Combat Brain Injury Symptoms Could Be Post Traumatic Stress, Study

A new study by US army medical researchers has revealed that combat troops who served in Iraq who still have health problems months after a mild traumatic brain injury or concussion, could actually be suffering from post traumatic stress, raising the possibility that some of them could be misdiagnosed and incorrectly treated.

The study is published early online in the 30th January issue of the New England Journal of Medicine and is the work of Dr. Charles W Hoge, director of the division of psychiatry and neuroscience at the Walter Reed Army Institute of Research, Silver Spring, Maryland, and colleagues.

Hoge and colleagues explained that the medical profession is becoming more and more concerned about the long term effect of mild traumatic brain injury (TBI), or concussion, particularly from roadside blasts and explosions, and that there is not enough good scientific information that relates specifically to this type of injury in combat troops.

So they examined 2,525 US army infantry troops 3 or 4 months after returning from a 1 year tour of duty in Iraq and using validated screening questionnaires, distinguished soldiers who reported mild TBI from soldiers who reported other types of injury.

TBI was defined as "injury with loss of consciousness or altered mental status" (for instance dazed or confused).

The researchers found that:

• 124 (4.9 per cent of the 2,525) soldiers reported injuries with loss of consciousness.


• 260 (10.3 per cent) reported injuries with altered mental status.


• 435 (17.2 per cent) reported receiving other injuries while serving in Iraq.


• Of those who reported loss of consciousness, 43.9 per cent met criteria for post traumatic stress disorder (PTSD).


• This compared to only 27.3 of those who reported altered mental status, 16.2 per cent with other injuries, and 9.1 per cent with no injuries.


• Soldiers with mild TBI, in the main those who had loss of consciousness, were significantly more likely to report missed work days, poor general health, medical visits, and a high number of somatic and postconcussive symptoms than were those who reported other injuries.


• However, after adjusting for PTSD and depression, mild TBI was "no longer significantly associated with these physical health outcomes or symptoms, except for headache".

Hoge and colleagues concluded that:

"Mild traumatic brain injury (i.e. concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home."

They added:

"PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems."

In an accompanying editorial, Professor Richard A. Bryant, specialist in PTSD based at the School of Psychology, University of New South Wales, Sydney, Australia, wrote that misattributing symptoms following concussion could have negative consequences because it might be assumed that the recovery will follow a path that depends on neurological factors rather than say psychological factors.

He mentions that mild TBI can temporarily damage cogntive function and distort a person's ability to manage the consequences of their psychological trauma, thus compounding the effect, and leading to a greater incidence of PTSD.

Bryant suggests that this research by Hoge and colleagues had led to two very important points. One is that soldiers with mild TBI are at greater risk for health related problems, and the other is that "soldiers should not be led to believe that they have a brain injury that will result in permanent change".

Bryant appears to be suggesting that managing the expectations of injured soldiers returning with mild TBI and PTSD appears to be as important as getting the diagnosis right, for:

"If troops currently serving in Iraq or Afghanistan are informed about a postconcussive syndrome and persistent problems emerging from mild traumatic brain injury, a new syndrome could arise from the current conflict in which soldiers attribute a range of common stress reactions to the effects of brain injury."

If this happens, it could damage morale, wrote Bryant, as wealth as soldiers' mental health, because:

"It could lead to the expectation of poor recovery."

But, in contrast, he wrote:

"The normalization of many of these reactions and the recognition that stress-related conditions can be managed with evidence-based strategies may minimize the unnecessary attribution of common stress reactions to pathology and facilitate resilience after mild traumatic brain injury."

Let us hope the experience of dealing with Gulf War Syndrome has something to offer here.

Diabetes In Older Americans Rising

The number of older Americans diagnosed with diabetes every year went up by 23 per cent in the decade leading up to 2003-2004, according to a new study published in the Archives of Internal Medicine carried out by researchers at the Duke University Medical Center in Durham, North Carolina.

Increasing numbers and percentages of Americans older than 65 having diagnosed diabetes is growing fast, which together with reducing death rates and lack of improvement in treating side effects, is contributing significantly to the growing burden of paying for and providing their medical care.

Dr Frank A Sloan, of Duke University Medical Center and colleagues wrote that the global prevalence of diabetes mellitus is growing, partly because the population is getting older, but also because it is rising in younger people. This is accompanied by a rise in diabetes-related complications, with an attendant increase in the need to monitor and manage the disease.

Sloan and colleagues comment also that "adherence to recommended practices remains low".

The researchers looked at trends in the rates of occurrence of diabetes and its accompanying complications in Americans older than 65 by performing a longitudinal analysis of nationwide Medicare claims and other Medicare information.

Specifically, they looked for people first diagnosed with diabetes during 1994 (33,164 persons), 1999 (31,722) or 2003 (40,058). They compared them with 2 control groups, about the same size, who were not diagnosed with diabetes, either during 1994, 1999 or 2003, or for the entire period from 1994 to 1999 or from 1999 to 2004.

The main events they included in their analysis were deaths, and diabetes-related complications such as problems with eyes, kidneys, lower extremities, cardiovascular and cerebrovascular.

They found that:

• The annual incidence of diabetes increased by 23 per cent between 1994-1995 and 2003-2004.


• Prevalence increased by 62 per cent.


• Surprisingly, the rate of death after diagnosis in people having diagnosed diabetes decreased by 8.3 per cent compared with that in the control groups.


• Complication rates among people diagnosed with diabetes generally increased or stayed the same compared with those in the control groups during 1994 to 2004. The exception was diabetes-related eye diseases.


• Rates for some major complications were high.


• One example of this was the rate for congestive heart failure in the diabetes group during 1999 to 2004, which was 475 per 1000 persons.


• In some cases, such as kidney problems, including the most serious complications, there were increases in prevalence in both the diabetes and control groups.

Sloan and colleagues concluded that:

"The burden of financing and providing medical care for persons older than 65 in the United States having diagnosed diabetes is growing rapidly as a result of increased incidence and, especially, prevalence of diagnosed diabetes, decreased mortality, and overall lack of improvement in rates of complications in persons having diagnosed diabetes."

They wrote that their findings emphasized the "overwhelming burden of diabetes, including the near 90 percent prevalence of an adverse outcome and many serious and resource-consuming outcomes such as coronary heart failure, myocardial infarction [heart attack] and stroke."

In an accompanying editorial in the same issue of the journal, Dr Frank Vinicor of the US Centers for Disease Control and Prevention (CDC) wrote that if these trends continue there won't be enough money to pay for individual treatment of diabetes patients.

The urgency to implement effective programs to prevent diabetes in older people has never been so acute.

Cough And Cold Medicines Put 7,000 American Children A Year In The Emergency Department

Over 7,000 children in the US end up in emergency departments every year because of complications from taking cough and cold medicines, found researchers who did a nationwide study of the problem. They said there is an urgent need for fresh ideas to tackle the problem, especially since the largest proportion of emergency cases are the result of children getting hold of and taking cough and cold medicines unsupervised.

The study was carried out by researchers from the US Centers for Disease Control and Prevention (CDC) and is published in the 28th January online issue of Pediatrics.

The researchers, led by Daniel S. Budnitz, observed that adverse events resulting from children ingesting cough and cold drugs is a not insignificant public health problem, and decided to investigate this on a national level, to help policy makers and health professionals put together age-appropriate measures to tackle the issue.

They looked at records dated from the beginning of 2004 to the end of 2005, of adverse events related to cough and cold medications in children under 12 years of age from 63 US emergency departments.

The results showed that:

• An estimated 7,091 children under 12 were treated every year in emergency departments for adverse events related to cough and cold medications.


• This number accounts for 5.7 per cent of emergency department visits for all medications in this age group.


• Most of the visits (64 per cent) were by children aged between 2 and 5 years.


• Most of the visits were caused by children taking the medications by themselves (66 per cent).


• This is significantly higher than the proportion of "unsupervised ingestions" recorded for other medications (47 per cent).


• Also, most of the unsupervised ingestions of cough and cold medicines that led to emergency department visits were by children aged between 2 and 5 (77 per cent).


• The vast majority of children (93 per cent) did not require hospitalization or extended observation.

The researchers concluded that:

"Timely national surveillance data can help target education, enforcement, and engineering strategies for reducing adverse events attributable to cough and cold medications among children."

They suggested that preventing children taking cough and cold remedies without supervision was the area that most needed fresh ideas, since this was the biggest cause of adverse events. The ideas could also be applied to other children's medication.

This comes in the wake of a new Public Health Advisory from the US Food and Drug Administration (FDA) recommending children under 2 years of age are not given over the counter cough and cold medicines (click here to read more about this), because of question marks over their effectiveness and safety.

The FDA said it is also reviewing the case for making such a recommendation for older children and will make a further announcement when it has completed its evaluation of OTC cough and cold medications in older populations.

This study received a warm welcome from a number of groups concerned about what they describe as the high risk versus the questionable benefits of cough and cold medicines for young children.

Speaking to the Washington Post, Baltimore's public health commissioner, Joshua M. Sharfstein, who led the group that petitioned the FDA to restrict marketing of the medicines for children, said it was time to pull the plug on these products, commenting that:

"This is a lot of trips to the emergency room for products that have no known benefit."

Industry representatives on the other hand, pointed to lack of parental understanding about the right dose, or failing to keep the medicines out of the reach of children, as the main problem, and that the products were safe and effective when used correctly.

CMA Statement On Health Reform, USA

The following statement was made by Richard Frankenstein, M.D., president of the California Medical Association

"We are here not to rejoice in the demise of another health reform plan, but to praise the efforts of those who have worked to further its important goals, and to declare our hope for and continued commitment to health reform in the near future. This bill may not advance, but the cause of health care for California surely has. Governor Schwarzenegger, Senator Perata, and Speaker Nuñez deserve a lot of credit for maintaining the high profile of this issue, and for laying the groundwork for the reform that eventually must happen.

We thank the Governor for bringing this important issue to the forefront, and we appreciate the efforts of all those who've worked so diligently on health reform during the past several months. There are many innovative ideas and solutions contained in this proposal, and we look forward to continued work that will make health reform possible in the future.

While this effort may not have succeeded today, it is NOT the end of the discussion.

This issue isn't going away. Our health care system stills needs to be fixed. Millions of Californians still lack health coverage. People who do have insurance are squeezed daily by insurance companies. For-profit insurance companies are taking billions in profits, on top of the billions they spend on "administration". It's no wonder we can't afford universal health care when we're not spending the health care funds we do have on actual health care.

California's doctors remain committed to health care reform. We have been working on this issue for many years, and will continue to do so as long as it takes to make sure all Californians have access to top-quality health care.

We are hopeful that this effort will pay dividends in the near future, and that all Californians will have the access to top-quality health care that they deserve."

The CMA represents 35,000 California physicians in all modes or practice and specialties.

California Medical Association

Some Scientists Questioning Folic Acid Fortification, Baltimore Sun Reports

Some scientists are questioning whether a 1998 FDA requirement to fortify flour, bread and pasta with folic acid in an effort to prevent birth defects has had "unforeseen trade-offs," including an increase in colon and prostate cancer cases and an increase in cognitive impairment among seniors, the Baltimore Sun reports. However, proponents of folic acid fortification say the benefits -- including a decrease in birth defects and possible prevention of some cancers and cardiovascular disease -- are proven and argue that "potential downsides" to fortification are unproven (Desmon, Baltimore Sun, 1/27).

According to CDC, the fortification requirement and an effort launched in 1992 to encourage women to take daily vitamins containing folic acid has contributed to a decline of about one-third in the rate of infants born from spina bifida and anencephaly from 1991 to 2005. March of Dimes, the American Medical Association and several pediatric groups in the last two years have called on FDA to double the amount of folic acid required in fortification (Daily Women's Health Policy Report, 1/23).

According to the Sun, scientists are uncertain how folic acid works, but many believe it assists in forming DNA, stimulating cell growth, preventing damage and helping DNA replicate. Folic acid also helps cells divide in normal tissues but can have the same effect in precancerous tissue, causing cancer cells to reproduce quickly, the Sun reports.

A report published last summer by Joel Mason -- director of the Vitamins and Carcinogenesis Laboratory at Tufts University -- and colleagues found a possible link between folic acid fortification in the U.S. and Canada, and colorectal cancer rates, which are not declining as quickly as they were prior to fortification. According to the study, folic acid fortification has lead to as many as 15,000 additional colorectal cancer cases in the U.S. annually and 1,500 in Canada. Mason said that although his study is not definitive, the U.S. cannot "afford" a 10% chance that it is valid. Mason does not recommend that the U.S. stop fortification until more data are collected, but he does believe that the United Kingdom, which is currently considering fortification requirements, should wait until more data is available.

Walter Willett, chair of the department of nutrition at the Harvard School of Public Health, said that it will take about 10 years until the impact of fortification is known. "I think we've done something that overall is beneficial, and we won't know the full balance of benefits or possible adverse effects for many years," he said, adding that "overall the picture looks good" (Baltimore Sun, 1/27).

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

California Medical Association Says State Regulators' Actions Against UnitedHealth/PacifiCare Encouraging, But Bad Behavior By Insurers Must Stop

Fines announced against UnitedHealth/PacifiCare in response to CMA complaints on behalf of doctors and patients send an important message to health insurers that their misdeeds have consequences, but the CMA called upon regulators to be continually vigilant in protecting patients.

"We are encouraged that California's two regulatory agencies have taken the important step of banding together to tell United/PacifiCare enough is enough," said Richard Frankenstein, M.D., president of the California Medical Association, which asked regulators to investigate the insurance company early last year. "For-profit health plans have made billions of dollars in California by putting profits ahead of patients. Just because United said they're sorry and will pay fines, it doesn't mean patients are protected and won't continue to suffer. These fines won't give them back their money or their health."

Since the United PacifiCare merger more than two years ago, there has been great chaos for doctors and patients. The insurance company was not able to keep track of the patients it insured and the doctors with whom it had contracts, creating a bureaucratic nightmare for patients and doctors at best, potentially costing patients access to health care at worst. United's poor administrative practices affected thousands of patients who in some cases went without care or lacked continuity of care.

Meanwhile, United profits nationwide continued to soar and its top officials collected billions of dollars in salary and other benefits.

The CMA had publicly opposed the United/PacifiCare merger from the beginning, saying it would be a detriment to patient care, yet United officials have used the merger as an excuse for their inefficiencies and errors.

"UnitedHealth has bought up little and big health plans all over the country," said Dr. Frankenstein. "If they weren't prepared to manage that business from day one, they shouldn't have done it."

Doctors and patients from throughout the state complained to CMA about problems with United, including patients being told erroneously that they would have to switch doctors, or that their doctors were out of network when they actually were not. Patients were told they had different coverage than they signed up and paid for, and were given lists of doctors in network that were very outdated. The mistakes caused delays and denials of patient care. CMA passed the many complaints on to regulators.

ISMP Survey Shows Unnecessary Risks Still Exist With Automated Dispensing Cabinets

Automated dispensing or distribution cabinets (ADCs) can decrease the amount of time before a medication is available for administration, ensure greater security, and reduce the risk of medication errors, but only when specific safeguards are consistently used. A recent survey by the Institute for Safe Medication Practices (ISMP) shows that although use of ADCs has become prevalent in the last decade, safety improvements have been incremental and not as widespread as needed to maximize the benefits that the technology offers.

According to the 800 respondents to the 2007 ADC survey, which was sent to readers of ISMP's acute care and nursing newsletters, 94% are using ADCs in their facilities. Of those, more than half (56%) are using the technology as the primary means of drug distribution. An analysis of the 2007 survey results was published in the January 17, 2008 issue of the ISMP Medication Safety Alert! newsletter. The analysis compares data from ISMP's 2007 and 1999 ADC surveys and highlights areas of concern.

Survey Findings of Concern

Checking Processes. The requirement for a pharmacist to check ADC stock medications before they leave the pharmacy increased from 65% in 1999 to 75% in 2007. However, no improvement was seen regarding verification processes after restocking. In both years, just 18% of respondents reported that another person verifies drug placement in the ADC. Requiring another practitioner to double-check a drug removed via an override, before pharmacy review, only increased by 10%. These manual checking processes are important to prevent stocking and/or wrong drug retrieval errors, similar to the events occurring in Indianapolis and Los Angeles that led to harmful 1,000-fold heparin overdoses in neonates.

Pharmacist Review and Overrides. In 1999, only 28% of respondents reported that a pharmacist must verify orders before drugs can be removed from ADCs, but in 2007, that percentage increased to 64%. However, just 59% of 2007 respondents reported that all ADCs in their facilities are capable of profiling, which provides a direct interface between the pharmacy information system and ADCs so that pharmacists can profile, screen, and approve medications before they are removed from the cabinet for administration.

Cabinet Design. An increase by 20 percentage points occurred between 1999 and 2007 regarding the user's ability to remove only the requested drug from the ADC. Nevertheless, just 50% of respondents noted that individual compartments for each drug are always or frequently available in the ADC cabinets.

ADC Stock. In both 1999 and 2007, 35% of respondents reported that they always or frequently encounter multiple concentrations of medications in ADCs. In 2007, respondents also reported that they encounter fewer ready-to-administer medications in ADCs than reported in 1999. Almost a quarter (23%) of 2007 respondents reported that non-medications are being stored in ADCs, a 15% increase from 1999.

Workflow and Practice Habits. In 2007, additional questions were added to the ADC regarding workflow and practice habits. Almost a third (30%) of frontline nurses reported that they always or frequently wait in line to access the ADC, and almost half (48%) reported that the ADCs are not located in areas free from distractions. Only two-thirds (69%) of frontline nurses reported that they always or frequently remove just one patient's medication at a time, implying that multiple patients' medications are removed one-third of the time- a practice that is known to lead to drug administration errors.

Draft ADC Safety Guidelines

Few resources exist to guide healthcare organizations toward best practices and safest use of this technology. To address this deficit, ISMP convened a group of stakeholders in spring 2007 to develop ADC practice guidelines. The draft guidelines, which contain 12 core processes associated with safe ADC use, are posted here.

Practitioners are encouraged to review the guidelines and core processes and attempt to employ as many as possible this year to reduce the risk of serious errors associated with ADC use.

About ISMP The Institute for Safe Medication Practices (ISMP) is a 501c(3) nonprofit organization that works closely with healthcare practitioners and institutions, regulatory agencies, consumers, and professional organizations to provide education about medication errors and their prevention. ISMP represents more than 30 years of experience in helping healthcare practitioners keep patients safe, and continues to lead efforts to improve the medication use process.

Physically Active People Age More Slowly

A new study on twins by researchers in the UK showed that people who are physically active in their leisure time aged more slowly than their more sedentary counterparts.

The study is published in the 28th January issue of the Archives of Internal Medicine, and is the work of Dr Lynn F Cherkas, of King's College London, and colleagues.

The researchers noted that previous research had already suggested that:

"A sedentary lifestyle increases the propensity to aging-related disease and premature death."

Regular exercise is linked to lower rates of high blood pressure, heart and circulation problems, type 2 diabetes, cancer, obesity and osteoporosis, they said.

But Cherkas and colleagues suggested their study showed that:

"Inactivity may diminish life expectancy not only by predisposing to aging-related diseases but also because it may influence the aging process itself."

In this study, 2,401 white twins (2,152 women and 249 men) filled in questionnaires about how much they exercised, whether and how much they smoked, and their socioeconomic status. All participants were healthy and they also gave blood samples so that their DNA could be examined.

The researchers were interested in the length of telomere sequences at the ends of the chromosomes in the participants' leukocytes or white blood cells, what they termed the "leukocyte telomere length" or LTL. These tend to get shorter as people age and are used as an indicator of a person's biological age.

To be precise, the researchers defined an LTL measure as the "mean terminal restriction fragment length", which is expressed in terms of structural units called nucleotides.

They found that on average, LTL decreased with age at a loss of 21 nucleotides per year.

After adjusting for age and other potential confounders, such as age, sex, body mass index, smoking, socioeconomic status, and physical activity at work, the results showed that men and women who were less physically active in their leisure time had shorter LTLs than those who were more physically active.

In addition, the results showed that:

• The LTLs of the most active participants were 200 nucleotides longer than the least active.


• The most active participants performed an average of 199 minutes a week of exercise in their leisure time compared with 16 minutes for the least active.


• The link between longer LTLs and physical activity was confirmed by looking at a subset of twins where one was physically active in his or her leisure time and the other was sedentary.


• On average, the LTL of the more active twins were 88 nucleotides longer than those of the less active twins.

Cherkas and colleagues concluded that:

"A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process."

They suggested this finding showed that "adults who partake in regular physical activity are biologically younger than sedentary individuals" and:

"Provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise."

Speculating on the reasons behind this link between longer telomeres and exercise, Cherkas and colleagues suggested that sedentary lifestyles probably increase inflammation and oxidative stress damage to cells.

Perceived stress levels have been linked to telomere length in other studies, and they suggest that by decreasing psychological stress, physical activity mitigates its influence on telomeres and aging.

They went on to point out the importance of following guidelines for physical exercise. The US guidelines for example recommend people have 30 minutes of moderate intensity physical activity on five days every week.

Dr Jack M Guralnik, of the National Institute on Aging, Bethesda, Maryland, USA, said that more research was needed to establish a direct link between aging and physical activity. In an editorial in the same issue of the journal he explained there could be other factors at play:

"Persons who exercise are different from sedentary persons in many ways, and although certain variables were adjusted for in this analysis, many additional factors could be responsible for the biological differences between active and sedentary persons, a situation referred to by epidemiologists as residual confounding."

But he added that:

"Nevertheless, this article serves as one of many pieces of evidence that telomere length might be targeted in studying aging outcomes."

Telomeres are thought to act a like a buffer zone of "useless" DNA on the ends of the DNA strands that protects the integrity of the useful information in our DNA because every time a cell divides and its DNA is copied, it loses some of the edges of the DNA. This is like every time you take a photocopy of a photocopy, the image creeps toward the edges and deteriorates, until eventually you lose the bits around the edge.

Snoring Affects Development Of Chronic Brochitis, Study

A study by researchers in South Korea found that snoring influenced the development of chronic bronchitis, but how and why remained somewhat of a mystery.

The research was carried out by scientists at Korea University Ansan Hospital, in Ansan, South Korea, and is published in the 28th January issue of the Archives of Internal Medicine.

Previous research had already found that snoring is more common in people who have chronic bronchitis, but few studies have examined the link between snoring and onset of chronic bronchitis.

Bronchitis is classed as a subcategory of Chronic Obstructive Pulmonary Disease (COPD) and occurs when the air passages or tubes (bronchi) in the lungs become inflamed. There are two types: acute and chronic. Acute bronchitis usually follows an infection and either resolves on its own or with treatment.

Chronic bronchitis is usually caused by habitual exposure to chemicals and particles that irritate the lungs, such as from smoking tobacco products or working in a polluted environment every day. Chronic bronchitis is characterized by over-secretion of mucus, with a cough that does not go away easily (persists for more than 3 months in 2 consecutive years).

For this study, which ran from June 2001 to January 2003, the researchers recruited 5,015 male and female Korean citizens as participants. When the study started their ages ranged from 40 to 69 years.

The participants underwent comprehensive health exams and interviews and also filled in questionnaires at Korea University Ansan Hospital. From the original cohort, 4,270 participants (52 per cent men and 48 per cent women) went on to the first 2 year follow-up, and those who met the same inclusion criteria were followed for another two years. The total follow-up period was 4 years, finishing in November 2006.

The questionnaires they filled in at the beginning of the study asked the participants about their snoring, and the researchers noted all new cases of chronic bronchitis that arose during the 4 year follow-up. Participants who reported existing symptoms of bronchitis at the start of the study were excluded from the follow up (for instance if they had cough and sputum on most days for at least 3 months a year).

When the researchers examined and analysed the results they found:

• 314 new onset cases of chronic bronchitis in the 4 year follow up.


• This is equivalent to an incidence rate of 27.1 cases per 1,000 person years (a measure commonly used by epidemiologists in public health fields).


• After removing the effect of age, smoking, and other demographic and risk factors, they found snoring was significantly linked to new onset chronic bronchitis, and the more frequent the snoring, the stronger the link.


• The risk of developing chronic bronchitis was 25 per cent higher for participants who snored 5 times or less per week compared with those who never snored.


• This risk rose to 68 per cent for those who snored 6 to 7 times a week.


• Grouping results according to risk factors, such as smoking status, type of job and BMI (body mass index) showed that the link between snoring and chronic bronchitis onset was stronger among non-smokers, house workers, and people who were overweight.


• Non smokers who snored had a 39 per cent higher risk of developing chronic bronchitis compared with non smokers who never snored.


• For smokers who never snored this risk was 31 per cent higher.


• But for smokers who snored this risk was higher at 86 per cent.

The researchers concluded that:

"This prospective study observed that snoring is associated with chronic bronchitis. Our findings provide support for the hypothesis that snoring influences the development of chronic bronchitis."

A research fellow at the University of Michigan Sleep Disorders Center, Dr Robert Keeton, told the Washington Post that he found the study interesting, but would not call it conclusive.

"It can't be something you can cite to tell patients in the clinic that they have chronic bronchitis because they snore," he told the paper.

He also commented on the suggestion made by the researchers, who proposed two reasons for their findings. One was that the vibrations of snoring possibly cause inflammation of the bronchi, and the other possibility is the bronchi become inflamed, the snoring follows, and this lead to sleep apnea, a condition where breathing stops or is very shallow for about 20 seconds.

Keeton said a common cause of snoring is obstructive sleep apnea and it was not unusual for people to have such symptoms.

Another expert interviewed by the paper suggested the explanation around sleep apnea warrants further investigation, as sleep apnea was already known to be associated with increased inflammation in the body.

Caffeine Increases Blood Sugar In People With Type 2 Diabetes

A small US study suggests that people with type 2 diabetes who drink the equivalent of four cups of coffee or more a day may be causing their blood sugar levels to go up by 8 per cent (compared to non caffeine days), thus making it harder for them to manage their condition.

The study was carried out by Dr James Lane, a psychologist at Duke University Medical Center, in Durham, North Carolina, and colleagues, and is published in the February issue of Diabetes Care.

Other recent studies have shown that in habitual coffee drinkers with type 2 diabetes, caffeine appears to raise glucose and insulin after intakes of standardized carbohydrate loads. Lane and colleagues decided to investigate if this effect manifested after meals in the everyday life of type 2 diabetics and how it might undermine their efforts to manage their condition.

They used small glucose detection devices implanted under the abdominal skin of 10 patients so they could observe the rise and fall of their blood sugar while they went about their normal day for 72 hours, the first time such a thing has been done in relation to caffeine consumption, they said.

The patients had established type 2 diabetes and were regular coffee drinkers who consumed at least two cups everyday. They were also trying to manage their diabetes through a combination of diet, exercise and drugs, but not with extra insulin.

On one day the patients took caffeine capsules equal to about four cups of coffee and on the other day they took identical capsules except they contained a placebo. The study was a double blind crossover study, so neither the patients nor the drug administrators knew which capsules contained the caffeine and which contained the placebo.

The patients all had the same nutrition drink for breakfast but chose their own food for lunch and dinner.

The results showed that on caffeine days, the patients' average daily sugar levels went up by 8 per cent. After meals the blood sugar levels were even higher: 9 per cent after breakfast, 15 per cent after lunch, and 26 per cent after dinner.

Lane said they didn't know how caffeine drove up the glucose levels but they had a couple of ideas.

"It could be that caffeine interferes with the process that moves glucose from the blood and into muscle and other cells in the body where it is used for fuel. It may also be that caffeine triggers the release of adrenaline -- the fight or flight -- hormone that we know can also boost sugar levels," said Lane.

Either way, it appears that caffeine causes blood sugar to rise which is bad news for patients with diabetes, he added.

As more research evidence gathers to support this conclusion, it is likely that official guidelines for how to manage diabetes will advise diabetics to avoid coffee and other drinks that contain caffeine, said the researchers.

As Lane pointed out:

"Coffee is such a common drink in our society that we forget that it contains a very powerful drug: caffeine."

"Our study suggests that one way to lower blood sugar is to simply quit drinking coffee, or any other caffeinated beverages. It may not be easy, but it doesn't cost a dime, and there are no side effects," he added.

The next stage would be to do a study where coffee drinking diabetes patients gave up caffeine to see if this helped them manage their blood sugar levels more easily.

Nigerian Children At Government Schools Suffer High Burden Of Intestinal Worms

Intestinal worms are more common in Nigerian children attending government- owned schools than those attending private school, and the water supply and sanitation are worse in the government schools, according to a new study published January 30 in the open-access journal PLoS Neglected Tropical Diseases.

Dr Uwem Friday Ekpo (Department of Biological Sciences, University of Agriculture, Abeokuta, Nigeria) and colleagues surveyed children at three schools in the Ikenne Local Government Area of Ogun State, Nigeria. The prevalence of intestinal worms (helminth infections) was 54.9% in the urban government school, 63.5% in the rural government school, and 28.4% in the private school. The most common worm was roundworm (Ascaris lumbricoides), followed by whipworm (Trichuris trichiura), tapeworm (Taenia species), and hookworm.

Given that these infections are related to poor sanitation and lack of clean water, the researchers assessed the water supply, presence of garbage around school compounds, conditions of latrines, and presence of soap in classrooms at the three schools. The water and sanitary conditions were poorer in government-owned schools than in the private school. The water supply was inadequate in both government-owned schools: tap water was irregular, and pupils brought bottles of water to school from their homes. In contrast, at the private school the water supply was regular, from a borehole, and pupils drank water using personal cups from the containers in their classes.

"The study shows clearly that the burden of parasitic infections in schoolchildren and poor sanitary conditions of the urban and rural schools owned by the government constitute a public health priority," say the authors. "It strongly supports the need for school health programmes aimed at reducing the prevalence of helminth infections in schoolchildren and improving the sanitation conditions in and around the schools."

American Academy Of Pediatrics Calls For Cancellation Of ABC's "Eli Stone " Premiere

The American Academy of Pediatrics (AAP) is demanding ABC cancel the opening episode of "Eli Stone" scheduled for Thursday, January 31. As reported in The New York Times, the episode features a lawyer who argues in court that a vaccine caused a child's autism. While the show includes statements that science has refuted any link between autism and vaccines, the episode's conclusion delivers a contrary impression; the jury awards the mother $5.2 million, leaving audiences with the destructive idea that vaccines do cause autism.

"A television show that perpetuates the myth that vaccines cause autism is the height of reckless irresponsibility on the part of ABC and its parent company, The Walt Disney Co.," said Renee R. Jenkins, MD, FAAP, president of the AAP. "If parents watch this program and choose to deny their children immunizations, ABC will share in the responsibility for the suffering and deaths that occur as a result. The consequences of a decline in immunization rates could be devastating to the health of our nation's children."

No scientific link has been found between vaccines and autism. The AAP and other health organizations will continue to work to ensure the safety of childhood vaccines.

For accurate information on autism, immunization and other child health topics, visit the AAP's Web site, http://www.aap.org.

Related Items:

- Letter from AAP President Renee R. Jenkins, MD, FAAP to ABC

- Autism Health Topic Info

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.

American Academy of Pediatrics

Anti-Inflammatory Drug Improves Glycemia, Lowers Inflammation In Obese, Young Adults

An anti-inflammatory drug similar to aspirin may provide an inexpensive means of treating and/or reducing the risk for diabetes in obese young adults by reducing glycemia and lowering inflammation, a study being published in the February issue of Diabetes Care finds.

While researchers have long been aware that high doses of aspirin could reduce blood glucose levels, they have neither understood the mechanisms behind this effect nor been willing to tolerate the risk for stomach bleeding associated with this treatment. However, recent breakthroughs in our understanding of why weight gain is unhealthy point an incriminating finger at inflammation, and suggest that anti-inflammatory treatment strategies might have benefits.

Salsalate - a nonsteroidal, anti-inflammatory medication similar to aspirin that does not cause bleeding - has been used for decades to reduce the pain of rheumatoid arthritis. This double-masked, placebo-controlled study found that salsalate substantially reduced glycemia as well as inflammation in obese, young adults, thereby likely reducing the risk of developing type 2 diabetes and heart disease.

"People who are overweight or obese are at high risk for developing type 2 diabetes," said lead researcher Dr. Allison B. Goldfine, Assistant Professor at Harvard Medical School and Research Investigator at the Joslin Diabetes Center. "We know they can reduce that risk by losing weight and increasing physical activity. But many people aren't good at maintaining those types of lifestyle changes over the long-term. Those people can be helped through pharmaceutical interventions. Our study was the first to look at the metabolic changes that occur when you give salsalate to obese people who have not yet developed diabetes. And we're really encouraged by what we found."

Specifically, the study found that people who took 4 grams per day of salsalate reduced fasting glucose levels by 13 percent and C-reactive protein concentrations (a marker of inflammation) by 34 percent. Previous studies have implicated inflammation in the development of type 2 diabetes and heart disease.

The encouraging results from this small population study have prompted the National Institutes of Health to fund a larger, follow-up study that will look at safety and efficacy of targeting inflammation using salsalate in the treatment of type 2 diabetes. The study is currently ongoing at multiple sites across the country.

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations.

About the ADA

The American Diabetes Association is the nation's premier voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities. The Association's commitment to research is reflected through its scientific meetings; education and provider recognition programs; and its Research Foundation and Nationwide Research Program, which fund breakthrough studies looking into the cure, prevention, and treatment of diabetes and its complications.

American Diabetes Association

Merck, Schering-Plough Offer Explanation For Delay In Release Of Vytorin Study Results

Merck and Schering-Plough recently offered a detailed explanation of their decision to delay the release of the results of a study of the cholesterol medication Vytorin, the Wall Street Journal reports. The study, called Enhance, ended in April 2006, but the companies did not release the results until Jan. 14 (Winslow/Wilde Mathews, Wall Street Journal, 1/26).

The study found that Vytorin is no more effective than a medication available in generic form in the prevention of accumulation of plaque on artery walls. For the study, 720 participants took either Vytorin -- a combination of Zetia, which blocks absorption of cholesterol in the intestines, and Zocor, a statin available in generic form -- or Zocor alone. The two-year study found that participants who took Vytorin experienced a 58% decrease in their LDL cholesterol levels, compared with 41% for those who took Zocor. However, the study found no statistically significant difference in the accumulation of plaque on artery walls among participants who took Vytorin and those who took Zocor (Kaiser Daily Health Policy Report, 1/17).

The companies attributed the delay in the release of the results to efforts to ensure accuracy of imaging data collected during the study. The companies in late 2005 raised concerns about the quality of the imaging data. In subsequent months, the companies established a plan to reanalyze the images that included the establishment of two panels of outside experts to discuss the issue. In January 2007, one expert said the concerns about the quality of the imaging data were similar to those in other studies, but the companies decided to continue with the plan. The companies also said that the results of the study were "blinded" throughout the process and that they remained unaware of whether the results were positive or negative until Dec. 31, 2007.

According to the Journal, "Critics said that, despite the recounting, they didn't fully understand why the companies spent so long working on the data," and the "affair shows the problems that can arise when corporate sponsors, rather than independent academic investigators, control how a study is run" (Wall Street Journal, 1/26).

Additional Developments
Summaries of several developments related to the results of the Vytorin study appear below.

• FDA recommendations: FDA on Friday said that patients should not end treatment with Vytorin immediately based on the results of the study, CQ HealthBeat reports. According to FDA officials, the study does not indicate that Vytorin is ineffective. They added that patients who take Vytorin should discuss whether they should switch medication with their physicians. FDA officials also said that the agency will review the results of the study, with results expected in six months (Lubbes, CQ HealthBeat, 1/25).
  
  
• New York investigation: The office of New York Attorney General Andrew Cuomo (D) on Saturday announced that he has sent subpoenas to Merck and Schering-Plough as part of an investigation into the delay in the release of the results of the study, the Journal reports. The investigation seeks to determine whether the company "deliberately concealed" results of the study. Both companies said that they have received the subpoenas and will cooperate with the investigation (Rubenstein, Wall Street Journal, 1/28).
  
  
• Lawsuits: Merck and Schering-Plough face at least 10 federal lawsuits over allegations that the companies "reaped billions of dollars in profits" through their delay in the release of the results of the study, the Philadelphia Inquirer reports. The lawsuits -- filed in California, Colorado, New Jersey, New York and Ohio -- allege that the delay prompted patients to purchase Vytorin, rather than a lower-cost, generic version of Zetia. Skip Irvine, a spokesperson for the companies, said that they plan to fight the lawsuits (Stark, Philadelphia Inquirer, 1/26).
  
  
• Patient response: Many patients who are "dismayed by recently released research" on Vytorin "have been asking their doctors what to do," the Arkansas Democrat-Gazette reports. According to the Democrat-Gazette, many physicians are "keeping their patients on Vytorin, while others have made changes." The American College of Cardiology has recommended that physicians not make "major clinical decisions" based on the results of the study, and the American Heart Association has recommended that patients consult with their physician before they end treatment with Vytorin (Tubbs, Arkansas Democrat-Gazette, 1/28).

Opinion Piece
"The idea that cholesterol plays a key role in heart disease is so tightly woven into modern medical thinking that it is no longer considered open to question," but based on the results of the Vytorin study, scientists should "question the role of LDL cholesterol in heart disease," Gary Taubes -- author of "Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease" -- writes in a New York Times opinion piece.

Taubes writes, "If the evidence continues to challenge the role of cholesterol, then rethink it, without preconceptions, and consider what these other pathways in cardiovascular disease are implying about cause and prevention." He concludes, "A different hypothesis may turn out to fit the facts better and one day help prevent considerably more deaths" (Taubes, New York Times, 1/27).

Infra Red Helmet For Reversing Early Alzheimer's To Be Tested

Medical experts in the North-East of England, UK, have found that safe exposure to infra-red light improves learning and cognitive functioning in the brain, and they are going to test the method by getting Alzheimer's patients to wear an infra-red "helmet" for a short time every day.

The scientists believe the method can turn back the brain's biological clock and reverse some of the early stage damage typical of dementia and memory loss.

Dr Gordon Dougal, a director of medical research company Virulite, in County Durham, came up with the idea of using infra red to repair damage to human brain cells after successfully developing a cold sore machine that boosts the body's own ability to fight the virus instead of attacking it directly.

The idea has been tested independently by researchers at the University of Sunderland, who showed that low power infra-red light (1072nm) improved learning.

Human trials on patients with diseases like Alzheimer's are due to start. The low level of infra-red light is the same as that which occurs in natural sunlight and is completely safe, said the researchers. The level of exposure is the same as that used in the cold sore machines, which have now been approved for prescription on the NHS.

The idea is that patients could use an infra red helmet for ten minutes a day in their own home and notice a significant improvement in the space of four weeks.

The researchers are hoping to start testing the idea on patients with Alzheimer's and other degenerative brain diseases this summer.

It is possible that the method not only halts but actually reverses the effects of dementia, said Dougal, who went so far as to suggest that one day the method might even be used to change the rate at which our bodies age.

"As we get older, cells stop repairing themselves and we age because our cells lose the desire to regenerate and repair themselves," said Dougal.

"This ultimately results in cell death and decline of the organ functions, for the brain resulting in memory decay and deterioration in general intellectual performance," he added.

"But what if there was a technology that told the cells to repair themselves and that technology was something as simple as a specific wavelength of light? Near infrared light penetrates human tissues relatively well, even penetrating the human skull, just as sunlight passes through frosted glass," explained Dougal.

Neuroscientists at the University of Sunderland, Drs Dr Abdel Ennaceur and Paul Chazot carried out the independent research that confirmed Dougal's findings. Chazot said:

"The treatment can indeed improve learning ability. The results are completely new this has never been looked at before."

"Dr Dougal's treatment might have some potential in improving learning in a human situation by delivering infra red through the thinnest parts of the skull to get maximum access to the brain," he added.

Suppressing Anger In Marriage Linked To Shorter Life

A new US study found that husbands and wives who suppressed their anger when one verbally attacked the other had a higher risk of early death compared to those who expressed their anger.

The study is to be published in the January 2008 issue of the Journal of Family Communication, which is not yet available online, and was the work of researchers from the University of Michigan (U-M).

The research team enlisted 192 couples living in Tecumseh, Michigan, and followed them over 17 years. The spouses were aged between 35 and 69 years when the study began in 1971.

The couples were individually asked questions about how they dealt with anger in their marriage. They were asked to imagine they were being shouted at by their partner for something that they thought was not their fault, and then say how they would respond.

Anger suppression was defined as doing at least two of the following: not show anger, not object to the attack, feel guilty after showing anger.

The couples were placed into four groups, depending on whether they communicated their anger and resolved conflicts.

Group 1 was where both spouses communicated their anger when they felt unfairly attacked by the other; groups 2 and 3 were where one spouse communicated and the other suppressed his or her anger; and group 4 was where both partners suppressed their anger and brooded.

Lead author Dr Ernest Harburg, who is professor emeritus with the U-M School of Public Health and the Psychology Department, said that:

"Comparison between couples in which both people suppress their anger, and the three other types of couples, are very intriguing."

The researchers found that early death was twice as likely to occur in the group where both partners suppressed their anger, compared to the other three groups.

As Harburg said:

"When couples get together, one of their main jobs is reconciliation about conflict."

He said that usually people are not trained in how to resolve conflict in relationships. If they had parents that were good at it, they had role models to imitate, but otherwise couples don't know how to resolve conflict.

The key, said Harburg, is how do you resolve conflict when it happens?

He explained that:

"If you bury your anger, and you brood on it and you resent the other person or the attacker, and you don't try to resolve the problem, then you're in trouble."

The study only examined anger resulting from attacks that were considered unfair or undeserved by the person on the receiving end, said Harburg. People who perceive the attack as "fair", don't get angry, he said.

Harburg and his co-researchers found that of the 192 couples they followed:

• In 26 of them, both partners suppressed their anger.


• There were 13 deaths over the period of study in that group.


• In the remaining 166 couples, there was a total of 41 deaths (all of the three other groups combined).


• In 27 per cent of the couples where both suppressed anger, one of the partners died, and in 23 per cent, both died, during the study period.


• This compared to just 19 per cent of couples in the remaining three groups where one partner died and 6 per cent where both partners died.

The researchers adjusted for a range of demographic and lifestyle variables, including age, weight, smoking, blood pressure, cardiovascular risk, and bronchial and breathing problems.

The researchers said these numbers were small, but gave a preliminary view of the likely conclusions. They are in the process of gathering 30 year follow up data, which will include double the numbers of deaths.

It is also important that readers note this study only established a link between anger suppression and death. Although it ruled out certain risk factors like health, age and lifestyle, it did not establish that anger suppression caused early death. There could be an unexplored factor that linked the two.

Over 100 Cases Of Salmonella Linked To Pet Turtles In The US

The US Centers for Disease Control and Prevention said last week it is still investigating a 9 month multistate outbreak of gastroenteritis that has infected over 100 people who most likely caught Salmonella from small pet turtles.

The CDC announced the results of their ongoing epidemiologic and laboratory investigation into the oubreak in the 25th January issue of Morbidity and Mortality Weekly Report (MMWR). The first reported case occurred in May 2007 and the investigation started in October 2007.

The investigation links 103 cases of gastroenteritis in 33 states to Salmonella Paratyphi B var. Java believed to have been caught by being exposed to small turtles.

Most of the patients who were asked, confirmed they had been in contact with a turtle in the seven days leading up to the onset of their symptoms.

Health authorities first noticed the outbreak when they investigated two cases of severe gastroenteritis in teenage girls who had both swum in the same family owned unchlorinated pool at the same time as two small pet turtles.

One of the girls, aged 13, visited a South Carolina hospital emergency department on the 31st August 2007, after experiencing 5 days of bloody diarrhea, abdominal cramps, fever, and vomiting. She was treated but not hospitalized and she recovered 7 days later. A stool specimen was analyzed and shown to contain Salmonella Paratyphi B var. Java.

The other girl, aged 15, was admitted to a hospital in North Carolina with a similar symptom history but she also had acute kidney failure. She spent 8 days in hospital and made a full recovery.

A joint investigation by the two state health departments found that the girls has swum with pet turtles with shells smaller than 4 inches that had been sold illegally in a pet shop in South Carolina.

Tests of the where the turtles were being kept at the pet shop confirmed the same strain of Salmonella Paratyphi B var. Java as that isolated from the younger girl.

Turtles and other reptiles are a well known cause of human Salmonella infection. A study spanning 1967 to 1997 found that 6 per cent of all human laboratory-confirmed, sporadic cases of Salmonella infections in the United States were caused by exposure to reptiles and amphibians. For those under the age of 21 the figure is nearly double, at 11 per cent. A study in New Jersey in 1972 found that small pet turtles accounted for approximately 23 per cent of Salmonella infections in children.

For this reason, the sale and distribution of small turtles with a shell length under 4 inches has been banned in the US since 1975. But in spite of this ban, the public is able to get hold of small turtles from pet shops, flea markets, street vendors, and through the internet, said the CDC.

The North Carolina Department of Public Health (NCDPH) conducted a wider database search of other reports of salmonella infections and found three other people had been infected with Salmonella Paratyphi B var. Java identical to the strain found in the pet shop turtles. And then, following a nationwide request from the NCDPH, other states started reporting the same strain linked to gastroenteritis outbreaks.

This led to a multistate investigation by the CDC and state and local health departments to find out how big this outbreak was nationwide and where the infections were coming from.

The MMWR report from the CDC last week said that as of 18th January 2008, by searching reportable disease databases they have identified 103 cases of human Salmonella infections from this same outbreak strain, in 33 states.

Over half the patients are under 10 years of age and the first patient fell ill in May last year. Of the 80 patients who were asked about contact with turtles, 47 of them said they had been exposed to them in the 7 days leading up to onset of symptoms. No deaths have been reported.

In order to confirm the link with small turtles, the agency carried out a case-control telephone based study during November 15 to December 5 where they asked 70 patients and 45 neighborhood-matched controls about their exposure to turtles, other reptiles, or aquariums containing tropical fish.

Patients who said they had been exposed to turtles answered detailed questions about the type of exposure, for example whether and how they had handled their pets and their habitats. They were also asked about the size, type and source of their pets, and about their awareness of the link between exposure to reptiles and Salmonella infection.

The study revealed that 44 of the 70 patients had reported exposure to a pet turtle before they fell ill, compared with only 2 of the 45 controls.

The patients had come by their turtle in a variety of ways: from pet shops, flea markets, street vendors, as gifts, and one or two said they had either got it through the Internet, from the wild, hatched from an egg given by a relative, or bought it at a conference.

The CDC is still trying to find out if there is one common distributor or farm of origin for the turtles.

Like other reptiles, the majority of turtles carry Salmonella. Small turtles sold as pets are often bred in crowded ponds and nesting areas, which encourages Salmonella. Using antibiotics to try and stop the Salmonella just makes things worse because the bacteria become resistant.

Turtles tend to shed Salmonella when they are stressed, and this makes it very difficult to tell when an animal is free of the bacteria, said the CDC.

The Pope's Attitude To Science Depends On The Issue

The Pope has said there is much scientific proof of evolution; in 2006 the Vatican sponsored a scientific conference on climate change. However, on some issues his views go against the general flow of the scientific community's. He has defended the Catholic Church's 1663 heresy trial of Galileo.

A speech that was to be given by Pope Benedict XVI at La Sapienza University, Rome, was cancelled after protests at his comments on Galileo's trial. The protesters - students and lecturers - accused the Pope of being hostile towards science.

An Editorial in The Lancet discusses this theme.

The writer explains that the Pope has been less positive when it comes to statements regarding world health. In spite of asking the Pontifical Council for Health Pastoral Care to undertake a scientific, technical, and moral study on HIV/AIDS prevention, Benedict has not altered his position on the use of condoms as one of the measures to prevent HIV infection. His anti-abortion legalization views have been clearly reiterated.

Of the 1.1 billion Catholics that exist on this planet, not all agree with Benedict's viewpoint on science and health. A growing number of Catholics and clerical leaders realize the significant contribution condoms can make towards tackling the HIV/AIDS pandemic - they are also becoming increasingly aware of the number of women who die annually from unsafe abortions - the figure is estimated to stand at 68,000 a year.

Cardinal Carlo Maria Martini, on the other hand, backs condoms in the HIV/AIDS fight, and has said that the legalization of abortion has significantly reduced the number of back-street (illegal) abortions. Cardinal Carlo Maria Martini was a candidate for the papacy in 2005.

The Editorial explains that many Catholic aid workers who do essential and extraordinary work in developing countries have privately distributed condoms to HIV patients.

"It is progressive Catholics like these who remind us that science and religion are not incompatible. Dialogue between scientists and Catholic leaders must always be kept open, on university campuses and elsewhere, even if scientists disagree with the church's interpretation of the world around us," the writer concludes.

A Novel CpG Island Set Identifies Tissue-Specific Methylation At Developmental Gene Loci

The human genome contains about 22,000 genes, each encoding one of the proteins required for human life. A particular cell (e.g. blood, skin, etc.) expresses a specific subset of protein genes and silences the remainder.

This week in the open-access journal PLoS Biology, Robert Illingworth, Adrian Bird, and colleagues shed light on the mechanisms that cause genes to be activated or shut down, by showing how they studied DNA sequences called "CpG islands" (CGIs).

These sequences are found at over half of all human genes and can exist in either the active or silent state depending on the presence or absence of methyl groups on the DNA. They devised a method for purifying all CGIs and showed that, unexpectedly, only half occur at the beginning of genes near the promoter, the rest occur within or between genes.

Notably, methylation of CGIs causes stable gene silencing. They tested 17,000 CGIs in 4 human tissues and found that 6-8% were methylated in each. Genes whose protein products play an essential role during embryonic development (and which need to be switched off at later stages) were biased toward methylation, suggesting that gene expression during development is regulated by CGI methylation.

The Evolution Of Quorum Sensing In Bacterial Biofilms

Bacteria are increasingly recognized as highly interactive organisms with complex social lives, which are critical to their capacity to cause disease. In particular, many species inhabit dense, surface-bound communities, termed biofilms, within which they communicate and respond to local cell density through a process known as quorum sensing. Enormous effort has been devoted to understanding the genetics and biochemistry of biofilm formation and quorum sensing, but how and why they evolve remains virtually unexplored.

Many bacteria use quorum sensing to regulate the secretion of sticky extracellular slime, an integral feature of biofilm life. Intriguingly, however, some species turn on slime production at high cell density, while others turn it off. In this week's issue of the open-access journal PLoS Biology, Carey Nadell, Kevin Foster, and colleagues show that by using an individual-based model of biofilm growth, they investigated why different species use quorum sensing to control slime production in opposite ways. The secret underlying this variation appears to reside in the nature of infections.

Turning slime on at high cell density can allow one strain to suffocate another when competition is intense, as occurs in long-lived chronic infections. Meanwhile, turning slime secretion off at high cell density can benefit a strain causing an acute infection by allowing rapid growth before departing the host.

Avastin Receives Broad Label Extension In Europe For The Treatment Of Patients With Metastatic Colorectal Cancer

Roche announced that the European Commission (EC) has given its approval for the significantly wider use of its anti-angiogenic agent Avastin (bevacizumab) in patients suffering from metastatic colorectal cancer.

This new broader label will now allow Avastin to be used in combination with any chemotherapy, including Roche's oral chemotherapy Xeloda (capecitabine)*, for 1st and later treatment lines in patients with metastatic colorectal cancer. This news means that virtually all patients with metastatic colorectal cancer now have access to Avastin's proven survival benefits. It is estimated that more than 400,000 people in Europe will be diagnosed with colorectal cancer in 2008.

The Avastin approval follows the European Committee for Medicinal Products for Human Use (CHMP) positive recommendations for the extended use of both Avastin and Xeloda in December 2007. *The final EC decision on Xeloda for its extended use is expected imminently.

The new Avastin label will allow it to be used in combination with every standard fluoropyrimidine based chemotherapy and also allows for combinations with Xeloda or oxaliplatin. Avastin formerly could only be used in combination with IV 5-FU or IV 5-FU/irinotecan-based chemotherapy regimen _ where it had demonstrated an impressive survival extension of nearly 5 months. Physicians now have the flexibility to use Avastin with a broad variety of standard chemotherapy of their choice in any line of metastatic colorectal cancer.

"This is a major turning point in the treatment of metastatic colorectal cancer patients," said Professor Alberto Sobrero, Head of Medical Oncology, Hospital San Martino, Genoa, Italy. "This approval means that many more patients can benefit from Avastin's significant survival benefits."

The approval of this broad label is based on the results of two large international phase III pivotal studies (NO16966 and E3200).

About the Phase III studies that formed the basis of the approval
Note: Progression-free survival is a measure of the time patients live without their disease advancing.

NO16966 study

NO16966 is a large, international phase III trial which recruited 2,034 patients. It was originally planned to compare XELOX vs FOLFOX as first-line treatment in metastatic colorectal cancer. After release of the pivotal Avastin data in colorectal cancer in 2003, the protocol was amended to investigate using a 2 by 2 factorial design: FOLFOX/XELOX + placebo vs FOLFOX/XELOX + Avastin.

The primary objective was to answer two questions: 1) whether the XELOX regimen is non-inferior to FOLFOX; 2) whether the addition of Avastin to chemotherapy improved progression-free survival compared to chemotherapy alone. The secondary endpoints included overall survival, overall response rates, time to, and duration of, response and safety profile. Results of the study showed:

The addition of Avastin to chemotherapy (XELOX or FOLFOX-4) significantly improved progression-free survival by 20% compared with chemotherapy alone.
In patients that received treatment until disease progression, the benefit was even greater, and adding Avastin to chemotherapy improved progression-free survival by 58%.
The chemotherapy combination XELOX is as effective in terms of progression-free survival as FOLFOX.

E3200 study

The E3200 study is a randomized, controlled, multi-center phase III trial of 829 patients with advanced or metastatic colorectal cancer who had received previous treatment with irinotecan and 5-FU as initial therapy for metastatic disease or as adjuvant therapy. The study showed that patients who received Avastin plus the 5-FU-based chemotherapy regimen known as FOLFOX4 (oxaliplatin/5-FU/leucovorin) had a 25 percent reduction in the risk of death (based on a hazard ratio of 0.75), the primary endpoint, which is equivalent to a 33 percent improvement in overall survival, compared to patients who received FOLFOX4 alone. Median survival for patients receiving Avastin plus FOLFOX4 was 12.9 months, compared to 10.8 months for those receiving FOLFOX4 alone.

Studies Demonstrate Increased Efficacy Of Erbitux In Metastatic Colorectal Cancer Patients With KRAS Wild-type Tumors

Findings from three studies demonstrate the increased efficacy of Erbitux® (cetuximab) in patients with metastatic colorectal cancer (mCRC) who have a wild-type KRAS tumor, highlighting the potential role of KRAS as a predictive biomarker in the treatment of this common cancer.1-3

Data presented at the American Society of Clinical Oncology 2008 Gastrointestinal Cancers Symposium in Orlando, FL, showed that response rate (RR) for Erbitux plus FOLFIRI was higher for the patient population with wild-type KRAS than for those patients with mutated KRAS. The wild-type KRAS patients showed a RR of 55% versus 32% for those with mutated KRAS. The relative risk of progression in the KRAS wild-type group was reduced by 53% compared to the KRAS mutant group.

Two other retrospectively analyzed studies recently published in the Journal of Clinical Oncology and Annals of Oncology confirm this clinically important correlation.

"Biomarkers are proving to be an interesting area of investigation. Not only do the results demonstrate that Erbitux is highly effective in patients with KRAS wild-type tumors but they also add to the pool of evidence that supports the use of predictive factors in the future of oncology treatment," commented study principal investigator, Professor Josep Tabernero, Vall D'Hebron University Hospital, Barcelona, Spain. "These data give the first evidence of the importance of KRAS as a biomarker in the first-line setting as well as in pretreated patients. Using biomarkers to predict which patients are likely to respond best to targeted therapies allows us to stratify their treatment appropriately and thus improve outcomes. This is of particular importance in the first-line setting as it enables us to select the best treatment strategy for the patient with metastatic disease from day one."

The wild-type or non-mutant KRAS gene is found in up to 65% of colorectal cancer patients and it may prove to be an important biomarker for predicting patient response to targeted treatments such as Erbitux that inhibit the epidermal growth factor receptor (EGFR) pathway.

The two retrospective analyses investigating the impact of KRAS mutations on the efficacy of Erbitux demonstrated that patients with mCRC who have the wild-type KRAS tumor realize a greater benefit from Erbitux in combination with irinotecan-based chemotherapy than those patients with a KRAS mutation.1,2

- The study recently published in the Journal of Clinical Oncology found that pretreated mCRC patients with KRAS wild-type tumors had improved survival over patients with a mutated KRAS tumor [median PFS: 31 weeks vs 10 weeks, p=0.0001].2

- The second study published in Annals of Oncology also demonstrated an improved survival in pretreated mCRC patients with KRAS wild-type tumors vs. tumors with the mutated gene [median overall survival (OS): 43 weeks vs. 27 weeks respectively, p=0.020]. In addition, the results found that patients with the wild-type tumor experienced more significant decreases in tumor size than patients with a mutated tumor, and these patients experienced significantly better OS compared to those without decreases in tumor size [median OS: 75 weeks vs 31 weeks, p=0.00000012].1

"The treatment outcome with Erbitux in combination with irinotecan for metastatic CRC patients with KRAS wild-type tumors reported in these analyses is outstanding for a population of pretreated patients. Progression free survival clearly exceeds earlier findings in non-selected patients," said Professor Pierre Laurent-Puig from the Université Paris-Descartes and Assistance Publique-Hôpitaux de Paris, France.

"These studies demonstrate - in both first-line and pretreated settings - the consistent, clinically relevant efficacy of Erbitux in metastatic CRC patients with KRAS wild-type tumors, further exceeding the benefit provided by Erbitux plus irinotecan in non-selected patients," added Professor Sabine Tejpar, University Hospital Gasthuisberg in Leuven, Belgium.

Merck Serono is committed to improving the lives of people with cancer and is pioneering research into the use of biomarkers to identify patients who will most benefit from treatment with targeted therapies such as Erbitux. The ongoing analyses of the large randomized first-line studies of Erbitux in combination with chemotherapy will further help to understand the potential role of KRAS in the treatment of metastatic colorectal cancer.

More than 370,000 people develop colorectal cancer in Europe every year, accounting for 13% of the total cancer burden and around 200,000 deaths.4 Approximately 25% of patients present with metastatic disease.5 Five-year survival rates for patients with mCRC are as low as 5%.6

The Mind And Body Together Lean Toward 'Truthiness'

'Truthiness,' according to television satirist Stephen Colbert, represents the human preference to follow our intuition despite the presence of facts or evidence. For example, the more ambiguous an answer to a question, the more likely an individual will believe it is truthful.

At least that is what psychologists Rick Dale of the University of Memphis, Michael Spivey of Cornell University and the late Chris McKinstry found when they asked college students questions that ranged in levels of vagueness and tracked their corresponding arm movements to clicking 'yes' or 'no' on a computer screen.

Specifically, questions such as "is murder sometimes justifiable?" are considered ambiguous and could cause the sensation of being 'pulled' in both directions at once; however, questions like "can a kangaroo walk backwards?" have a high probability of 'no' responding.

The results of participants' cursor movements suggested that the human brain thinks and acts at the same time, in contrast to what many researchers previously assumed: That the decision-making process was completed by the cognitive subsystem, or the brain's thought center, before it was shared with other parts of the brain.

"These dynamic data showed that participant arm movements had lower velocity and curved more toward the alternative response box during 'no' responses than during 'yes' responses - suggesting that we experience a general bias toward assuming statements are true," the authors explained.

The findings, which appear in the January 2008 issue of Psychological Science, a journal of the Association for Psychological Science, suggest that the mind and body do in fact work together and the resulting collaboration may prompt us to lean toward 'truthiness.'

Deficient Regulators In The Immune System Responsible For Type 1 Diabetes

The main regulators of the immune system, called CD4+Treg cells, are thought to be highly involved in a large range of immune diseases. The gradual reduction in their regulating capacity seems to play a critical role in the onset of type 1 diabetes, as demonstrated in the latest study by Dr. Ciriaco Piccirillo, a researcher in the Department of Microbiology and Immunology at the Research Institute of the McGill University Health Centre and the principal investigator for this project. This study was published this month in the journal Diabetes.

The immune system needs to be regulated so that it attacks only the site of an inflammation and focuses its attack on pathogens rather than on the body tissues, causing an autoimmune disease.

In a healthy patient, CD4+Treg cells deactivate any T lymphocytes, a type of immune cell, that are misprogrammed and could attack the body. Dr Piccirillo's research indicates that in type 1 diabetic patients this control mechanism may be deficient, thereby allowing the misprogrammed T lymphocytes to proliferate and gain the ability to destroy the insulin-producing cells of the pancreas. This leads to type 1 diabetes.

"We have been able to demonstrate this in mice with type 1 diabetes, and other genetic studies have shown that this same mechanism is applicable to humans," explained Dr. Piccirillo. Dr Piccirillo is an assistant professor at the McGill University, and the Canada Research Chair in Regulatory Lymphocytes of the Immune System. "Furthermore, the predominant role of nTreg cells leads us to believe that they are also involved in other autoimmune pathologies. Finding this common denominator among diseases that were previously thought to be unrelated is a very promising avenue for future study", he adds.

Although the mechanism of action of CD4+Treg cells has not yet been completely unravelled, the scientific community generally accepts that this mechanism is of crucial importance to the entire immune system. Major fundamental and applied research efforts are currently being directed down this path and aim to clarify the role of CD4+Treg cells in order to develop innovative cellular therapies that could restore immune stability in patients.

"The eventual hope is to treat the cause of type 1 diabetes and other autoimmune diseases and not just their symptoms, as we do today", says Dr Piccirillo.

Lesotho Aims To Increase HIV/AIDS, Health Cooperation With China, Ambassador Says

Lesotho hopes to increase cooperation with China on HIV/AIDS treatment and other health issues, Lesotho's ambassador to Beijing, Anthony Thibeli, said on Wednesday, Xinhua/CRIEnglish.com reports. China's first medical team to Lesotho arrived in 1997, and the second team arrived in 1999. A team of 15 Chinese doctors currently is working in health care centers throughout Lesotho. "Fifteen is a small number," Thibeli said, adding that Lesotho needs "more Chinese doctors to help us." Lesotho's Minister of Health and Social Welfare last year visited China to discuss cooperation between the two countries on the use of Chinese herbal medicines as HIV/AIDS treatments, doctor training and telemedicine.

Lesotho has decreased its HIV/AIDS prevalence to an estimated 26% from 31%, largely because of efforts to increase voluntary HIV testing, as well as access to no-cost counseling and treatment for people living with the virus, according to Thibeli (Xinhua/CRIEnglish.com, 1/23).

Chinese State FDA Completes Technical Review Of Calypte Biomedical's Oral HIV Test Application

Calypte Biomedical Corporation (OTCBB: CBMC), a developer, manufacturer and marketer of HIV diagnostic tests, announced that the Chinese State Food and Drug Administration ("SFDA") has notified Calypte's Chinese manufacturing subsidiary, Beijing Marr Bio-pharmaceutical Co., Ltd., ("Beijing Marr") that the technical review of its Aware™ HIV-1/2 OMT rapid oral test product application has been completed. Pending the SFDA's review of conformity to product standard documents and labeling to applicable regulations, the application will progress to the concluding administrative approval.

Roger I. Gale, Calypte's President and Chief Executive Officer, stated, "This is a major milestone in a long and difficult approval process. We are extremely pleased that the SFDA has determined that our scientific data has met their criteria, and that we are now moving into the final phase of the registration process. We believe that in meeting the technical standards established by the SFDA, we have demonstrated to them the high quality of our product."

Dr. Ronald W. Mink, Calypte's Chief Science Officer, commented, "The technical review is considered the most challenging and lengthy portion of the SFDA review process, and is the penultimate milestone in the approval process. We are absolutely delighted that we have overcome what is arguably the highest hurdle in the approval process, and are ready to move into the final administrative stage."

David K. Harris, Beijing Marr's Chief Executive Officer stated that, "The notice from the SFDA is of paramount importance and indicates that the substantive content of the application and the technology itself have met with the acceptance of the SFDA and are acceptable for the Chinese market. Nearing the end of an arduous approval process, we are very proud to see this recognition of years of hard work in developing the AwareTM HIV-1/2 OMT product."

Calypte operates in China through Beijing Marr, a joint venture between Calypte and the Marr Group established to manufacture Calypte's Aware™ line of rapid HIV tests, including the Aware™ HIV-1/2 OMT product for both the Chinese and international markets. The Aware™ HIV-1/2 OMT product is a rapid test using oral fluid to diagnose HIV-1 or HIV-2 infection in as little as 20 minutes with an accuracy comparable to that of U.S. FDA approved blood based laboratory HIV EIA tests.

About The Marr Group

The Marr Group is a private group of companies having a large and diverse number of investments and projects globally, principally in Europe, the Far East, the Middle East and the CIS.

About Calypte Biomedical

Calypte Biomedical Corporation is a U.S.-based healthcare company focused on the development and commercialization of rapid testing products for sexually transmitted diseases such as the Aware™ HIV-1/2 OMT test that are suitable for use at the point of care and at home. Calypte believes there is a significant need for rapid detection of such diseases globally to control their proliferation, particularly in developing countries, which lack the medical infrastructure to support laboratory-based testing. Calypte believes that testing for HIV and other sexually transmitted infectious diseases may make important contributions to public health, and could increase the likelihood of treating those with undetected HIV and other sexually transmitted diseases.

Statements in this press release that are not historical facts are forward-looking statements within the meaning of the Securities Act of 1933, as amended. Those statements include statements regarding the intent, belief or current expectations of the Company and its management. Such statements reflect management's current views, are based on certain assumptions and involve risks and uncertainties. Actual results, events, or performance may differ materially from the above forward-looking statements due to a number of important factors, and will be dependent upon a variety of factors, including, but not limited to, the Company's ability to obtain additional financing, if and as needed, and access funds from its existing financing arrangements that will allow it to continue its current and future operations and whether demand for its test products in domestic and international markets will generate sufficient revenues to achieve positive cash flow and profitability. The Company undertakes no obligation to publicly update these forward-looking statements to reflect events or circumstances that occur after the date hereof or to reflect any change in the Company's expectations with regard to these forward-looking statements or the occurrence of unanticipated events. Factors that may impact the Company's success are more fully disclosed in the Company's most recent public filings with the U.S. Securities and Exchange Commission ("SEC"), including its annual report on Form 10-KSB for the year ended December 31, 2006 and its subsequent filings with the SEC.

Recent Studies Of Vytorin, Avandia Prompt Debate About FDA Approval Process For New Medications

Recent studies that raised questions about the benefits of the cholesterol medication Vytorin, manufactured by Merck and Schering-Plough, and the safety of the type 2 diabetes treatment Avandia, manufactured by GlaxoSmithKline, are "reigniting debate" about the FDA approval process for new medications, the Wall Street Journal reports. House Energy and Commerce Committee members John Dingell (D-Mich.) and Bart Stupak (D-Mich.) on Thursday sent letters to the American Heart Association, the American College of Cardiology, Merck and Schering-Plough to request information about Vytorin, and Sen. Chuck Grassley (R-Iowa) on Thursday began a separate investigation into the medication.

According to the Journal, the "lawmakers' interest is the latest sign that the flap over" Vytorin, as well as the safety concerns about Avandia, "is adding new fuel to a long-running debate" about the use of "surrogate markers" in the FDA approval process. FDA approved Vytorin and Avandia in large part based on evidence that they helped control cholesterol and blood sugar levels, respectively, with those measures "believed to reflect important clinical benefits" that "serve as proxy markers, or surrogates, for the drug's broader and more important effect on the body," the Journal reports. The use of surrogate markers helps reduce approval times for new medications because "studies can generally be shorter, smaller and cheaper," but the markers "can be misleading," according to the Journal.

Grassley said that, "in light of what's happened with Avandia and Vytorin, maybe the FDA needs to re-examine when it's appropriate to use surrogate endpoints." He added, "These two cases also highlight the importance of vigilant postmarketing surveillance and the need for more postmarketing studies to address important safety questions." Stupak said that "people taking Vytorin are doing so because they believe it will reduce their risk of heart attack." In addition, he said, "It would make sense for FDA to require manufacturers to conduct an endpoint study to determine whether Vytorin just reduces cholesterol or if it also reduces heart attacks."

FDA officials said that they would examine the use of surrogate markers in the agency approval process. A "shift by the FDA toward tougher scrutiny of new drugs could add hundreds of millions of dollars to the cost of developing a drug at a time when some big drug makers are struggling to replenish product pipelines," the Journal reports (Wilde Mathews/Winslow, Wall Street Journal, 1/25).

Method For Assigning Probabilities To Human Protein Interactions Devised By Stowers Proteomics Center

The Stowers Institute's Proteomics Center has published a novel method of using normalized spectral counts derived from a series of affinity purifications analyzed by mass spectrometry (APMS) to generate a probabilistic measure of the preference of proteins to associate with one another.

The work - which allows for the assignment of probabilities not only to the interactions within well-defined protein assemblies, but also to interactions between complexes - has been posted to the Web site of the Proceedings of the National Academy of Sciences (PNAS).

Large-scale APMS studies have played important roles in the assembly and analysis of comprehensive protein interaction networks for lower eukaryotes, such as yeast. But the development of such networks for human proteins has been slowed by the high cost and significant technical challenges associated with systematic studies of protein interactions.

The Stowers Institute's Proteomics Center has addressed this challenge by developing a method for building local and focused protein networks. With this computational approach, the probability for two proteins to associate is calculated from the bait-to-prey relationship alone, an improvement over other methods requiring systematic reciprocal bait-prey interactions or co-purification of preys by a third bait.

"Previous protein interaction networks built using protein mass spectrometry data were largely based on binary 'yes/no' data, where a protein is present in a sample or it is not," explains Michael Washburn, Ph.D., Director of Proteomics and senior author on the paper. "We were interested in quantitative proteomics approaches. We were able to develop a method to generate more information-rich networks, where the preference of two proteins to associate within a defined complex or within a larger network assembly can be estimated using Baysian probabilities. The new approach adds more information to the analysis of protein complexes and networks, since not all proteins interact in the same way."

The work not only provides a significant advancement in proteomic analysis, it also holds promise in facilitating the development of treatments for disease.

"By having insight regarding the most probable contacts within a multiprotein complex, we can devise targeted strategies to disrupt specific interactions," said Mihaela Sardiu, Ph.D., Postdoctoral Research Associate and lead author on the paper. "This could be useful for developing new drugs for disrupting protein complexes involved in disease."

The Proteomics Center is one of three technology development centers that support research at the Stowers Institute. In addition to collaborating with Stowers Institute independent research teams, the centers pursue cutting-edge solutions to the evolving challenges of basic biomedical research.

"The Stowers Institute's Proteomics Center is providing technology solutions that fundamentally change the way that Stowers researchers approach their work," said Robb Krumlauf, Ph.D., Scientific Director. "Because of the support provided by our technology development centers, Stowers research teams can approach long-standing problems in new and innovative ways, elevating their research and results."

an Francisco Chronicle Examines Use Of Technology For Sex Education

The San Francisco Chronicle on Thursday examined the use of technology by educators and public health professionals to provide sex education to teenagers. The "push" to use technology to communicate with teenagers about sex follows a CDC report that found that the teenage birth rate increased for the first time in 15 years in 2006, the Chronicle reports.

According to the Pew Internet & American Life Project, 90% of people ages 12 to 17 use the Internet, and more than 60% of the group use it daily. A report by Nielsen found that 35% of children ages eight to 12 own cell phones and that 20% use text messaging. In response, educators and health professionals are using video podcasts that speak frankly about sex, as well as computer games and text messages to educate teenagers about safer sex, pregnancy, sexually transmitted infections and sexuality.

Oakland, Calif.-based Internet Sexuality Information Services on Tuesday and Wednesday held the inaugural SexTech Conference, which examined how sex education messages could be disseminated using the Internet, mobile technology and video game tools. ISIS in June plans to partner with the University of Colorado and Columbia University to test an HIV/AIDS awareness project on MySpace for people ages 14 to 18. Deb Levine, executive director of ISIS, said, "The youth are using the next new [technologies]. They're early adopters ... They're looking for information on sex online and on their cell phones, so let's make it available to them in a legitimate way."

The San Francisco Department of Public Health uses a text messaging service to answer commonly asked questions, such as what to do if a condom breaks. Jeffrey Klausner, director of San Francisco's STD prevention and control services section, said that there are "important issues of privacy" regarding sex "that technology can overcome." He added, "People can access information privately and remain anonymous."

According to the Chronicle, some educators and public health advocates say that they feel they constantly are playing "catch-up" to new technologies and that they are challenged by acquiring and keeping funding for sex education projects. "There's still nothing better than high-quality, comprehensive sex education in school, but with abstinence-only programs, the ball is getting dropped and the Internet is able to pick it up," William Neville, manager of marketing and new media for Advocates for Youth, said (Lee, San Francisco Chronicle, 1/24).