CDC Endorses Circumcision for Health Reasons

 

The U.S. Centers for Disease Control and Prevention on Tuesday released its first-ever draft guidelines on circumcision that recommend that doctors counsel parents and uncircumcised males on the health benefits of the procedure.

The guidelines do not outright call for circumcision of all male newborns, since that is a personal decision that may involve religious or cultural preferences, Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Associated Press.

But "the scientific evidence is clear that the benefits outweigh the risks," Mermin said.

Circumcision involves the surgical removal of the foreskin covering the tip of the penis. Germs can collect and multiply under the foreskin, creating issues of hygiene.

Clinical trials, many done in sub-Saharan Africa, have demonstrated that circumcision reduces HIV infection risk by 50 percent to 60 percent, the CDC guidelines note. The procedure also reduces by 30 percent the risk of contracting herpes and human papilloma virus (HPV), two pathogens believed to cause cancer of the penis.

The guidelines do point out that circumcision has only been proven to prevent HIV and sexually transmitted diseases in men during vaginal sex. The procedure has not been proven to reduce the risk of infection through oral or anal sex, or to reduce the risk of HIV transmission to female partners.

The scientific evidence is mixed regarding homosexual sex, the guidelines say, with some studies having shown that circumcision provides partial protection while other studies have not.

Circumcision does reduce the risk of urinary tract infections in infants, according to the CDC guidelines.

The most common risks associated with the procedure include bleeding and infection.

Male circumcision rates in the United States declined between 1979 and 2010, dropping from almost 65 percent to slightly more than 58 percent, according to a CDC report issued last year.

The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics in 2012.

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Brain Scans Yield Clues to Future Stroke Risk

 

The study included more than 2,000 people who had CT scans of the brain within 24 hours of suffering a mild, non-disabling stroke or a transient ischemic attack, which are sometimes called "mini-strokes." Of those patients, 40 percent had brain damage due to a lack of sufficient blood flow (ischemia).

Compared to people who didn't have an interruption in blood flow to part of their brains, the risk of another stroke within 90 days was almost three times higher in those with new brain damage due to poor blood circulation (acute ischemia), according to the researchers.

The study also found that the risk of another stroke was more than five times higher in people with previous brain damage from ischemia (chronic ischemia) in addition to the damage from the recent stroke.

The risk was also nearly five times higher in people with damage from insufficient blood flow along with any type of small blood vessel damage in the brain, according to the study. An example of small blood vessel damage is the narrowing of the small vessels (microangiopathy) in the brain.

The study also found that the risk of another stroke was about eight times higher in those people who had recent damage from ischemia and chronic ischemia, as well as small blood vessel damage.

While slightly more than 3 percent of all the patients in the study had another stroke within 90 days, the rate was 25 percent among those with all three types of damage to the brain, the researchers found.

"During the 90-day period, and also within the first two days after the initial attack, patients did much worse in terms of experiencing a subsequent stroke if they had additional areas of damage along with acute ischemia," co-senior author Dr. Jeffrey Perry, an associate professor of emergency medicine at the University of Ottawa in Canada, said in a news release from the American Heart Association.

"These findings should prompt physicians to be more aggressive in managing patients with transient ischemic attack [mini-stroke] or non-disabling stroke who are diagnosed with acute ischemia, especially if there is additional chronic ischemia and/or microangiopathy," he added.

Measures to prevent another stroke include heart monitoring or medications that lower blood pressure and cholesterol, or drugs to prevent blood clots, the researchers suggested.

The study was published online Dec. 4 in the journal Stroke.

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BPA in Canned Goods May Raise Your Blood Pressure: Study

 

BPA previously has been linked to a variety of ills, including heart problems, developmental problems in children and high blood pressure. The chemical is widely used in products ranging from plastic bottles and food containers to dental fillings and cash register receipts. In cans, BPA is used as a lining, the researchers said.

"We found that drinking two canned beverages increased systolic blood pressure by 5 mm Hg," said lead researcher Dr. Yun-Chul Hong, director of the Environmental Health Center at Seoul National University College of Medicine in Korea.

Putting that in perspective, he said a 20 mm Hg increase in systolic blood pressure doubles the risk for heart disease. The systolic blood pressure number is always the first of two numbers given in a blood pressure reading.

"Because these results confirm findings from other studies, doctors and patients, particularly those with high blood pressure or heart disease, should be aware of the possible risks from increased blood pressure when consuming canned foods or beverages," he said.

Previous research has shown that BPA in containers can leach into food and beverages.

Since BPA acts like the hormone estrogen, Hong thinks it raises blood pressure as it interacts with cells in the heart and blood vessels that are sensitive to estrogen.

For the study, Hong's team had 60 men and women, aged 60 and up, drink soy milk from either cans or glass bottles on three occasions. The researchers assessed participants' blood pressure and heart rate two hours after drinking the soy milk and also tested their urine for BPA.

Urine tests showed a 1,600 percent increase in BPA among those who drank from cans, compared with those who drank from glass bottles. Soy milk was chosen for the test because it has no known ingredient that elevates blood pressure, the researchers said.

The report was published online Dec. 8 in the journal Hypertension.

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Babies Still Sleeping With Soft Bedding Despite SIDS Risk: CDC

 

Use of soft bedding among parents declined sharply from 1993 through 2000, but has mostly leveled off since the early 2000s, the study found. The American Academy of Pediatrics has recommended since 1996 that infants be placed in sleeping environments without any soft surfaces or objects that might trap air, the study noted.

"Soft bedding has been shown to increase the risk of SIDS. Soft objects and loose bedding -- such as thick blankets, quilts and pillows -- can obstruct an infant's airway and impose suffocation risk," said lead author Carrie Shapiro-Mendoza, a senior scientist in the Maternal and Infant Health Branch of the U.S. Centers for Disease Control and Prevention.

About 16 babies per 100,000 died from accidental suffocation during sleep and 53 per 100,000 died from SIDS in 2010, according to background information in the study.

The researchers analyzed the results of the National Infant Sleep Position survey. This poll was conducted by phone annually between 1993 and 2010. Over that time, nearly 19,000 parents of children younger than 8 months answered questions about their baby's sleep environment. Most respondents were white mothers, nearly half had a college education, and about half had a previous child, according to the study.

The researchers found that the use of bedding for infants declined from an average of 86 percent between 1993 and 1995 to an average of 55 percent between 2008 and 2010. Most of that decline, however, occurred before 2000.

The findings were reported online Dec. 1 in Pediatrics.

The most common use of bedding occurred among teen mothers, more than 80 percent of whom used bedding. Not having a college education and younger mothers in general were also linked to more frequent use of bedding. Minority mothers were more likely than white mothers to use soft bedding, the study reported.

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Are Routine Ultrasounds for Women With Dense Breasts Worthwhile?

 

Although dense breasts are a known risk factor for breast cancer, this increasingly common strategy doesn't appear to improve survival much but does "substantially" boost costs and false-positive results, researchers found.

"Performing ultrasound for all women with dense breasts after a negative mammogram would produce relatively few benefits," said study researcher Brian Sprague, assistant professor of surgery at the University of Vermont.

In the United States, at least 19 states require doctors to notify women of their breast density after undergoing a mammogram, according to background information in the study. Those with dense breasts may then be advised to talk to their doctor about supplemental testing.

Legislation mandating such notification nationwide is also under consideration, the study says.

"Be aware that screening ultrasound may lead to unnecessary biopsies," Sprague said. "There is a small chance it could save your life, but there is a much greater chance you will have a false-positive result."

Breast density is categorized on a scale of 1 to 4, with 1 deemed mostly fatty breasts and 4 being the least fatty and most dense breasts. About 45 percent of women aged 40 to 74 have dense breasts, Sprague found in previous research.

Dense breasts have more fibrous and glandular tissue than fatty tissue, which can also make it difficult for a radiologist to detect cancer on a mammogram. Dense tissue, like cancer, shows up white on the mammogram. Fatty tissue is dark, so any cancer is more visible.

For the study, published in the Dec. 9 online issue of the Annals of Internal Medicine, Sprague and his team used a computer-based simulation model to look at three scenarios. In one, women got routine mammograms only. In the second, women with category 4 breast density got a mammogram and an ultrasound. In the third scenario, Sprague grouped categories 3 and 4 together.

Using information from breast cancer surveillance databases, the researchers looked at how many breast cancer deaths could likely be prevented by adding ultrasound and how many biopsies would occur after a false-positive ultrasound. They also evaluated potential costs.

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Antacids May Improve Head and Neck Cancer Survival

The researchers examined the effects that two types of antacids -- proton pump inhibitors and histamine 2 blockers -- had on head and neck cancer patients. More than two-thirds of the nearly 600 patients in the study took one or both types of the antacids after their cancer diagnosis.

Acid reflux -- commonly known as heartburn -- is a common side effect of chemotherapy or radiation treatment, according to the researchers. Proton pump inhibitors include drugs such as Prilosec, Nexium and Prevacid, while histamine 2 blockers include drugs such as Tagamet, Zantac and Pepcid.

Compared to patients who didn't take antacids, those who took proton pump inhibitors had a 45 percent lower risk of death, according to the researchers. They also found that those who took histamine 2 blockers had a 33 percent lower risk of death.

The study is published in the December issue of the journal Cancer Prevention Research.

"We had suspicions that these medications somehow had a favorable impact on patient outcomes. This led us to review our large cohort of patients and screen them for common medications, focusing on antacids. In fact, our study did show that people taking antacids are doing better," study author Dr. Silvana Papagerakis, research assistant professor of otolaryngology--head and neck surgery at the University of Michigan Medical School, said in a university news release.

It's not clear why antacids may improve survival. But, the researchers have started looking for answers to that question.

"Currently, patients might be on and off of this medication according to their symptoms of acid reflux. We believe this medication can also be beneficial at stopping cancer progression. Perhaps longer duration of treatments may have significant effect in terms of outcome survival," Papagerakis said.

"What this study makes clear is these medications may be more beneficial to the patients than just controlling side effects," Papagerakis added.

The researchers also want to investigate if the use of antacids by people with reflux disease or with precancerous lesions might reduce their risk of developing head and neck cancer.

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Peanut Protein in Dust May Raise Allergy Risk

In a new study, published online Nov. 18 in the Journal of Allergy and Clinical Immunology, being exposed to peanut protein in house dust doubled the chance of having a peanut allergy. In children who have eczema, the risk of having peanut allergy was even higher.

Researcher Helen Brough, from the department of pediatric allergy at King's College London, U.K., and colleagues note that eczema "is often cited as the first step in the allergic march."

They say that exposure to peanut proteins in dust through eczema-inflamed skin can trigger a peanut allergy.

How peanut allergies develop is not yet clear, says Carla M. Davis, MD, a specialist in children's allergies at Texas Children's Hospital in Houston. There is still plenty of controversy in the field, she says.

For instance, some researchers are testing a "patch" for people who already have a peanut allergy that would introduce the allergen through the skin to build tolerance. That seems to contradict the findings in this study, she says.

The researchers found out how much peanut protein infants were exposed to by measuring dust vacuumed from the patients' living rooms.

The researchers studied 359 children who had a high risk of developing a peanut allergy because they were already allergic to cow's milk or eggs, or had moderate or severe levels of eczema and had allergies to those foods.

"This study adds to the growing body of evidence that exposure to peanut via a damaged skin barrier [as in ezcema] may increase the risk of peanut allergy,” Brough says in a news release.

Several co-authors report receiving support from the Immune Tolerance Network, the Wellcome Trust Intermediate Clinical Fellowship, DBV Technologies, Dyax, and Hycor Biomedical. One co-author is a minority stockholder in Allertein and Mastcell Pharmaceuticals. Another has stock options with DBV Technologies. Several co-authors report receiving royalties from UptoDate. One co-author is a member of the Scientific Advisory Board for DBV Technologies. Several co-authors report consultancy arrangements or having received payments for lectures from one or more of the following companies or groups: Novartis, Abbott Laboratories, Dow AgroSciences, McNeill Nutritionals, Merck, Schering Plough, GLC Research, ExploraMed Development, Regeneron Pharmaceuticals; Unilever; Allertein Therapeutics; Danone Research Institute; Anaphalaxis Campaign; and the National Peanut Board. ThermoFisher Scientific, UCB, Pfizer, Sodilac, Nestle Nutrition, and GlaxoSmithKline.

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Researchers Find Stem Cells That Help Nails Regenerate

Using mouse nail cells, University of Southern California scientists identified stem cells that can perform two roles. In normal conditions, the stem cells assist in the growth of both the nails and nearby skin. However, if a nail is damaged or destroyed, the stem cells focus exclusively on nail repair, according to the study.

"That was a very surprising discovery, since the dual characteristic of these nail stem cells to regenerate both the nail and skin under certain physiological conditions is quite unique and different from other skin stem cells, such as those of the hair follicle or sweat gland," principal investigator Krzysztof Kobielak said in a university news release.

The researchers wonder if it might be possible to get these nail stem cells to produce other types of tissue. If so, it could lead to new ways to help people with everything from nail and finger defects to severe skin injuries and amputations.

Findings from the study were published online recently in the Proceedings of the National Academy of Sciences.



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Restroom Hand Dryers Spread More Germs Than Paper Towels, Study Finds

British researchers placed a harmless type of bacteria on the hands of volunteers in order to simulate poorly washed hands. They then had them use warm-air dryers, high-powered "jet-air" dryers or paper towels to dry their hands.

The investigators measured airborne bacteria levels and found higher amounts of germs around both types of dryers than around towel dispensers.

Jet-air dryers were the worst, the study found. Bacteria levels in the air around jet-air dryers were 4.5 times higher than around warm air dryers and 27 times higher than around paper towel dispensers, said a team led by Mark Wilcox of the University of Leeds.

His team also found that the bacteria persisted in the air around hand dryers long after they were used. Forty-eight percent of the bacteria around hand dryers was collected more than five minutes after use, and the bacteria could still be detected 15 minutes after use.

"Next time you dry your hands in a public toilet using an electric hand dryer, you may be spreading bacteria without knowing it. You may also be splattered with bugs from other people's hands," Wilcox said in a university news release.

"These findings are important for understanding the ways in which bacteria spread, with the potential to transmit illness and disease," he added.

The study was published Nov. 20 in the Journal of Hospital Infection and was also presented at the Healthcare Infection Society International Conference in Lyon, France.

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Senior-to-Senior Aggression Common in U.S. Nursing Homes

The study of 10 centers in New York state found that, in the space of just one month, nearly 20 percent of residents were involved in some type of incident with a fellow resident.

Most often, it was a verbal clash, with someone yelling or cursing at another resident. In other cases, the incidents involved hitting or kicking -- or, in a small percentage, inappropriate touching.

"We discovered that this is a much more prevalent problem than any of us realized," said researcher Karl Pillemer, a gerontology professor at Weill Cornell Medical College in New York City.

Results of the study were presented at a recent meeting of the Gerontological Society of America. Findings from studies presented at meetings are generally considered preliminary until they've been published in a peer-reviewed journal.

Pillemer's research also zeroed in on the residents who were most likely to be involved in incidents. "Typically," Pillemer said, "they were people who were in the moderate stages of dementia, but were still physically able to get around."

That makes sense, according to Dr. Laura Mosqueda, a geriatrics specialist who was not involved in the study. Mosqueda directs the National Center on Elder Abuse at the University of Southern California, in Los Angeles.

Nursing home residents with dementia commonly become confused, and may act out aggressively -- but only if they have the physical capacity to do so, explained Mosqueda.

"I think the point this study raises is, who's responsible or accountable for this behavior?" Mosqueda said. "It's not the residents. In my view, it's the owners and people running the facilities. Do they have enough staff with the appropriate training?"

Still, Mosqueda also cautioned against an alarmist interpretation of the findings.

She noted that one of the more common forms of "aggression" in this study was "unwelcome entry" into another resident's room or going through another person's possessions.

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