WHO Urges All Countries To Ban Smoking

Coinciding with today being World No Tobacco Day, the World Health Organization (WHO) is urging all countries to bring in a 100 per cent ban on smoking in indoor public places and workplaces and has released its new policy recommendations on protection from exposure to second-hand tobacco smoke.

“The evidence is clear, there is no safe level of exposure to second-hand tobacco smoke,” said WHO Director-General Dr Margaret Chan in a prepared statement earlier this week.

“Many countries have already taken action. I urge all countries that have not yet done so to take this immediate and important step to protect the health of all by passing laws requiring all indoor workplaces and public places to be 100 per cent smoke-free,” she added.

Tobacco smoke contains 4,000 known chemicals, with more than 50 of them known to cause cancer, said the WHO.

More than 5 million deaths a year are caused by tobacco, making it the leading preventable cause of death in the world. The developing world is seeing the fastest growth in tobacco use, and half of tobacco-related deaths occur there. If this growth continues, 80 per cent of tobacco-related deaths will be in the developing world.

Also, exposure to second hand smoke causes heart disease and premature death in adults due to respiratory and cardiovascular diseases.

Workplace exposure to tobacco smoke is estimated to kill 200,000 workers a year, and the WHO estimates that 700 million children, that is half the world’s minors, breathe in tobacco smoke, mostly at home.

In the six years between 1999 and 2005, the WHO and the US Centers for Disease Control and Prevention (CDC) conducted the Global Youth Tobacco Survey where youngsters aged 13 to 15 in 132 countries were interviewed about their exposure and attitude to tobacco smoke. More than three quarters of the youngsters favoured a ban on smoking in public places.

The survey also showed that 44 per cent of the young interviewees breathed in tobacco smoke at home while 56 per cent of them were exposed to it in public places.

The WHO is not alone in highlighting the dangers to children from second hand smoke. According to the US Environmental Protection Agency (EPA), breathing in second hand smoke harms children by causing “asthma, Sudden Infant Death Syndrome (SIDS), bronchitis and pneumonia and ear infections”.

The EPA suggests that American children’s exposure to second hand smoke is responsible for:
An increase in the number of asthma attacks and severity of symptoms in 200,000 to 1 million children with asthma.
Between 150,000 and 300,000 lower respiratory tract infections (for children under 18 months), and
Respiratory tract infections that result in 7,500 to 15,000 hospital admissions every year.
They point out that young children’s lungs are particularly susceptible to second hand smoke because they are still developing, breathe more rapidly than adults and they don’t control their environment. Children exposed to high levels of second hand smoke, and this is particularly the case if their mothers smoke, are more likely to have poor health.

The WHO’s new policy recommendations draw on the conclusions of three new major reports:
Monograph 83 Tobacco Smoke and Involuntary Smoking by the International Agency for Research on Cancer (IARC),
The United States Surgeon General’s Report on The Health Consequences of Involuntary Exposure to Tobacco Smoke, and
The California Environmental Protection Agency’s Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant.
The WHO are also keen to highlight the cost that smoking incurs on people, businesses and society, not just as a result of disease. This includes loss of productivity and material costs to enterprises that have to renovate and clean workplaces, pay higher insurance premiums, and run an increased risk of fire.

The end of next month, on 30th June in Bangkok, sees the start of the Second Conference of the Parties to the WHO Framework Convention on Tobacco Control, where participating countries will discuss the practicalities of protection against exposure to second-hand tobacco smoke.

Acting Director of the WHO Tobacco Free Initiative, Dr Douglas Bettcher, speaking about the Second Conference of the Parties, said that:

“This topic should matter to everyone, because everyone benefits from smoke-free places.”

“With this year’s theme, we hope that everyone, especially policy makers and employers, will be inspired to claim, create and enjoy spaces that are 100 per cent free from tobacco smoke. By doing so, we keep the bodies inside those spaces smoke-free too, and greatly increase our effectiveness in preventing serious diseases and saving lives in future generations,” he added.

World No Tobacco Day is celebrated all over the world in different ways, with marches, workshops to help people stop smoking, educational meetings, and various campaigns to raise awareness about the dangers of second hand smoke.

Last year, Michael R Bloomberg, mayor of New York City, announced his intention to donate 125 million dollars over the next two years toward ending the global tobacco epidemic. The money will be awarded in the form of grants, and applications are sought from the 15 high burden countries in particular: Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine and Vietnam.

Source : www.medicalnewstoday.com

British nurses stressed out, underpaid, under-valued and their sex lives suffer

In a survey of nurses in the UK, it has been found that almost half of nurses feel their sex lives are damaged by the emotional stress of their job.
The survey by the magazine Nursing Times questioned almost 2,000 nurses, and found 70% said they suffered from physical or mental health problems linked to work-related stress, while some 44% said their sex life was suffering as a result; 25% said they had started drinking more as a result of pressure and one in 10 nurses were smoking more.

The magazine lays the blame for the current situation on the pressure of financial deficits and the threat of job cuts in the National Health Service (NHS).

Almost a third of the nurses polled admitted to taking more days sick than usual and more than one in five of those surveyed had taken 30 or more days off during the last year.

The Royal College of Nursing (RCN) says the survey confirms that nurses are under pressure, and are also under valued and under paid.

The RCN says stress is a serious issue for nurses who are subjected on a daily basis to violence and abuse from patients and relatives, while trying to cope with the day-to-day pressures of having to carry out more tasks with fewer resources because of deficit-led cost cutting.

Added to that are concerns regarding job security and pay cuts and the RCN says it comes as no surprise that stress levels are affecting nurses’ personal lives and relationships.

According to a RCN poll last year more than a quarter of nurses surveyed had been physically attacked at work, while nearly half had been bullied or harassed by a manager.

The RCN says such issues must be addressed for nurses to stay in the profession and in order to attract new recruits.

Experts agree that the impact of stress on NHS employees was “vastly under-estimated” and is costing the health service £300-400million a year.

The survey results have backed calls from both political parties in Britain for nurses to be awarded a full 2.5% pay increase this year; currently nurses in England, Wales and Northern Ireland have been offered a 1.5% rise followed by another 1% in November, but nurses want the 2.5% immediately and are being balloted by the RCN on whether they want a vote on industrial action.

To date 186 MPs from all parties have committed their support for the full 2.5% pay rise for nurses.

The Royal College of Midwives have also voted unanimously to consider a ballot for industrial action for the first time in their history over the staged 2.5% pay rise.

Nurses have not in the past been permitted to take industrial action but a rule change in the mid-1990s allows measures which do not harm patient care, which means an all-out strike is unlikely but it does let nurses take other steps such as refusing to do overtime.

Source : www.news-medical.net

Low serum testosterone levels independently associated with fall risk in elderly men

Prolonged hypogonadism may result in erectile dysfunction, decreased libido, anemia, sarcopenia, memory loss, bone mineral loss, and the metabolic syndrome.
While a low serum testosterone level is well-known for its association with osteoporosis, the impact of hypogonadism on overall physical functioning and fall risk has not been prospectively evaluated.

In the October 23 issue of the Archives of Internal Medicine, Orwoll and colleagues from the Osteoporotic Fractures in Men Study Group report on a longitudinal, observational study designed to evaluate the relationship between serum testosterone and the development of age-related disorders, including the risk of falling.

A total of 2586 men ages 65 to 99 were randomly selected from a cohort of 5995 volunteers. Serum testosterone and estradiol levels were measured at baseline and compared to the incidence of falls, which were ascertained every 4 months for 4 years.

Fifty six percent of men reported at least one fall over the follow-up period. The risk of a fall was 40% higher in men in the lowest testosterone quartile when compared to those in the highest testosterone quartile. Interestingly, the association between low serum testosterone and falling was highest among the youngest men (relative risk 1.8, 95% CI 1.2 to 2.7) and was not statistically significant in those men over 80 years of age. This association persisted despite adjusting for overall physical performance.

This important study suggests that in a cohort of men older than 65 years, a low serum testosterone was associated with an increased risk of falling which was independent of the patient’s overall physical performance. While testosterone replacement in this age group should be used cautiously due to their higher prostate cancer risk, these data certainly should heighten our awareness that androgen deprivation is not innocuous and may be associated with significant risks beyond bone mineral loss.

Source : www.news-medical.net

Insurers Promote Use Of Generic Anticholesterol Drugs

The Syracuse Post-Standard on Monday examined how many health insurers have begun to encourage members to use generic versions of the anticholesterol medication Zocor, which reached the U.S. market last June, rather than Lipitor, manufactured by Pfizer, to reduce costs.

For example, Excellus BlueCross BlueShield of New York has begun to provide members with a one-month supply of simvastatin, the generic version of Zocor, at no cost and has reduced the cost of simvastatin for members to about $7.50 monthly, compared with about $135 monthly for Lipitor. Joel Owerbach, chief pharmacy officer for Excellus, said, “Lipitor is a great drug, but the reality is, for the vast majority of people who are taking Lipitor, you can get to the same place by taking a drug that’s going to cost a lot less.”

Meanwhile, Pfizer has begun an “ad blitz” to promote the use of Lipitor, which will lose patent protection in 2010, the Post-Standard reports. The market share of Lipitor has decreased from 34.7% to 28.9% since generic versions of Zocor reached the market, but first-quarter sales of Lipitor increased by 8% to $3.36 billion. Arthur Levin of the Center for Medical Consumers said that Lipitor sales are “very important to the company’s bottom line,” adding that “they are going to do everything possible to not allow that position to erode” (Mulder, Syracuse Post-Standard, 5/22)

Source : www.medicalnewstoday.com

Unexplained Chest Pain Relieved By New Treatment

The discomfort caused by esophageal (non-cardiac) chest pain is often severe, driving many patients to emergency rooms and physicians’ offices despite the fact that the ailment has no definable pathology. Although this pain may sometimes be the result of acid reflux disease, when this is absent most patients present hypersensitivity of the esophagus, and a recent study suggests a potential new way of managing this and other symptoms.

The study finds that theophylline, taken either intravenously or orally, appears to reduce esophageal chest pain by relaxing the esophageal wall and decreasing hypersensitivity. Lead author Satish S.C. Rao finds evidence that these beneficial effects may also be influenced by theophylline’s actions on adenosine receptors, altering esophageal sensory thresholds at the same time as relaxing the muscles.

Rao notes that “following oral administration, symptomatic improvement was seen in nearly 60 percent of patients, and the drug was reasonably well tolerated,” adding that “if a cardiac, pulmonary, musculoskeletal or esophageal source such as acid reflux disease can be excluded, our findings suggest that a trial of theophylline may be effective in relieving chest pain.”

Source : www.medicalnewstoday.com

Stomach Microbe Linked To Asthma Prevention

The stomach bacterium Helicobacter pylori, which causes stomach cancer and peptic ulcers, may not be all bad. According to a new study, it may help protect kids from asthma.

The study, based on an analysis of a health survey of 7,663 adults, showed that a virulent strain of H. pylori was especially associated with being asthma-free before the age of 15. People who carry the strain were 40 percent less likely to have had asthma at an early age than those who didn’t carry the strain. The study also found that the microbe was associated with protection against ragweed and other allergies due to pollens and molds particularly among younger adults.

The study is published in the Archives of Internal Medicine.

“Ultimately, the potentially protective properties of Helicobacter are consistent with one another,” explains Martin J. Blaser, M.D., the Frederick H. King Professor of Internal Medicine, Chairman of the Department of Medicine, and Professor of Microbiology at NYU School of Medicine, who has been studying H. pylori for more than 20 years.

“These properties point toward a much more complex view of the organism – not just as ulcer-pathogen or cancer-pathogen, but as an organism that has its costs and benefits to us,” says Dr. Blaser. “The relative costs and benefits clearly differ among individuals.”

Dr. Blaser performed the study with Yu Chen, Ph.D., MPH, assistant professor in the Department of Environmental Medicine at NYU School of Medicine, a new faculty member with expertise in epidemiology.

H. pylori lives in the mucous layer lining the stomach where it persists for decades. It is acquired usually before the age of 10, and is transmitted mainly in families. Dr. Blaser’s previous studies have confirmed the bacterium’s link to stomach cancer and elucidated genes associated with its virulence, particularly a gene called cagA.

Over recent years, Dr. Blaser began to suspect that the organism, the dominant bacteria in the stomach, may play a role in human health as well as disease. This observation, he says, is consistent with a theory called the hygiene hypothesis. It suggests that exposure to microbial infections in early childhood prevents or diminishes the development of allergies and asthma.

Dr. Blaser has proposed that H. pylori may protect against diseases of the upper gastrointestinal tract, such as gastroesophageal reflux disease (GERD), which may lead to Barrett esophagus, a premalignant condition, and adenocarcinoma of the esophagus. All of these conditions have become more common in developed countries – esophageal cancer of this type is the fastest rising cancer in the United States – as H. pylori has become far less common due to improved sanitation and widespread use of antibiotics, says Dr. Blaser. (At the same time, the incidence of peptic ulcers and gastric cancer has declined in developed countries.)

Today, less than 10 percent of children carry the organism in industrialized countries, while some 90 percent of children are infected usually by age 5 in developing countries. “This bacterium has been the dominant organism in our stomach for tens of thousands of years, and it can’t disappear from us without consequences,” says Dr. Blaser. He says that a substantial body of work now shows that H. pylori helps protect against GERD and the conditions it leads to in the esophagus.

“The hypothesis that colonization of H. pylori, especially cagA strain, is protective of asthma risk needs to be tested by prospective studies. The findings from our study and others will collectively provide evidence,” says Dr. Chen.

If the relationship between H. pylori and asthma is confirmed in other studies, which is always the yardstick of scientific validity, then it raises the question about whether “we should be trying to eliminate Helicobacter from children,” says Dr. Blaser. “This is probably the first time in human history that we have children who are growing up without Helicobacter guiding their immune responses,” he says. “By the repeated courses of antibiotics given to children, we are changing human microecology and we don’t know what we are doing.”

In the new study, Drs. Blaser and Chen evaluated whether H. pylori’s protective effect against GERD could play a role in asthma, another condition sometimes associated with GERD. They used data from the Third National Health Nutrition Examination Survey (NHANES III), which was conducted from 1988 to 1994, and originally involved nearly 40,000 people. The survey included questions about a medical history of asthma, allergic rhinitis, and allergy symptoms. Nearly 8,000 of the participants were tested for antibodies to H. pylori and the cagA protein in their blood. This subgroup formed the basis of the study.

Drs. Blaser and Chen found no overall association between the presence of the cagA strain of H. pylori and current asthma status in the individuals they studied, but found an inverse association with ever having had asthma. Those with the virulent strain were 20 percent less likely to have ever had asthma compared with participants without H. pylori. In addition, the association differed quite strikingly by age of onset. It was strongest among participants who had the cagA strain of H. pylori and had had asthma before the age of 15. This result was statistically significant, meaning that the results were not likely due to chance. Those with the virulent strain were 40 percent less likely to have had asthma at a young age.

In another part of the study, they analyzed the results of allergy skin testing to six allergens, including ragweed, rye grass, and Russian thistle, among a subgroup of 2,386 adults who had the skin tests. They correlated the results with participants’ H. pylori status and found the strongest association for these allergens among the younger people in the group who carried the bug. This suggested that H. pylori is involved in protection from sensitivity to pollens and molds, says Dr. Blaser.

“No one would have predicted that the presence or absence of bacteria in your stomach is associated with your sensitivity to pollens and molds,” says Dr. Blaser. “But now we have that observation and we can begin to construct a model. One hypothesis is if you have H. pylori in your stomach, you have an inflammatory process that is on-going for decades, and this is skewing the immune response in a particular direction.”

Source : www.medicalnewstoday.com