Newborn Screening Suggests Decline in Cystic Fibrosis

(HealthDay News) -- The incidence of cystic fibrosis may be decreasing, and a more severe form of the disease caused by one particular gene also appears to be on the decline.

Those are the two main findings from a Massachusetts study that found the overall incidence of cystic fibrosis dropped from between 25 and 35 babies a year before 2003 to less than 20 babies each year for most years after 2003.

The study also found that the incidence of a severe form of the disease, caused by the genotype ΔF508/ΔF508, also dropped dramatically. Before 2003, at least 10 babies were born with this form of cystic fibrosis each year. In 2003 and beyond, only about five babies were born annually with this type of cystic fibrosis in the Massachusetts area, according to the study.

"The most severe genotype has dropped out dramatically. The new mix has some severe genotype, but overall, it's a milder group of kids, though not everyone has mild disease," said one of the study's authors, Anne Marie Comeau, deputy director of the New England Newborn Screening Program in Jamaica Plain, and an associate professor of pediatrics at the University of Massachusetts Medical School in Worcester.

The findings were published as a letter in the Feb. 28 issue of the New England Journal of Medicine.

Cystic fibrosis is an inherited disorder that affects mucus production and the sweat glands, making mucus sticky and thick, and sweat becomes extremely salty. The disorder affects many major organs, such as the lungs, pancreas and intestines. Mucus can clog the lungs, causing breathing problems and making it easy for bacteria to grow, leading to lung infections and lung damage.

While there's no cure for cystic fibrosis, treatments have improved greatly in recent years. Until the 1980s, most deaths from the disorder occurred in children and teens. Today, people live, on average, to be more than 35 years old, according to the U.S. National Library of Medicine.

Both parents must be carriers of a cystic fibrosis gene for a child to be born with the disorder.

However, carriers have no symptoms and often have no idea that they carry the cystic fibrosis gene. Even when both parents carry a cystic fibrosis gene, the chances are only one in four that a child will be born with the disorder, according to the U.S. National Heart, Lung, and Blood Institute (NHLBI).

About 30,000 Americans have cystic fibrosis, and it's most common in white people of Northern European descent, although people from all races can be born with cystic fibrosis, according to NHLBI.

The new research included data from the New England Newborn Screening Program and the Massachusetts Cystic Fibrosis Newborn Screening Work Group.

Comeau said the researchers believe that the decrease in the incidence of the ΔF508/ΔF508 type, as well as other forms of cystic fibrosis, owes to prenatal screening to see if parents are carriers of a cystic fibrosis gene.

She said the most important implication of this research, however, is for people evaluating treatments for cystic fibrosis. She said it's very important for such researchers to know that "the cohort of children may be changing. If you test a treatment on kids inherently bound to have a less severe disease, you have to be careful when applying those findings to all kids," Comeau said.

Dr. David Orenstein, director of the Antonio J. and Janet Palumbo Cystic Fibrosis Center at Children's Hospital of Pittsburgh, said, "This study raises an interesting possibility. There have been some other geographic areas where this same trend toward lower birth rates or fewer children born with cystic fibrosis has been observed, and so it's possible that it's real. But, these things do go up and down a bit naturally."

Orenstein said he'd have liked to have seen the data broken down by ethnic groups, since the disease is more prevalent in people of Northern European descent. But, he also pointed out that the numbers of children included in this study were very small, which means the findings need to be confirmed.

More information
To learn more about cystic fibrosis and available genetic tests, visit the March of Dimes.

Laser Screen Detects Diseases in Breath

(HealthDay News) -- A special technique that uses laser light to sample a person's breath can detect molecules that may be markers for a number of diseases, a U.S. study says.

This approach, called cavity-enhanced direct optical frequency comb spectroscopy, may one day help doctors screen patients for diseases such as asthma, cancer, kidney failure and diabetes, according to the team of scientists at JILA, a joint institute of the National Institute of Standards and Technology and the University of Colorado at Boulder.

"This technique can give a broad picture of many different molecules in the breath all at once," lead researcher Jun Ye said in a prepared statement.

Optical frequency comb spectroscopy was developed in the 1990s. This study describes the potential use of the technology in detecting disease.

Each breath exhaled by a person contains more than a thousand different molecules, some of which may be indicators of disease. For example, excess levels of methylamine may indicate liver or kidney disease, ammonia may be a sign of renal failure, elevated acetone levels may indicate diabetes, and nitric oxide levels can be used to diagnose asthma.

In this study, Ye and colleagues used the technique to analyze the breaths of several volunteers. They exhaled into an optical cavity (a space between two mirrors) and a pulsed laser light was then aimed into the optical cavity. The laser light bounced back and forth between the mirrors, covering a distance of several kilometers by the time it exited the optical cavity. During this time, the laser light struck all the molecules within the cavity.

The technology was able to detect a wide range of molecules, the scientists said. The findings, published in the current issue of Optics Express, suggest this technique, which still needs to be evaluated in clinical trials, may offer a low-cost, rapid and noninvasive method of health screening, the researchers said.

More information
The American Association for Clinical Chemistry has more about health screening tests.

Cancer Death Rates Still Declining

(HealthDay News) -- Good news continues to come forth from the cancer front: U.S. death rates from the disease have declined by 18.4 percent among men and by 10.5 percent among women since mortality rates first started going down in the early 1990s.

In 2008, an estimated 1,437,180 new cancers will be diagnosed, and 565,650 people will die of the disease, according to a report released Wednesday from the American Cancer Society (ACS). Death rates were at their highest for men in 1990, and for women in 1991.

Although the rate of cancer deaths decreased from 2004 to 2005, there was an increase in number of actual deaths (5,424) in 2005 compared to 2004, the report showed.

"We do not know why the declines in death rate from 2004 to 2005 slowed, compared to the previous two years," said Ahmedin Jemal, strategic director for cancer surveillance at the ACS. "But we can say that this occurred for almost all of the major cancer sites for men and women, which include colon and rectum in both men and women, breast cancer in women, and prostate cancer in men."

"Death rates from cancer continue to decrease because of prevention, early detection and treatment," Jemal added. "These have been decreasing from the early '90s and, really, because of this decrease, over half a million deaths from cancer have been avoided."

Jemal is first author of Cancer Statistics 2008, which is published in the March/April issue of CA: A Cancer Journal for Clinicians. The report has been an annual fixture since 1952.

"This is both good news and bad news," said Dr. Louis Weiner, director of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C. "The good news is that cancer rates continue to decline, and that the lives of hundreds of thousands of Americans have been saved over past 15 or 16 years as a result of this improvement in cancer death rates."

"The bad news is that more than a half a million Americans can be anticipated to die of cancer this year," Weiner continued. "That's equivalent to nearly the entire population of Washington, D.C., and losing more than the entire population of New Orleans in 2003. Viewed from that perspective, we have a long way to go."

According to Jemal, "smoking is a big part [of the decline.] Smoking rates have been decreasing for the last 30 to 40 years, when the Surgeon General came out with his report."

Screening for colorectal, breast and cervical cancer have also contributed to the decrease, he added.

Today, about one-quarter of deaths in the United States today are due to cancer, killing more people under 85 than heart disease.

Some specifics from this year's report:

• In men, cancers of the prostate, lung, colon and rectum represented about half of all newly diagnosed cancers. Prostate cancer alone accounted for one-quarter of the total cancer cases in men.
• In women, the three most commonly diagnosed cancers in 2008 will be breast, lung and colorectal. These account for about half of all cancer cases in women. Breast cancer alone accounts for 26 percent of new cancer cases among women (although the incidence decreased by 3.5 percent per year from 2001 to 2004, part of which may be due to declines in the use of postmenopausal hormone replacement therapy). About one-quarter of all deaths from cancer in women in 2008 will be from lung cancer.
• In men aged 40 and younger, leukemia is the most common cause of cancer death, while lung cancer is the leading killer in men over the age of 40.
• Leukemia is also the leading cause of cancer death among females under 20, while breast cancer takes the greatest toll in women aged 20 to 59. Lung cancer is the biggest cancer killer in women over 60.
• The incidence of cancer is 19 percent higher and the death rate 37 percent higher among black men compared with white men. For black women, the incidence rate is 6 percent lower, but the death rate is 17 percent higher than for white women.
• The five-year survival rate for children with cancer has improved from 58 percent for those diagnosed between 1975 and 1977 to 80 percent for those diagnosed between 1996 and 2003.

This year's report also includes a special section that discusses the impact of health insurance status on cancer prevention, diagnosis, treatment and outcomes. Earlier this week, researchers from the American Cancer Society reported that people who either have no health insurance or rely on Medicaid are more likely to be diagnosed with advanced cancers.

More information
Visit the American Cancer Society for more on this report and on different types of cancer.

Allergy Disorders Linked With Irritable Bowel Syndrome

(HealthDay News) -- There may be a link between allergies and irritable bowel syndrome (IBS) in adults, says a study by researchers at Rush University Medical Center in Chicago.

IBS occurs in about 15 percent of the U.S. population. Some studies have suggested that allergen exposure may lead to IBS symptoms in some patients, but the frequency hadn't been examined.

In this study, researchers looked at 125 adults and found the likelihood of IBS was much higher in patients with allergic eczema (3.85 times) and seasonal allergic rhinitis (2.67) times. They also found that IBS was 2.56 times more likely in people with depression.

"The reported presence of allergic dermatitis was highly correlated to the presence of IBS in our population," the study authors wrote. "In atopic disease, allergic dermatitis is the first step of the 'atopic' march.' In early childhood, AE (allergic eczema) is frequently associated with gastrointestinal dysfunction and food allergy. A clinical history of AE may be a useful marker for patients with gut hypersensitivity and atopic IBS."

The researchers also found that asthma and IBS were reported by 12 of 41 patients (29 percent), similar to findings in a previous study. The researchers proposed that "this subgroup of IBS (atopic IBS) be considered separately from patients with IBS without atopic symptoms, because they may have distinct pathophysiologic features and may benefit from specific therapeutic interventions."

The study was published recently in the Annals of Allergy, Asthma & Immunology.

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about IBS.

Tango Classes Put Parkinson's Patients a Step Ahead

(HealthDay News) -- Not only is the tango a dance of romance and passion, it also helps improve balance and mobility in people with Parkinson's disease, a new study suggests.

Researchers at the University of Washington School of Medicine in St. Louis compared the effects of Argentine tango lessons and exercise classes on the functional mobility of 19 Parkinson's patients. The patients were randomly assigned to do 20 one-hour tango classes or group strength and exercise sessions designed for Parkinson's patients and the elderly.

All the patients were assessed prior to the start of these activities and after they completed the sessions. The dance classes included stretching, balance exercises, tango-style walking, footwork patterns, experimenting of timing of steps, and dance with and without a partner. The exercise classes included 40 minutes of seated exercise, followed by standing exercises supported by a chair, core strengthening and stretching.

By the end of the sessions, both groups showed significant improvements in standard tests designed to measure mobility. People in the tango group showed more improvement in balance than those in the exercise group.

"Given these preliminary results, we think tango is feasible for individuals with Parkinson's disease and may be an appropriate and effective form of group exercise for individuals with Parkinson's disease," researcher Gammon M. Earhart, an assistant professor of physical therapy, said in a prepared statement.

"Although some participants were initially skeptical because they hadn't danced in years or thought they couldn't because of the disease, this study shows that dance can improve functional mobility," Earhart said.

While dance in general may benefit people with Parkinson's, several aspects of tango movement may be especially helpful to these patients, including dynamic balance, turning, initiation of movement, moving at different speeds, and walking backward.

"This type of therapy looks to be superior than what is currently offered," researcher Madeline E. Hackney, a predoctoral trainee in movement science, said in a prepared statement. "The quality of life improved in these patients because of the social aspect of dancing."

The study was published in the Journal of Neurologic Physical Therapy.

Further studies with larger groups of patients are needed to confirm these preliminary findings, the researchers said.

More information
The National Parkinson Foundation has more about Parkinson's disease treatment options.

Spouse's Sickness Bodes Ill for Partner's Health

(HealthDay News) -- It's called the "widow" or "widower" effect, and doctors have long been familiar with this curious but very real phenomenon: When a husband or wife dies, there's a greater likelihood that the surviving spouse will pass soon afterward.

Now, researchers are gaining a better understanding of the forces at work, realizing problems often start with the hospitalization of a spouse.

New findings suggest that having a husband or wife who needs to be admitted to a hospital with a serious illness poses health risks for the partner. The culprit: The stress and upheaval the partner experiences while enduring the hospitalization of an ailing husband or wife.

"It's not like your spouse's sickness somehow magically makes you worse," said Dr. Nicholas A. Christakis, a professor of medical sociology at Harvard Medical School's Department of Health Care Policy. "We believe it works by imposing some kind of burden."

To unravel the connection, Christakis and co-researcher Paul D. Allison, a University of Pennsylvania statistician, examined records of more than a half million couples who were in enrolled in Medicare from 1993 through 2001. Their findings, published in the New England Journal of Medicine, demonstrate the ripple effect of a spouse's hospitalization -- across various illnesses -- on the partner's health.

"What this work shows is that illness in one person -- in a spouse -- can affect the health, the mortality, of another person," Christakis explained. "And this, in turn, means taking better care of someone who's sick not only benefits the sick person, but also benefits other people, such as their spouse."

In the United States, at least 44 million adults, including spouses, provide care for a loved one, the National Alliance for Caregiving estimates. Yet, few of these individuals are adequately prepared to cope with the rigors of caring for another person or the toll it can take on their health, according to the Family Caregiver Alliance.

Overall, Christakis' study found that a spouse's hospitalization boosted the risk of a man's death by 22 percent compared with the death of a spouse. A husband's hospitalization increased a woman's death risk by 16 percent.

Some diseases posed more of a burden than others. For example, a woman's hospitalization for stroke, congestive heart failure or hip fracture raised her husband's death risk by 6 percent, 12 percent and 15 percent, respectively. Similarly, a man's hospitalization for colon cancer did not significantly influence his wife's death risk, but other diseases did have a major impact.

A spouse's hospitalization for dementia proved most stressful, raising risk of death 22 percent for men and 28 percent for women, Christakis said. "In fact," he added, "we show that having a demented spouse is as bad for you as having a dead spouse."

Some diseases are deadly, but don't pose as much of a burden on the caregiver, be it physical, psychological, financial or some combination of these, he explained.

The study also identified certain time frames during which caregivers are particularly vulnerable, including immediately after a hospitalization and again three to six months into the illness.

Suzanne Mintz, president and co-founder of the National Family Caregivers Association, said the study offers additional proof that the stress of caring for a family member can have negative health consequences.

"The findings should frighten family caregivers," she said, "but more importantly, hopefully, help them give priority status to their own health needs."

Spousal family caregivers' risk of depression is six times greater than that of non-caregivers, Mintz noted. And, they are less likely to reach out for help, she said. To protect their health, Mintz urges family caregivers to spread the work load.

"Caregiving is much more than a one-person job, especially when both the family caregiver and the care recipient are elderly," she said. "Often, spousal caregivers do not want to ask for or take help from their grown children, but that really is the first place we should all turn."

More information
To learn more, visit the National Family Caregivers Association.

Transparent Fish Gives New Window on Disease

(HealthDay News) -- Medical researchers can now get a clearer view into human biology and disease with a newly developed, totally transparent breed of zebrafish, a common model for medical research.

According to the Children's Hospital Boston researchers who developed the new breed, zebrafish are genetically similar to humans. This new transparent form of the small fish will provide researchers with a direct view of its internal organs and the opportunity to observe processes such as the spread of cancer or blood production after bone marrow transplant, as they occur in a living organism.

In normal zebrafish, embryos are transparent but adults become opaque. The new permanently transparent fish, created by mating two existing zebrafish breeds, is described in the Feb. 7 issue of Cell Stem Cell.

Currently, researchers studying human diseases in animals induce the illness and allow it to progress, then kill and dissect the animals. But that approach is bound to miss something in cancer and other rapidly changing processes, according to the team that developed the transparent zebrafish.

"It's like taking a photograph when you need a video," Dr. Richard White, a clinical fellow in the Stem Cell Program at Children's Hospital Boston and an instructor of medicine at the Dana-Farber Cancer Institute, said in a prepared statement.

In his first experiment with the transparent zebrafish, White viewed how cancer spreads.
"The process by which a tumor goes from being localized to widespread and ultimately fatal is the most vexing problem that oncologists face," White said. "We don't know why cancer cells decide to move away from their primary site to other parts of the body."

He placed a fluorescent melanoma (skin cancer) tumor in the abdominal cavity of a transparent zebrafish and, using a microscope, saw the cancer cells begin to spread within five days. The melanoma cells moved toward the skin after leaving the abdominal cavity.

"This told us that when tumor cells spread to other parts of the body, they don't do it randomly. They know where to go," White said.

He plans to investigate cancer cell homing and to look for ways to prevent spreading cancer cells from finding their way to their intended destination.

In another experiment, White investigated how transplants of blood stem cells can help rebuild healthy blood in cancer patients after treatment. He irradiated bone marrow in a transparent zebrafish and then transplanted fluorescent blood-forming stem cells from another zebrafish.

After four weeks, White could see that the transplanted fluorescent stem cells had migrated and grown in the fish's bone marrow. Even individual stem cells were visible.

Being able to observe how stem cells embed and build blood in the transparent fish may help scientists find faster ways to help rebuild healthy blood in cancer patients. For example, drugs and genes could be tested in the fish and scientists could directly view the effects, White said.

Because their brain, heart and digestive tract are readily visible, the transparent fish will enable researchers to study genetic defects in these organs and learn more about a variety of disorders ranging from Alzheimer's disease to inflammatory bowel disease, White added.

More information
The University of Oregon has more about zebrafish.

Pregnant Women With Asthma Should Stay on Low Dose of Meds

(HealthDay News) -- During pregnancy, asthmatic women should continue to use their asthma medication in the lowest dose possible to manage symptoms.

So recommends a new Practice Bulletin just released by the American College of Obstetricians and Gynecologists (ACOG).

The bulletin says women with moderate or severe asthma should also be monitored throughout pregnancy for fetal growth restriction and signs of possible preterm birth.

During pregnancy, asthma attacks may deprive the fetus of oxygen and may be associated with premature birth, growth restriction and other fetal complications, as well as illness and death in women, the ACOG said.

The new recommendations are based on a review of existing studies and support the position of the U.S. National Asthma Education Prevention Program that "it is safer for pregnant women with asthma to be treated with asthma medications than it is for them to have asthma symptoms and exacerbations."

"Previously, there was limited guidance regarding the management of asthma during pregnancy," Dr. Andrew J. Satin, chairman of the ACOG's Committee on Practice Bulletins-Obstetrics, said in a prepared statement. "With the growing number of asthmatics in the U.S., it became a priority to formalize recommendations for ob-gyns, who will likely see an increasing number of asthmatic patients."

"Research consistently shows that women with well-controlled asthma can have healthy pregnancies with excellent maternal and perinatal outcomes," Dr. Mitchell P. Dombrowski, an ACOG Fellow who contributed to the new Practice Bulletin, said in a prepared statement. "The ultimate goal of controlling asthma during pregnancy is to ensure that the fetus continues to get adequate oxygen by preventing asthma attacks."

The bulletin is published in the February issue of Obstetrics & Gynecology.

More information
The American Academy of Allergy, Asthma and Immunology has more about asthma and pregnancy.