know that it's a lot higher than the general population, but the numbers that have been out there are really radically different. So this is important because it gives a real direct measure of something that was asserted a few years back," he said.

Noting that the national registry used "is really quite incredible," Dr. Caine said that the data are important to the world at large because they are so complete.

"If we assume that the general clusters of psychiatric disorders diagnosed there are roughly comparable, then the information that comes out of Denmark can be very, very valuable. And even though it's really focused here on the psychiatric population, it teaches us about the burden of suicide across much of the life course," he noted.

Some of the concerns he voiced included that "some people were only tracked a few years and others were tracked since the 1950s," that the investigators used changing diagnostic systems, and that 3 definitions of self-harm were used over the course of the study.

Dr. Caine noted that although rates of suicide were less than what other researchers have estimated in the past, they were still quite substantial.

"I think this study really teaches us that all those prior results were in the right direction, but we're now seeing much more clearly what the proper magnitude is, and what the burden of suicide is."

"You can also clearly see that the suicide risk continues to climb over years. Certainly there's a steep climb in the first year after hospitalization, but it continues to climb. So, this isn't something you think about just the first day or week or month. This is something you think about for years," he concluded.

The study was supported in part by the Stanley Medical Research Institute. The study authors and Dr. Caine have disclosed no relevant financial relationships.

Arch Gen Psychiatry. 2011;68:1058-1064. Abstract

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Frequent Aspirin Use Tied to Aging Macula Disorder

October 11, 2011 — Frequent use of aspirin is associated with early aging macula disorder (AMD), as well as wet late AMD, and risks for those problems appear to be linked to how often aspirin is consumed.

Those findings are from a study of nearly 4700 European patients aged 65 years or older that was published online September 13 inOphthalmology.

"Associations between aspirin use and AMD have been addressed in various settings with inconsistent results," write Paulus T.V.M. de Jong, MD, PhD, from the Netherlands Institute for Neuroscience and Academic Medical Center, Amsterdam, and colleagues.

To find out more about that possible association, Dr. de Jong and colleagues conducted a cross-sectional, population-based study using structured interviews to assess aspirin use and AMD in 4691 people who lived in 7 European countries: Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain.

In addition to being queried about their aspirin use, the participants were also asked about their sociodemographic status, educational level, current and past smoking history, and consumption of alcohol. Other questions focused on their medical history, including history of stroke or myocardial infarction, and whether they had been diagnosed with either angina or diabetes mellitus.

Aspirin use was gauged using a precoded response category of 7 options that ranged from "never" to "daily."

Cholesterol levels were also determined using fasting blood samples.

Digitized fundus images were then obtained from participants, and the images sent to a grading center and evaluated by 2 experienced staffers. The images were graded according to the International Classification and Grading System for Age-Related Maculopathy and AMD.

The researchers defined dry AMD as any sharply demarcated round or oval area of apparent absence of the retinal pigment epithelium, with the largest diameter more than 175 μm, with visible choroidal vessels, and with no presence of wet AMD.

Wet AMD was defined as the presence of a serous or hemorrhagic detachment of the retinal pigment epithelium, a subretinal neovascular membrane, subretinal hemorrhage, periretinal fibrous scarring, or a combination of those characteristics. That definition held even when fundus images showed patches of dry AMD.

The authors report that 36.4% of the participants had evidence of early AMD and 3.3% had evidence of late AMD.

About 41% of participants reported monthly aspirin use, 7% reported using aspirin at least once weekly, and 17.3% reported daily use.

"For daily aspirin users, the [odds ratios], adjusted for potential confounders, showed a steady increase with increasing severity of AMD grades," the researchers write. "When adjustment was made for all known confounders including [cardiovascular disease] or angina, the associations did not change. However, there may be other confounders that were not measured," they write.

Those relative increases in severity were noted as follows: grade 1, 1.26 (95% confidence interval [CI], 1.08 - 1.46;P < .001); grade 2, 1.42 (95% CI, 1.18 - 1.70); and wet late AMD, 2.22 (95% CI, 1.61 - 3.05; P < .001).

The authors advise caution in interpreting the results of the study. "This was a cross-sectional study, and the possibility that people with AMD took aspirin after experiencing visual problems cannot be excluded," they note. Another limitation is that “[i]t is possible that participants incorrectly reported their [cardiovascular disease] history, leading to residual confounding and measurement error.” However, the authors say, "[t]he protocol attempted to minimize misreporting by asking about serious events such as heart attack and stroke and also recorded the date of the event."

Even with the limitations of the study, however, the authors conclude, "[t]his interesting observation warrants further evaluation of the associations between aspirin use and AMD."

The study was supported by the European Commission Vth Framework, Brussels, Belgium. Funding for cameras was provided by the Macular Disease Society UK. Additional funding in Alicante, Spain, was provided by the Spanish Ministry of Health, Madrid, and CIBER de Epidemiologi´ y Salud Pública and the Generalitat Valenciana, both in Valencia. One author received support from the Estonian Ministry of Education and Science. The authors have disclosed no relevant financial relationships.

Ophthalmology. Published online September 13, 2011. Abstract

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TB Cases Decline Worldwide for the First Time

October 11, 2011 (Washington, DC) — For the first time, the number of people infected with tuberculosis (TB) each year is declining, according to Mario Raviglione, MD, director of the World Health Organization (WHO)'s Stop TB program.

He spoke here today during a press conference to release Global Tuberculosis Control 2011, WHO's 16th annual report on TB, which summarizes advances made and challenges ahead. The report features data on TB in nearly 200 countries with treatment results and financing trends.

In a numbers-heavy talk, Dr. Raviglione highlighted a mix of positive and sobering news from the report. Among achievements, he noted that:

• The number of people who were infected with TB decreased to 8.8 million in 2010, after peaking at 9 million in 2005.
• In 2010, TB deaths declined to the lowest level in a decade, to 1.4 million deaths, after reaching 1.8 million deaths in 2003.
• The TB death rate dropped 40% between 1990 and 2010.
• All regions except Africa are on track to achieve a 50% decline in mortality by 2015.

In 2009, 87% of patients treated were cured, bringing the total successfully treated to 46 million cured and 7 million lives saved under WHO guidelines since 1995. "It's a major achievement," he said.

However, although 6 million TB cases are reported every year from countries worldwide, in another 3 million cases, no one knows whether diagnosis and treatment are appropriate, because patients are not notified. "We fear most are detected late, and their outcomes are uncertain," said Dr. Raviglione.

Worldwide, major funding hurdles now need to be overcome, he said. Countries are reporting a funding gap of $1 billion for TB implementation in 2012. Continued international funding is more critical than ever, especially for the lower-income countries, he said. Without further help, Africa might be the 1 region in 2015 that does not see a 50% decline in TB deaths since 1990. Worldwide, 86% of TB financing comes from domestic sources, but only about 50% is from domestic sources in the lowest-income countries, particularly those in Africa.

One bright spot in the fight against TB has been China, according to the report. The TB death rate there declined by nearly 80%, from 216,000 to 55,000 deaths, between 1990 and 2010. In addition, the incidence of TB infections was cut in half, from 215 to 108 per 100,000 people, he said.

One area that continues to pose a major challenge is multidrug-resistant (MDR) TB. Less than 5% of new and previously treated patients with TB were tested for MDR-TB in most countries in 2010, and the reported number of patients being treated reached only 16% of the 290,000 cases of MDR-TB estimated among notified patients with TB in 2010.

Laboratory tests are not available to test everyone, Dr. Raviglione said, citing a $200 million gap in funding for MDR-TB. One cause for optimism he cited was a new rapid molecular test for TB called Xpert MTB/RIF (Cepheid) that has the potential to substantially improve and speed diagnosis of TB and MDR-TB. The test is being used in 26 developing countries. By the end of the year, he said, 40 countries would be using it, just 6 months after WHO endorsed it.

"I've never seen a transfer of technology that was so rapid," he said. "The promise of testing more people for MDR-TB must be met now with the commitment to treat all of those who are detected. In fact, it would be a real scandal if we left people diagnosed with MDR-TB without drugs and without treatment, which is a real concern today."

The WHO report is notable because it is the first since 1997 in which research and development are explicitly part of the report, noted Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Chapter 7 of the report looks at research and development and offers a line-up of menus of diagnostics, therapeutics, and vaccines in various stages of the pipeline that Dr. Fauci calls "quite encouraging." He also spoke at the press conference.

In the past he has joked about the need to bring TB research into the 21st century from the 19th century. To make the research and development pipelines more robust, fundamental questions need answers, he said, particularly those that get at the relationship between the microbe and the host. Why do 10% of people not immunosuppressed during a lifetime go from latent to active TB? What are biomarkers for disease activity?

He compared TB with HIV, saying that the latter has a menu of more than 30 drugs that can rapidly bring the viral load below detectable levels. Biomarkers can tell what effect the drug has on a person with HIV down to the RNA copy of one, he said. "Can you imagine something even approaching that to understand where we stand with [TB]?" Dr. Fauci asked. "It is not impossible. We thought it was impossible with HIV years ago."

World Health Organization. Global Tuberculosis Control 2011. Released October 11, 2011.

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Quite interesting! Keep Walking.....

Jus to check this out...... 
The Organs of your body have their sensory touches at the bottom of your foot, if you massage these points you will find relief from aches and pains as you can see the heart is on the left foot. 

 Typically they are shown as points and arrows to show which organ it connects to. 

It is indeed correct since the nerves connected to these organs terminate here.

This is covered in great details in Acupressure studies or textbooks. 

God created our body so well... He made us walk so that we will always be pressing these pressure points and thus keeping these organs activated at all times. 

So, keep walking...

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Vitamin Supplements Associated With Increased Risk for Death

October 10, 2011 — In women aged 55 to 69 years, several widely used dietary vitamin and mineral supplements, especially supplemental iron, may be associated with increased risk for death, according to new findings from the Iowa Women's Health Study.

Although many vitamin supplements did not appear to be associated with a higher risk for total mortality, several were, including multivitamins, vitamins B₆, and folic acid, as well as minerals iron, magnesium, zinc, and copper.

Jaakko Mursu, PhD, from the Department of Health Sciences, Institute of Public Health and Clinical Nutrition at the University of Eastern Finland in Kuopio, Finland, and colleagues reported their findings in the October 10 issue of the Archives of Internal Medicine.

"Supplements are widely used, and further studies regarding their health effects are needed," Dr. Mursu and colleagues write. "Also, little is known about the long-term effects of multivitamin use and less commonly used supplements, such as iron and other minerals."

The current study sought to evaluate the link between supplement use and total mortality rate, using data from the Iowa Women's Health Study. A total of 38,772 older women were included in the analysis. Women were aged between 55 to 69 years, with an average of 61.6 years at the beginning of the study in 1986. Self-reported data on vitamin supplement use were collected in 1986, 1997, and 2004.

A total of 15,594 deaths were reported through December 31, 2008, representing about 40% of the initial participants. The use of multivitamins overall was associated with 2.4% increased absolute risk for death (hazard ratio, 1.06; 95% confidence interval, 1.02 - 1.10). Self-reported use of dietary supplements increased substantially between 1986 and 2004. In addition, supplement users had a higher educational level, were more physically active, and were more likely to use estrogen replacement therapy.

Vitamin B₆, folic acid, iron, magnesium, and zinc were associated with about a 3% to 6% increased risk for death, whereas copper was associated with an 18.0% increased risk for total mortality when compared with corresponding nonuse.

In contrast, use of calcium was inversely related to risk for death (hazard ratio, 0.91; 95% confidence interval, 0.88 - 0.94; absolute risk reduction, 3.8%).

The researchers assessed the findings for iron and calcium in more detailed analyses conducted during shorter periods (10-year, 6-year, and 4-year follow-up) and found results similar to those for the analyses conducted during the entire time.

"In agreement with our hypothesis, most of the supplements studied were not associated with a reduced total mortality rate in older women," Dr. Mursu and colleagues conclude. "In contrast, we found that several commonly used dietary vitamin and mineral supplements, including multivitamins, vitamins B₆, and folic acid, as well as minerals iron, magnesium, zinc, and copper, were associated with a higher risk of total mortality."

"Although we cannot rule out benefits of supplements, such as improved quality of life, our study raises a concern regarding their long-term safety," the authors add.

In a related editorial, Goran Bjelakovic, MD, DMSc, and Christian Gluud, MD, DMSc, from the Centre for Clinical Intervention Research, Cochrane Hepato-Biliary Group, Rigshospitalet, Copenhagen University Hospital, Denmark, note that the current study adds "to the growing evidence demonstrating that certain antioxidant supplements, such as vitamin E, vitamin A, and beta-carotene, can be harmful."

"We cannot recommend the use of vitamin and mineral supplements as a preventive measure, at least not in a well-nourished population," they add. "Those supplements do not replace or add to the benefits of eating fruits and vegetables and may cause unwanted health consequences."

This study was partially supported by the National Cancer Institute and the Academy of Finland, the Finnish Cultural Foundation, and the Fulbright program’s Research Grant for a Junior Scholar. One study author is an unpaid member of the Scientific Advisory Board of the California Walnut Commission. The other authors and editorialists have disclosed no relevant financial relationships.

Arch Intern Med. 2011;171:1625-1634.

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