Jonathan Gardner

Physicians should favor prescribing alendronate for secondary prevention of osteoporotic fragility fractures unless patients cannot take the medication, the clinical effectiveness agency for England and Wales has ruled.

The National Institute for Health and Clinical Excellence's final assessment of preventive drugs for postmenopausal women “who have osteoporosis and have sustained a clinically apparent osteoporotic fragility fracture” also allows other bisphosphonates—along with strontium ranelate, raloxifene, and teriparatide—if patients are intolerant to alendronate, have a contraindication, or cannot comply with the instructions for taking alendronate.

In the event that patients cannot take alendronate, NICE's guideline recommends risedronate and etidronate. A patient's intolerance to etidronate and risedronate allows physicians to move on to strontium ranelate and raloxifene, provided the patient has additional risk factors or meets a stricter bone mineral density threshold.

Teriparatide is recommended if patients have a contraindication, intolerance, or unsatisfactory response to the other drugs and have a combination of very low T scores and at least two fragility fractures.

Alendronate, the least expensive medication (at £53.56 for once-weekly tablets for the generic version), was the most cost effective and was no less effective than were alternatives in preventing fragility fractures in the population, according to the NICE panel that assessed the medications.

But the panel was able to develop thresholds for the use of alternative medications, based on age, clinical risk factors, and T scores, that would not increase the National Health Service's costs by more than £30,000 per quality-adjusted life-year gained.

For example, women aged 55-59 years must have a T score of −3 to qualify for the use of risedronate or etidronate if they do not have an independent risk factor, whereas women aged 70 years or older must have a T score of only −2.5. Women aged 50-54 years do not qualify for any of the alternative medications unless they have an independent clinical risk factor.

The guideline assumes patients are receiving adequate calcium and vitamin D. It also states that a dual-energy x-ray absorptiometry scan may not be necessary for patients 75 years and older, or patients with body mass index lower than 22 kg/m

Physicians should favor prescribing alendronate for secondary prevention of osteoporotic fragility fractures unless patients cannot take the medication, the clinical effectiveness agency for England and Wales has ruled.

The National Institute for Health and Clinical Excellence's final assessment of preventive drugs for postmenopausal women “who have osteoporosis and have sustained a clinically apparent osteoporotic fragility fracture” also allows other bisphosphonates—along with strontium ranelate, raloxifene, and teriparatide—if patients are intolerant to alendronate, have a contraindication, or cannot comply with the instructions for taking alendronate.

In the event that patients cannot take alendronate, NICE's guideline recommends risedronate and etidronate. A patient's intolerance to etidronate and risedronate allows physicians to move on to strontium ranelate and raloxifene, provided the patient has additional risk factors or meets a stricter bone mineral density threshold.

Teriparatide is recommended if patients have a contraindication, intolerance, or unsatisfactory response to the other drugs and have a combination of very low T scores and at least two fragility fractures.

Alendronate, the least expensive medication (at £53.56 for once-weekly tablets for the generic version), was the most cost effective and was no less effective than were alternatives in preventing fragility fractures in the population, according to the NICE panel that assessed the medications.

But the panel was able to develop thresholds for the use of alternative medications, based on age, clinical risk factors, and T scores, that would not increase the National Health Service's costs by more than £30,000 per quality-adjusted life-year gained.

For example, women aged 55-59 years must have a T score of −3 to qualify for the use of risedronate or etidronate if they do not have an independent risk factor, whereas women aged 70 years or older must have a T score of only −2.5. Women aged 50-54 years do not qualify for any of the alternative medications unless they have an independent clinical risk factor.

The guideline assumes patients are receiving adequate calcium and vitamin D. It also states that a dual-energy x-ray absorptiometry scan may not be necessary for patients 75 years and older, or patients with body mass index lower than 22 kg/m

Physicians should favor prescribing alendronate for secondary prevention of osteoporotic fragility fractures unless patients cannot take the medication, the clinical effectiveness agency for England and Wales has ruled.

The National Institute for Health and Clinical Excellence's final assessment of preventive drugs for postmenopausal women “who have osteoporosis and have sustained a clinically apparent osteoporotic fragility fracture” also allows other bisphosphonates—along with strontium ranelate, raloxifene, and teriparatide—if patients are intolerant to alendronate, have a contraindication, or cannot comply with the instructions for taking alendronate.

In the event that patients cannot take alendronate, NICE's guideline recommends risedronate and etidronate. A patient's intolerance to etidronate and risedronate allows physicians to move on to strontium ranelate and raloxifene, provided the patient has additional risk factors or meets a stricter bone mineral density threshold.

Teriparatide is recommended if patients have a contraindication, intolerance, or unsatisfactory response to the other drugs and have a combination of very low T scores and at least two fragility fractures.

Alendronate, the least expensive medication (at £53.56 for once-weekly tablets for the generic version), was the most cost effective and was no less effective than were alternatives in preventing fragility fractures in the population, according to the NICE panel that assessed the medications.

But the panel was able to develop thresholds for the use of alternative medications, based on age, clinical risk factors, and T scores, that would not increase the National Health Service's costs by more than £30,000 per quality-adjusted life-year gained.

For example, women aged 55-59 years must have a T score of −3 to qualify for the use of risedronate or etidronate if they do not have an independent risk factor, whereas women aged 70 years or older must have a T score of only −2.5. Women aged 50-54 years do not qualify for any of the alternative medications unless they have an independent clinical risk factor.

The guideline assumes patients are receiving adequate calcium and vitamin D. It also states that a dual-energy x-ray absorptiometry scan may not be necessary for patients 75 years and older, or patients with body mass index lower than 22 kg/m

At a landmark meeting, international leaders of government, public health and business sectors, UN agencies, and activist groups delineated specific measures that public health authorities should take to reduce tuberculosis deaths among people with HIV/AIDS.

According to a written statement, the HIV/TB Global Leaders' Forum marked the first time such a group has met to tackle the global threat of HIV/AIDS and TB coinfection. The group endorsed steps recommended by the World Health Organization, including screening patients for both infections and treating at-risk HIV/AIDS patients with isoniazid to prevent TB. "A six-month course of TB treatment costs US$20, and a course of preventive drug therapy costs US$2," the statement said.

According to the WHO, 250,000 immunocompromised HIV/AIDS patients die from tuberculosis each year, making it the single largest cause of death in that population.

Emerging strains of antibiotic-resistant tuberculosis are increasing the challenge, according to the WHO.

In a report from its April meeting, the WHO delineated its "Three I's" plan, which it had also emphasized in 2004: isoniazid preventive treatment (IPT), intensified case finding (ICF) for active TB, and TB Infection Control (IC).

These "are key public health strategies to decrease the impact of TB on people living with HIV," the organization noted.

"Implementation of the Three I's should be 'owned by' HIV programs and seen as indispensable as patient monitoring or cotrimoxazole prophylaxis," the report said.

At a landmark meeting, international leaders of government, public health and business sectors, UN agencies, and activist groups delineated specific measures that public health authorities should take to reduce tuberculosis deaths among people with HIV/AIDS.

According to a written statement, the HIV/TB Global Leaders' Forum marked the first time such a group has met to tackle the global threat of HIV/AIDS and TB coinfection. The group endorsed steps recommended by the World Health Organization, including screening patients for both infections and treating at-risk HIV/AIDS patients with isoniazid to prevent TB. "A six-month course of TB treatment costs US$20, and a course of preventive drug therapy costs US$2," the statement said.

According to the WHO, 250,000 immunocompromised HIV/AIDS patients die from tuberculosis each year, making it the single largest cause of death in that population.

Emerging strains of antibiotic-resistant tuberculosis are increasing the challenge, according to the WHO.

In a report from its April meeting, the WHO delineated its "Three I's" plan, which it had also emphasized in 2004: isoniazid preventive treatment (IPT), intensified case finding (ICF) for active TB, and TB Infection Control (IC).

These "are key public health strategies to decrease the impact of TB on people living with HIV," the organization noted.

"Implementation of the Three I's should be 'owned by' HIV programs and seen as indispensable as patient monitoring or cotrimoxazole prophylaxis," the report said.

At a landmark meeting, international leaders of government, public health and business sectors, UN agencies, and activist groups delineated specific measures that public health authorities should take to reduce tuberculosis deaths among people with HIV/AIDS.

According to a written statement, the HIV/TB Global Leaders' Forum marked the first time such a group has met to tackle the global threat of HIV/AIDS and TB coinfection. The group endorsed steps recommended by the World Health Organization, including screening patients for both infections and treating at-risk HIV/AIDS patients with isoniazid to prevent TB. "A six-month course of TB treatment costs US$20, and a course of preventive drug therapy costs US$2," the statement said.

According to the WHO, 250,000 immunocompromised HIV/AIDS patients die from tuberculosis each year, making it the single largest cause of death in that population.

Emerging strains of antibiotic-resistant tuberculosis are increasing the challenge, according to the WHO.

In a report from its April meeting, the WHO delineated its "Three I's" plan, which it had also emphasized in 2004: isoniazid preventive treatment (IPT), intensified case finding (ICF) for active TB, and TB Infection Control (IC).

These "are key public health strategies to decrease the impact of TB on people living with HIV," the organization noted.

"Implementation of the Three I's should be 'owned by' HIV programs and seen as indispensable as patient monitoring or cotrimoxazole prophylaxis," the report said.

A Mediterranean diet high in vegetables, fruits, and cereal grains and low in meat can significantly reduce the risk of diabetes in initially healthy people, according to a large Spanish cohort study published online in BMJ.

In a median of 4 years of follow-up with more than 13,000 Spanish university graduates without diabetes at baseline, researchers from the University of Navarra, Pamplona, found that those with food intake at baseline that conformed strongly with a Mediterranean diet had an adjusted 0.17 incidence rate ratio of type 2 diabetes, compared with those whose diet scored poorly on the 9-point dietary index. Those with a moderate Mediterranean diet score had an adjusted 0.4 incidence rate ratio of diabetes, compared with those who scored poorly.

Rich in vegetables, fruits, cereal grains, legumes, fish, and olive oil, and low in meat intake, a Mediterranean diet has, in previous studies, been found to be protective against coronary death. It also has been associated with a reduction in diabetes incidence among patients who have survived myocardial infarctions, the researchers noted.

“Two trials have shown that virgin olive oil protects against insulin resistance and the metabolic syndrome,” wrote the researchers, led by Dr. Miguel Ángel Martínez-González, chairman of the department of preventive medicine and public health at the university.

“Apart from olive oil, adherence to an overall Mediterranean-type food pattern is related to lower plasma concentrations of inflammatory markers and markers of endothelial dysfunction. These biomarkers are predictive of the future occurrence of type 2 diabetes,” the researchers wrote.

Researchers recruited university graduates and registered nurses to enroll in a long-term prospective cohort study beginning in December 1999. Of the enrollees, 13,380 had completed at least a 4-year follow-up questionnaire and did not report cardiovascular disease or diabetes at baseline (BMJ 2008 [Epub doi:10.1136/bmj.39561.501007.BE]).

The researchers assessed enrollees' dietary habits at baseline using a food frequency questionnaire with 136 items. Adherence to the diet was based on a score that added a point for every item of protective food that was consumed over the median and a point for every item of nonprotective food that was consumed under the median, researchers said. High scores were those between 7 and 9 and moderate scores were between 3 and 6.

At baseline, those scoring highest also had the highest mean body mass index, the greatest percentage with a family history of diabetes, and the largest percentage of members with hypertension, the researchers said.

In 4 years of follow-up, there were 33 confirmed cases of new onset diabetes in 58,918 person-years, according to the researchers. Unadjusted cumulative incidence rates were 0.4% in the low-scoring group, 0.23% in the moderate-score group, and 0.13% in the high-scoring group, the researchers said.

The small number of diabetes cases may have limited the statistical power of the study, the researchers acknowledge, although they add that the cohort is a young one (mean age 37.8 years) in which diabetes onset is less likely.

They added that the higher educational levels and high absolute consumption of favorable foods in the cohort may make its findings difficult to generalize either to people with less education or to non-Mediterranean countries in which consumption rates of the favorable foods are much lower. Additional trials and cohorts may be necessary to confirm their findings, the researchers wrote.

A Mediterranean diet is high in essential fatty acids and includes fish, olive oil, fruits, vegetables, legumes, and grains. ©Dušan

A Mediterranean diet high in vegetables, fruits, and cereal grains and low in meat can significantly reduce the risk of diabetes in initially healthy people, according to a large Spanish cohort study published online in BMJ.

In a median of 4 years of follow-up with more than 13,000 Spanish university graduates without diabetes at baseline, researchers from the University of Navarra, Pamplona, found that those with food intake at baseline that conformed strongly with a Mediterranean diet had an adjusted 0.17 incidence rate ratio of type 2 diabetes, compared with those whose diet scored poorly on the 9-point dietary index. Those with a moderate Mediterranean diet score had an adjusted 0.4 incidence rate ratio of diabetes, compared with those who scored poorly.

Rich in vegetables, fruits, cereal grains, legumes, fish, and olive oil, and low in meat intake, a Mediterranean diet has, in previous studies, been found to be protective against coronary death. It also has been associated with a reduction in diabetes incidence among patients who have survived myocardial infarctions, the researchers noted.

“Two trials have shown that virgin olive oil protects against insulin resistance and the metabolic syndrome,” wrote the researchers, led by Dr. Miguel Ángel Martínez-González, chairman of the department of preventive medicine and public health at the university.

“Apart from olive oil, adherence to an overall Mediterranean-type food pattern is related to lower plasma concentrations of inflammatory markers and markers of endothelial dysfunction. These biomarkers are predictive of the future occurrence of type 2 diabetes,” the researchers wrote.

Researchers recruited university graduates and registered nurses to enroll in a long-term prospective cohort study beginning in December 1999. Of the enrollees, 13,380 had completed at least a 4-year follow-up questionnaire and did not report cardiovascular disease or diabetes at baseline (BMJ 2008 [Epub doi:10.1136/bmj.39561.501007.BE]).

The researchers assessed enrollees' dietary habits at baseline using a food frequency questionnaire with 136 items. Adherence to the diet was based on a score that added a point for every item of protective food that was consumed over the median and a point for every item of nonprotective food that was consumed under the median, researchers said. High scores were those between 7 and 9 and moderate scores were between 3 and 6.

At baseline, those scoring highest also had the highest mean body mass index, the greatest percentage with a family history of diabetes, and the largest percentage of members with hypertension, the researchers said.

In 4 years of follow-up, there were 33 confirmed cases of new onset diabetes in 58,918 person-years, according to the researchers. Unadjusted cumulative incidence rates were 0.4% in the low-scoring group, 0.23% in the moderate-score group, and 0.13% in the high-scoring group, the researchers said.

The small number of diabetes cases may have limited the statistical power of the study, the researchers acknowledge, although they add that the cohort is a young one (mean age 37.8 years) in which diabetes onset is less likely.

They added that the higher educational levels and high absolute consumption of favorable foods in the cohort may make its findings difficult to generalize either to people with less education or to non-Mediterranean countries in which consumption rates of the favorable foods are much lower. Additional trials and cohorts may be necessary to confirm their findings, the researchers wrote.

A Mediterranean diet is high in essential fatty acids and includes fish, olive oil, fruits, vegetables, legumes, and grains. ©Dušan

A Mediterranean diet high in vegetables, fruits, and cereal grains and low in meat can significantly reduce the risk of diabetes in initially healthy people, according to a large Spanish cohort study published online in BMJ.

In a median of 4 years of follow-up with more than 13,000 Spanish university graduates without diabetes at baseline, researchers from the University of Navarra, Pamplona, found that those with food intake at baseline that conformed strongly with a Mediterranean diet had an adjusted 0.17 incidence rate ratio of type 2 diabetes, compared with those whose diet scored poorly on the 9-point dietary index. Those with a moderate Mediterranean diet score had an adjusted 0.4 incidence rate ratio of diabetes, compared with those who scored poorly.

Rich in vegetables, fruits, cereal grains, legumes, fish, and olive oil, and low in meat intake, a Mediterranean diet has, in previous studies, been found to be protective against coronary death. It also has been associated with a reduction in diabetes incidence among patients who have survived myocardial infarctions, the researchers noted.

“Two trials have shown that virgin olive oil protects against insulin resistance and the metabolic syndrome,” wrote the researchers, led by Dr. Miguel Ángel Martínez-González, chairman of the department of preventive medicine and public health at the university.

“Apart from olive oil, adherence to an overall Mediterranean-type food pattern is related to lower plasma concentrations of inflammatory markers and markers of endothelial dysfunction. These biomarkers are predictive of the future occurrence of type 2 diabetes,” the researchers wrote.

Researchers recruited university graduates and registered nurses to enroll in a long-term prospective cohort study beginning in December 1999. Of the enrollees, 13,380 had completed at least a 4-year follow-up questionnaire and did not report cardiovascular disease or diabetes at baseline (BMJ 2008 [Epub doi:10.1136/bmj.39561.501007.BE]).

The researchers assessed enrollees' dietary habits at baseline using a food frequency questionnaire with 136 items. Adherence to the diet was based on a score that added a point for every item of protective food that was consumed over the median and a point for every item of nonprotective food that was consumed under the median, researchers said. High scores were those between 7 and 9 and moderate scores were between 3 and 6.

At baseline, those scoring highest also had the highest mean body mass index, the greatest percentage with a family history of diabetes, and the largest percentage of members with hypertension, the researchers said.

In 4 years of follow-up, there were 33 confirmed cases of new onset diabetes in 58,918 person-years, according to the researchers. Unadjusted cumulative incidence rates were 0.4% in the low-scoring group, 0.23% in the moderate-score group, and 0.13% in the high-scoring group, the researchers said.

The small number of diabetes cases may have limited the statistical power of the study, the researchers acknowledge, although they add that the cohort is a young one (mean age 37.8 years) in which diabetes onset is less likely.

They added that the higher educational levels and high absolute consumption of favorable foods in the cohort may make its findings difficult to generalize either to people with less education or to non-Mediterranean countries in which consumption rates of the favorable foods are much lower. Additional trials and cohorts may be necessary to confirm their findings, the researchers wrote.

A Mediterranean diet is high in essential fatty acids and includes fish, olive oil, fruits, vegetables, legumes, and grains. ©Dušan

A workplace exercise and relaxation program can significantly reduce the frequency of headaches and shoulder pain as well as employees' use of analgesics, according to an Italian study of 384 workers.

Researchers from the University of Turin (Italy) and A.S.O. San Giovanni Battista di Torino said their findings suggest that educating workers on how to prevent headaches can be a noninvasive approach to reducing the burden of headaches, even among those with migraines and depression (Cephalalgia 2008;28:541-52).

“We observed a significant reduction of about 40% of the monthly frequency of headache and neck and shoulder pain in the study group subjects compared with controls,” wrote the researchers, led by Dr. Franco Mongini of the headache and pain unit at the university. Workers with frequent and more intense episodes benefited even more, the researchers found.

Researchers asked all of the participants to keep a diary of headaches, neck and shoulder pain, and analgesic use during a baseline period in March and April 2005. About 80% of the subjects enrolled were female; subjects in the control group were significantly younger than in the intervention group (median age 44 years vs. 48 years, respectively.)

One group of workers was then given instruction on exercises to relax face, neck, and shoulder muscles. Reminders to avoid excessive contraction of those muscles were posted in their offices. The control group was not given the instruction or the reminders.

The researchers then followed up with subjects in both groups in months 7 and 8.

They found significant reductions in the primary end points–reduction of monthly frequency of headaches, neck and shoulder aches, and analgesic consumption, and reduction among those with four or more episodes per month–and the secondary end point of a frequency and intensity index among those with four or more per month.

At follow-up, the adjusted change in the mean days per month with headaches for the intervention group was −2.72, compared with the control group; for neck and shoulder pain it was −3.2; and for analgesic use it was −0.83.

For patients with four or more episodes per month, the adjusted change in the mean days per month with headaches was −4.53, compared with the control group; for neck and shoulder pain it was −5.13; and for analgesic use it was −3.55, the researchers said. Among that patient group, the frequency and intensity index underwent a greater adjusted change in the intervention group: −0.33 for headaches, compared with the control group and −0.41 for neck and shoulder pain.

Patients with frequent pain episodes were also more likely to improve if they took part in the intervention program. Compared with the control group, those in the intervention group had 6.59 higher adjusted odds of decreasing headache frequency, 3.94 higher adjusted odds of decreasing neck and shoulder pain frequency, and 4.47 higher adjusted odds of decreasing analgesic use.

The researchers found it “particularly interesting” that subjects with anxiety or depression had even stronger responses: Those with depression or generalized anxiety disorder (GAD) had an adjusted change of −6.46 from baseline in headache frequency, compared with −1.50 for those with neither condition. “This result is in line with the observation in other studies that the placebo response was stronger in patients with GAD and major depression,” they wrote.

A workplace exercise and relaxation program can significantly reduce the frequency of headaches and shoulder pain as well as employees' use of analgesics, according to an Italian study of 384 workers.

Researchers from the University of Turin (Italy) and A.S.O. San Giovanni Battista di Torino said their findings suggest that educating workers on how to prevent headaches can be a noninvasive approach to reducing the burden of headaches, even among those with migraines and depression (Cephalalgia 2008;28:541-52).

“We observed a significant reduction of about 40% of the monthly frequency of headache and neck and shoulder pain in the study group subjects compared with controls,” wrote the researchers, led by Dr. Franco Mongini of the headache and pain unit at the university. Workers with frequent and more intense episodes benefited even more, the researchers found.

Researchers asked all of the participants to keep a diary of headaches, neck and shoulder pain, and analgesic use during a baseline period in March and April 2005. About 80% of the subjects enrolled were female; subjects in the control group were significantly younger than in the intervention group (median age 44 years vs. 48 years, respectively.)

One group of workers was then given instruction on exercises to relax face, neck, and shoulder muscles. Reminders to avoid excessive contraction of those muscles were posted in their offices. The control group was not given the instruction or the reminders.

The researchers then followed up with subjects in both groups in months 7 and 8.

They found significant reductions in the primary end points–reduction of monthly frequency of headaches, neck and shoulder aches, and analgesic consumption, and reduction among those with four or more episodes per month–and the secondary end point of a frequency and intensity index among those with four or more per month.

At follow-up, the adjusted change in the mean days per month with headaches for the intervention group was −2.72, compared with the control group; for neck and shoulder pain it was −3.2; and for analgesic use it was −0.83.

For patients with four or more episodes per month, the adjusted change in the mean days per month with headaches was −4.53, compared with the control group; for neck and shoulder pain it was −5.13; and for analgesic use it was −3.55, the researchers said. Among that patient group, the frequency and intensity index underwent a greater adjusted change in the intervention group: −0.33 for headaches, compared with the control group and −0.41 for neck and shoulder pain.

Patients with frequent pain episodes were also more likely to improve if they took part in the intervention program. Compared with the control group, those in the intervention group had 6.59 higher adjusted odds of decreasing headache frequency, 3.94 higher adjusted odds of decreasing neck and shoulder pain frequency, and 4.47 higher adjusted odds of decreasing analgesic use.

The researchers found it “particularly interesting” that subjects with anxiety or depression had even stronger responses: Those with depression or generalized anxiety disorder (GAD) had an adjusted change of −6.46 from baseline in headache frequency, compared with −1.50 for those with neither condition. “This result is in line with the observation in other studies that the placebo response was stronger in patients with GAD and major depression,” they wrote.

A workplace exercise and relaxation program can significantly reduce the frequency of headaches and shoulder pain as well as employees' use of analgesics, according to an Italian study of 384 workers.

Researchers from the University of Turin (Italy) and A.S.O. San Giovanni Battista di Torino said their findings suggest that educating workers on how to prevent headaches can be a noninvasive approach to reducing the burden of headaches, even among those with migraines and depression (Cephalalgia 2008;28:541-52).

“We observed a significant reduction of about 40% of the monthly frequency of headache and neck and shoulder pain in the study group subjects compared with controls,” wrote the researchers, led by Dr. Franco Mongini of the headache and pain unit at the university. Workers with frequent and more intense episodes benefited even more, the researchers found.

Researchers asked all of the participants to keep a diary of headaches, neck and shoulder pain, and analgesic use during a baseline period in March and April 2005. About 80% of the subjects enrolled were female; subjects in the control group were significantly younger than in the intervention group (median age 44 years vs. 48 years, respectively.)

One group of workers was then given instruction on exercises to relax face, neck, and shoulder muscles. Reminders to avoid excessive contraction of those muscles were posted in their offices. The control group was not given the instruction or the reminders.

The researchers then followed up with subjects in both groups in months 7 and 8.

They found significant reductions in the primary end points–reduction of monthly frequency of headaches, neck and shoulder aches, and analgesic consumption, and reduction among those with four or more episodes per month–and the secondary end point of a frequency and intensity index among those with four or more per month.

At follow-up, the adjusted change in the mean days per month with headaches for the intervention group was −2.72, compared with the control group; for neck and shoulder pain it was −3.2; and for analgesic use it was −0.83.

For patients with four or more episodes per month, the adjusted change in the mean days per month with headaches was −4.53, compared with the control group; for neck and shoulder pain it was −5.13; and for analgesic use it was −3.55, the researchers said. Among that patient group, the frequency and intensity index underwent a greater adjusted change in the intervention group: −0.33 for headaches, compared with the control group and −0.41 for neck and shoulder pain.

Patients with frequent pain episodes were also more likely to improve if they took part in the intervention program. Compared with the control group, those in the intervention group had 6.59 higher adjusted odds of decreasing headache frequency, 3.94 higher adjusted odds of decreasing neck and shoulder pain frequency, and 4.47 higher adjusted odds of decreasing analgesic use.

The researchers found it “particularly interesting” that subjects with anxiety or depression had even stronger responses: Those with depression or generalized anxiety disorder (GAD) had an adjusted change of −6.46 from baseline in headache frequency, compared with −1.50 for those with neither condition. “This result is in line with the observation in other studies that the placebo response was stronger in patients with GAD and major depression,” they wrote.

The study aimed at assessing what kinds of factors increase the risk of stroke clarifies the relationship between mental health and stroke, according to the lead investigator and his colleagues.

Paul Surtees, Ph.D., and his colleagues conducted a large population study of more than 20,000 residents of Norfolk taking part in the United Kingdom arm of the 10-country European Prospective Investigation Into Cancer.

They found that lower baseline scores on a mental health inventory (indicating greater distress) were associated with an 11% increased risk of stroke over 8 years of follow-up after adjustment for known stroke risk factors. The association indicated a dose-response relationship.

Having a major depressive episode in the 12 months before the baseline mental-health assessment or at any point in their lives was not significantly associated with a greater stroke risk, however (Neurology 2008;70:788–94).

Dr. Surtees and his colleagues found that of the 20,627 study participants aged 41–80, 5% reported having an episode of major depressive disorder (MDD) in the previous 12 months and 15% reported having such an episode any time during their lives. The mean score on the MHI-5 was 55.2 for those who had experienced an MDD episode in the past 12 months, 76.5 for those who had an MDD episode at any time, and 78.5 for participants who reported never having an MDD episode. The researchers identified 595 strokes in 8.5 years of follow-up, 167 of which were fatal.

For every standard deviation lower score on the MHI-5, overall stroke risk increased by 11%, after adjustment for cardiovascular risk factors.

A single standard deviation lower score on MHI-5 resulted in an adjusted hazard ratio of 1.22 for fatal stroke. A significantly elevated risk of stroke was not found among participants who had experienced an MDD episode in last 12 months or in their lives.

The study aimed at assessing what kinds of factors increase the risk of stroke clarifies the relationship between mental health and stroke, according to the lead investigator and his colleagues.

Paul Surtees, Ph.D., and his colleagues conducted a large population study of more than 20,000 residents of Norfolk taking part in the United Kingdom arm of the 10-country European Prospective Investigation Into Cancer.

They found that lower baseline scores on a mental health inventory (indicating greater distress) were associated with an 11% increased risk of stroke over 8 years of follow-up after adjustment for known stroke risk factors. The association indicated a dose-response relationship.

Having a major depressive episode in the 12 months before the baseline mental-health assessment or at any point in their lives was not significantly associated with a greater stroke risk, however (Neurology 2008;70:788–94).

Dr. Surtees and his colleagues found that of the 20,627 study participants aged 41–80, 5% reported having an episode of major depressive disorder (MDD) in the previous 12 months and 15% reported having such an episode any time during their lives. The mean score on the MHI-5 was 55.2 for those who had experienced an MDD episode in the past 12 months, 76.5 for those who had an MDD episode at any time, and 78.5 for participants who reported never having an MDD episode. The researchers identified 595 strokes in 8.5 years of follow-up, 167 of which were fatal.

For every standard deviation lower score on the MHI-5, overall stroke risk increased by 11%, after adjustment for cardiovascular risk factors.

A single standard deviation lower score on MHI-5 resulted in an adjusted hazard ratio of 1.22 for fatal stroke. A significantly elevated risk of stroke was not found among participants who had experienced an MDD episode in last 12 months or in their lives.

The study aimed at assessing what kinds of factors increase the risk of stroke clarifies the relationship between mental health and stroke, according to the lead investigator and his colleagues.

Paul Surtees, Ph.D., and his colleagues conducted a large population study of more than 20,000 residents of Norfolk taking part in the United Kingdom arm of the 10-country European Prospective Investigation Into Cancer.

They found that lower baseline scores on a mental health inventory (indicating greater distress) were associated with an 11% increased risk of stroke over 8 years of follow-up after adjustment for known stroke risk factors. The association indicated a dose-response relationship.

Having a major depressive episode in the 12 months before the baseline mental-health assessment or at any point in their lives was not significantly associated with a greater stroke risk, however (Neurology 2008;70:788–94).

Dr. Surtees and his colleagues found that of the 20,627 study participants aged 41–80, 5% reported having an episode of major depressive disorder (MDD) in the previous 12 months and 15% reported having such an episode any time during their lives. The mean score on the MHI-5 was 55.2 for those who had experienced an MDD episode in the past 12 months, 76.5 for those who had an MDD episode at any time, and 78.5 for participants who reported never having an MDD episode. The researchers identified 595 strokes in 8.5 years of follow-up, 167 of which were fatal.

For every standard deviation lower score on the MHI-5, overall stroke risk increased by 11%, after adjustment for cardiovascular risk factors.

A single standard deviation lower score on MHI-5 resulted in an adjusted hazard ratio of 1.22 for fatal stroke. A significantly elevated risk of stroke was not found among participants who had experienced an MDD episode in last 12 months or in their lives.

Women who follow a Mediterranean diet during pregnancy may avert asthmalike symptoms and atopy in their children, results of a population study in the journal Thorax suggest.

Researchers studying a birth cohort of 412 children in Menorca, Spain, found that offspring of mothers who closely followed a Mediterranean diet in pregnancy were less likely to experience persistent wheeze (adjusted odds ratio 0.22), atopic wheeze (OR 0.30), or atopy (OR 0.55) at a 6.5-year follow-up, compared with children of mothers who were less adherent to the diet.

Micronutrients such as antioxidants or polyphenols contained in the fruits, vegetables, legumes, and oils that are key ingredients of the Mediterranean diet may have protective effects against asthma, may protect the airways against oxidative damage, or may have anti-inflammatory effects, wrote Dr. Leda Chatzi of the University of Crete, Heraklion, Greece, and associates (Thorax 2008 Jan. 15 [Epub doi:10.1136/thx.2007.081745]).

Over a 12-month period beginning in mid-1997, the researchers enrolled 507 women seeking antenatal care at general practices in Menorca.

A total of 412 children of the women who were enrolled underwent skin-prick tests for allergies at a 6.5-year follow-up.

In addition, 468 parents completed questionnaires on children's respiratory and allergic symptoms, and supplied information on the mother's diet during pregnancy and the children's diet at 6.5 years using a food frequency questionnaire.

The questionnaires were then scored according to how much of the food intake matched a traditional Mediterranean diet.

A total of 36% of mothers had a low-quality Mediterranean diet in pregnancy; the remainder had a high-quality diet.

Approximately 13% of the children at follow-up had persistent wheeze, 6% had atopic wheeze, and 17% had atopy.

Maternal intake of vegetables more than eight times a week in pregnancy was significantly associated with a reduced risk of persistent wheeze (odds ratio 0.36) and atopy (OR 0.4) in their children, compared with children of mothers who ate fewer servings.

Eating fish two to three times a week and legumes at least once a week during pregnancy each was also significantly associated with a reduced risk of persistent wheeze (OR 0.34 and OR 0.36, respectively).

Although there was a trend toward a high-quality Mediterranean diet in pregnancy having a protective effect against atopic wheeze, the association was not significant, possibly because of the small number of children affected (n = 20), the investigators wrote.

At 6.5 years, 9% of the children had a diet that scored low, 54% scored intermediate and 37% scored high on Mediterranean diet measures.

A high score was protective against persistent wheeze, but the effect was only marginally significant, the researchers said.

Women who follow a Mediterranean diet during pregnancy may avert asthmalike symptoms and atopy in their children, results of a population study in the journal Thorax suggest.

Researchers studying a birth cohort of 412 children in Menorca, Spain, found that offspring of mothers who closely followed a Mediterranean diet in pregnancy were less likely to experience persistent wheeze (adjusted odds ratio 0.22), atopic wheeze (OR 0.30), or atopy (OR 0.55) at a 6.5-year follow-up, compared with children of mothers who were less adherent to the diet.

Micronutrients such as antioxidants or polyphenols contained in the fruits, vegetables, legumes, and oils that are key ingredients of the Mediterranean diet may have protective effects against asthma, may protect the airways against oxidative damage, or may have anti-inflammatory effects, wrote Dr. Leda Chatzi of the University of Crete, Heraklion, Greece, and associates (Thorax 2008 Jan. 15 [Epub doi:10.1136/thx.2007.081745]).

Over a 12-month period beginning in mid-1997, the researchers enrolled 507 women seeking antenatal care at general practices in Menorca.

A total of 412 children of the women who were enrolled underwent skin-prick tests for allergies at a 6.5-year follow-up.

In addition, 468 parents completed questionnaires on children's respiratory and allergic symptoms, and supplied information on the mother's diet during pregnancy and the children's diet at 6.5 years using a food frequency questionnaire.

The questionnaires were then scored according to how much of the food intake matched a traditional Mediterranean diet.

A total of 36% of mothers had a low-quality Mediterranean diet in pregnancy; the remainder had a high-quality diet.

Approximately 13% of the children at follow-up had persistent wheeze, 6% had atopic wheeze, and 17% had atopy.

Maternal intake of vegetables more than eight times a week in pregnancy was significantly associated with a reduced risk of persistent wheeze (odds ratio 0.36) and atopy (OR 0.4) in their children, compared with children of mothers who ate fewer servings.

Eating fish two to three times a week and legumes at least once a week during pregnancy each was also significantly associated with a reduced risk of persistent wheeze (OR 0.34 and OR 0.36, respectively).

Although there was a trend toward a high-quality Mediterranean diet in pregnancy having a protective effect against atopic wheeze, the association was not significant, possibly because of the small number of children affected (n = 20), the investigators wrote.

At 6.5 years, 9% of the children had a diet that scored low, 54% scored intermediate and 37% scored high on Mediterranean diet measures.

A high score was protective against persistent wheeze, but the effect was only marginally significant, the researchers said.

Women who follow a Mediterranean diet during pregnancy may avert asthmalike symptoms and atopy in their children, results of a population study in the journal Thorax suggest.

Researchers studying a birth cohort of 412 children in Menorca, Spain, found that offspring of mothers who closely followed a Mediterranean diet in pregnancy were less likely to experience persistent wheeze (adjusted odds ratio 0.22), atopic wheeze (OR 0.30), or atopy (OR 0.55) at a 6.5-year follow-up, compared with children of mothers who were less adherent to the diet.

Micronutrients such as antioxidants or polyphenols contained in the fruits, vegetables, legumes, and oils that are key ingredients of the Mediterranean diet may have protective effects against asthma, may protect the airways against oxidative damage, or may have anti-inflammatory effects, wrote Dr. Leda Chatzi of the University of Crete, Heraklion, Greece, and associates (Thorax 2008 Jan. 15 [Epub doi:10.1136/thx.2007.081745]).

Over a 12-month period beginning in mid-1997, the researchers enrolled 507 women seeking antenatal care at general practices in Menorca.

A total of 412 children of the women who were enrolled underwent skin-prick tests for allergies at a 6.5-year follow-up.

In addition, 468 parents completed questionnaires on children's respiratory and allergic symptoms, and supplied information on the mother's diet during pregnancy and the children's diet at 6.5 years using a food frequency questionnaire.

The questionnaires were then scored according to how much of the food intake matched a traditional Mediterranean diet.

A total of 36% of mothers had a low-quality Mediterranean diet in pregnancy; the remainder had a high-quality diet.

Approximately 13% of the children at follow-up had persistent wheeze, 6% had atopic wheeze, and 17% had atopy.

Maternal intake of vegetables more than eight times a week in pregnancy was significantly associated with a reduced risk of persistent wheeze (odds ratio 0.36) and atopy (OR 0.4) in their children, compared with children of mothers who ate fewer servings.

Eating fish two to three times a week and legumes at least once a week during pregnancy each was also significantly associated with a reduced risk of persistent wheeze (OR 0.34 and OR 0.36, respectively).

Although there was a trend toward a high-quality Mediterranean diet in pregnancy having a protective effect against atopic wheeze, the association was not significant, possibly because of the small number of children affected (n = 20), the investigators wrote.

At 6.5 years, 9% of the children had a diet that scored low, 54% scored intermediate and 37% scored high on Mediterranean diet measures.

A high score was protective against persistent wheeze, but the effect was only marginally significant, the researchers said.

Cranberry juice, which is frequently used as a home remedy to treat and prevent urinary tract infection, has been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65), and were most effective in women with recurrent UTIs.

Ruth Jepson, senior research fellow at the University of Stirling, Scotland, and associates searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI. Ten studies, comprising 1,049 patients, met the reviewers' data-quality standards (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi: 10.1002/14651858.CD001321.pub4

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria.

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than that of those in the placebo group.

In catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections. In a Canadian study of 40 children who had been intermittently catheterized, 89% of those in the intervention group drinking 15 mL/kg a day of a cranberry beverage dropped out, with just over half citing taste as a factor. “The large number of dropouts/withdrawals from some studies [suggests] cranberry juice may not be acceptable over long periods of time.”

In four trials, data showed that cranberry products reduced the incidence of UTI. ©Kerioak/Fotolia.com

Cranberry juice, which is frequently used as a home remedy to treat and prevent urinary tract infection, has been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65), and were most effective in women with recurrent UTIs.

Ruth Jepson, senior research fellow at the University of Stirling, Scotland, and associates searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI. Ten studies, comprising 1,049 patients, met the reviewers' data-quality standards (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi: 10.1002/14651858.CD001321.pub4

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria.

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than that of those in the placebo group.

In catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections. In a Canadian study of 40 children who had been intermittently catheterized, 89% of those in the intervention group drinking 15 mL/kg a day of a cranberry beverage dropped out, with just over half citing taste as a factor. “The large number of dropouts/withdrawals from some studies [suggests] cranberry juice may not be acceptable over long periods of time.”

In four trials, data showed that cranberry products reduced the incidence of UTI. ©Kerioak/Fotolia.com

Cranberry juice, which is frequently used as a home remedy to treat and prevent urinary tract infection, has been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65), and were most effective in women with recurrent UTIs.

Ruth Jepson, senior research fellow at the University of Stirling, Scotland, and associates searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI. Ten studies, comprising 1,049 patients, met the reviewers' data-quality standards (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi: 10.1002/14651858.CD001321.pub4

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria.

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than that of those in the placebo group.

In catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections. In a Canadian study of 40 children who had been intermittently catheterized, 89% of those in the intervention group drinking 15 mL/kg a day of a cranberry beverage dropped out, with just over half citing taste as a factor. “The large number of dropouts/withdrawals from some studies [suggests] cranberry juice may not be acceptable over long periods of time.”

In four trials, data showed that cranberry products reduced the incidence of UTI. ©Kerioak/Fotolia.com

Children with autism spectrum disorder had no greater immune response to the measles virus or the measles component of the measles, mumps, and rubella vaccine than did children without the disorder in a large case-control study.

British researchers said their community sample study of 250 children age 10–12 is the largest to date to fail to demonstrate any association between MMR vaccination and autism spectrum disorder (ASD) “using well-validated techniques.”

Concern about the possible connection has led to lower MMR vaccination rates, from 92% in 1995–1996 to 80% in 2004, according to UK Health Protection Agency data cited by the researchers (Arch. Dis. Child. 2007 Feb. 5 [Epub doi:10.1136/adc.2007.122937

Led by Dr. Gillian Baird of Guy's and St. Thomas' National Health Service Trust in London, the researchers said uptake of the second MMR vaccination was lower in the children who had autism or autism spectrum disorder than in the control population without autism (29% vs. 50%).

Children with special education needs but not ASD had lower vaccination rates than normal developing children. These differences in uptake between groups “may reflect parental concern about vaccination following a diagnosis of developmental abnormality,” they wrote.

Four of the authors listed conflicts of interests relating to lawsuits against manufacturers of the MMR vaccines, including Dr. Baird, who has served as an expert witness.

The researchers drew their subjects from a cohort of 56,946 children born between July 1, 1990 and Dec. 31, 1991 from the South Thames region of England.

After screening for autism spectrum disorders and special educational needs, the researchers identified 98 cases of autism spectrum disorders. They were compared with 52 control children with special educational needs but no diagnosis of autism, along with 90 control children with typical development.

The researchers analyzed blood from the subjects to determine whether they had persistent measles infections or abnormally high measles antibodies.

They found no differences in the distribution of measles antibodies or virus in the children with autism spectrum disorder or the controls, even when the comparison was restricted to children regardless of whether children had received one or both of the MMR vaccinations.

There also was no sign of altered persisting immunological response in ASD cases in those with or without a history of regression. (Regression of language was defined as a loss of at least five words used communicatively during a 3-month period or, in those who had not achieved the five-word stage, “a reported regression of words or skills in social communicative or play behaviour.”)

Authors of a case series published in 2000 had described a condition referred to as “autism enterocolitis,” postulated to be associated with the MMR vaccine and regression in autism. Researchers in the current study found no evidence of increased enterocolitis in the ASD group with regression.

Only one child in the study had “possible enterocolitis,” and this child was from a control group.

The researchers said their study is strong because of its size, the geographic definition of its sample, good vaccination histories, and a diagnostic procedure that allowed researchers to identify a dose-response relationship between autism symptoms and antibody levels.

However, the investigators note that the study's control population was not randomly selected, and that they might have gotten a biased control population because the parents were informed it was a study about MMR vaccination.

Children with autism spectrum disorder had no greater immune response to the measles virus or the measles component of the measles, mumps, and rubella vaccine than did children without the disorder in a large case-control study.

British researchers said their community sample study of 250 children age 10–12 is the largest to date to fail to demonstrate any association between MMR vaccination and autism spectrum disorder (ASD) “using well-validated techniques.”

Concern about the possible connection has led to lower MMR vaccination rates, from 92% in 1995–1996 to 80% in 2004, according to UK Health Protection Agency data cited by the researchers (Arch. Dis. Child. 2007 Feb. 5 [Epub doi:10.1136/adc.2007.122937

Led by Dr. Gillian Baird of Guy's and St. Thomas' National Health Service Trust in London, the researchers said uptake of the second MMR vaccination was lower in the children who had autism or autism spectrum disorder than in the control population without autism (29% vs. 50%).

Children with special education needs but not ASD had lower vaccination rates than normal developing children. These differences in uptake between groups “may reflect parental concern about vaccination following a diagnosis of developmental abnormality,” they wrote.

Four of the authors listed conflicts of interests relating to lawsuits against manufacturers of the MMR vaccines, including Dr. Baird, who has served as an expert witness.

The researchers drew their subjects from a cohort of 56,946 children born between July 1, 1990 and Dec. 31, 1991 from the South Thames region of England.

After screening for autism spectrum disorders and special educational needs, the researchers identified 98 cases of autism spectrum disorders. They were compared with 52 control children with special educational needs but no diagnosis of autism, along with 90 control children with typical development.

The researchers analyzed blood from the subjects to determine whether they had persistent measles infections or abnormally high measles antibodies.

They found no differences in the distribution of measles antibodies or virus in the children with autism spectrum disorder or the controls, even when the comparison was restricted to children regardless of whether children had received one or both of the MMR vaccinations.

There also was no sign of altered persisting immunological response in ASD cases in those with or without a history of regression. (Regression of language was defined as a loss of at least five words used communicatively during a 3-month period or, in those who had not achieved the five-word stage, “a reported regression of words or skills in social communicative or play behaviour.”)

Authors of a case series published in 2000 had described a condition referred to as “autism enterocolitis,” postulated to be associated with the MMR vaccine and regression in autism. Researchers in the current study found no evidence of increased enterocolitis in the ASD group with regression.

Only one child in the study had “possible enterocolitis,” and this child was from a control group.

The researchers said their study is strong because of its size, the geographic definition of its sample, good vaccination histories, and a diagnostic procedure that allowed researchers to identify a dose-response relationship between autism symptoms and antibody levels.

However, the investigators note that the study's control population was not randomly selected, and that they might have gotten a biased control population because the parents were informed it was a study about MMR vaccination.

Children with autism spectrum disorder had no greater immune response to the measles virus or the measles component of the measles, mumps, and rubella vaccine than did children without the disorder in a large case-control study.

British researchers said their community sample study of 250 children age 10–12 is the largest to date to fail to demonstrate any association between MMR vaccination and autism spectrum disorder (ASD) “using well-validated techniques.”

Concern about the possible connection has led to lower MMR vaccination rates, from 92% in 1995–1996 to 80% in 2004, according to UK Health Protection Agency data cited by the researchers (Arch. Dis. Child. 2007 Feb. 5 [Epub doi:10.1136/adc.2007.122937

Led by Dr. Gillian Baird of Guy's and St. Thomas' National Health Service Trust in London, the researchers said uptake of the second MMR vaccination was lower in the children who had autism or autism spectrum disorder than in the control population without autism (29% vs. 50%).

Children with special education needs but not ASD had lower vaccination rates than normal developing children. These differences in uptake between groups “may reflect parental concern about vaccination following a diagnosis of developmental abnormality,” they wrote.

Four of the authors listed conflicts of interests relating to lawsuits against manufacturers of the MMR vaccines, including Dr. Baird, who has served as an expert witness.

The researchers drew their subjects from a cohort of 56,946 children born between July 1, 1990 and Dec. 31, 1991 from the South Thames region of England.

After screening for autism spectrum disorders and special educational needs, the researchers identified 98 cases of autism spectrum disorders. They were compared with 52 control children with special educational needs but no diagnosis of autism, along with 90 control children with typical development.

The researchers analyzed blood from the subjects to determine whether they had persistent measles infections or abnormally high measles antibodies.

They found no differences in the distribution of measles antibodies or virus in the children with autism spectrum disorder or the controls, even when the comparison was restricted to children regardless of whether children had received one or both of the MMR vaccinations.

There also was no sign of altered persisting immunological response in ASD cases in those with or without a history of regression. (Regression of language was defined as a loss of at least five words used communicatively during a 3-month period or, in those who had not achieved the five-word stage, “a reported regression of words or skills in social communicative or play behaviour.”)

Authors of a case series published in 2000 had described a condition referred to as “autism enterocolitis,” postulated to be associated with the MMR vaccine and regression in autism. Researchers in the current study found no evidence of increased enterocolitis in the ASD group with regression.

Only one child in the study had “possible enterocolitis,” and this child was from a control group.

The researchers said their study is strong because of its size, the geographic definition of its sample, good vaccination histories, and a diagnostic procedure that allowed researchers to identify a dose-response relationship between autism symptoms and antibody levels.

However, the investigators note that the study's control population was not randomly selected, and that they might have gotten a biased control population because the parents were informed it was a study about MMR vaccination.

Dementia patients live a median of 4.5 years following the estimated onset of the condition, with male, older, and disabled patients having a significantly shorter survival time, according to a population study published online in BMJ.

The large multicenter study of English and Welsh patients found that those who were aged 65–69 years at dementia onset survived a median of 10.7 years, nearly three times the 3.8 years seen in patients with disease onset at age 90 or later (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Researchers said their study provides the first estimate of survival times for dementia patients in England and Wales.

“Some of these results may seem self-evident but they answer questions asked by those caring for and advising people with dementia,” wrote the researchers, led by Jing Xie, research associate with the Cambridge (England) University Institute of Public Health.

The analysis involved 13,004 patients taking part in the Medical Research Council's longitudinal cognitive function and aging study in England and Wales in 1991–2003. Participants were assessed for dementia at regular intervals. A total of 438 patients developed dementia by 2003 and were followed until Dec. 31, 2005. Of these 438 patients, 70% were women. They had a median age of 84 at dementia onset. A total of 356 dementia patients had died by the end of 2005; their median age at death was 89.

The investigators found a greater adjusted risk of death for men, compared with women (hazard ratio 1.4). In addition, disability with dementia was associated with a 3-year reduction in survival between the most and least functionally impaired. (Those who scored in the bottom third of the Blessed dementia scale had a hazard ratio for death of 2.1, compared with those in the top third.)

Hazard ratios for death were 2.7 in those aged 80–89 years at dementia onset and 3.1 in those aged 90 and older, compared with those aged 65–69.

The researchers found no difference in survival based on marital status, accommodation type (living in the community or residential home), self-reported health, score on Mini-Mental State Examination, educational status, or socioeconomic class.

In an accompanying editorial Murna Downs, Ph.D., of the University of Bradford (England) Dementia Group and Barbara Bowers, Ph.D., of the University of Wisconsin, Madison, nursing school wrote, “The study provides clear evidence that people with dementia need coordinated care and support from a range of professionals and practitioners from diagnosis to death to ensure maximum quality of life and prevent unnecessary disability and suffering” (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Dementia patients live a median of 4.5 years following the estimated onset of the condition, with male, older, and disabled patients having a significantly shorter survival time, according to a population study published online in BMJ.

The large multicenter study of English and Welsh patients found that those who were aged 65–69 years at dementia onset survived a median of 10.7 years, nearly three times the 3.8 years seen in patients with disease onset at age 90 or later (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Researchers said their study provides the first estimate of survival times for dementia patients in England and Wales.

“Some of these results may seem self-evident but they answer questions asked by those caring for and advising people with dementia,” wrote the researchers, led by Jing Xie, research associate with the Cambridge (England) University Institute of Public Health.

The analysis involved 13,004 patients taking part in the Medical Research Council's longitudinal cognitive function and aging study in England and Wales in 1991–2003. Participants were assessed for dementia at regular intervals. A total of 438 patients developed dementia by 2003 and were followed until Dec. 31, 2005. Of these 438 patients, 70% were women. They had a median age of 84 at dementia onset. A total of 356 dementia patients had died by the end of 2005; their median age at death was 89.

The investigators found a greater adjusted risk of death for men, compared with women (hazard ratio 1.4). In addition, disability with dementia was associated with a 3-year reduction in survival between the most and least functionally impaired. (Those who scored in the bottom third of the Blessed dementia scale had a hazard ratio for death of 2.1, compared with those in the top third.)

Hazard ratios for death were 2.7 in those aged 80–89 years at dementia onset and 3.1 in those aged 90 and older, compared with those aged 65–69.

The researchers found no difference in survival based on marital status, accommodation type (living in the community or residential home), self-reported health, score on Mini-Mental State Examination, educational status, or socioeconomic class.

In an accompanying editorial Murna Downs, Ph.D., of the University of Bradford (England) Dementia Group and Barbara Bowers, Ph.D., of the University of Wisconsin, Madison, nursing school wrote, “The study provides clear evidence that people with dementia need coordinated care and support from a range of professionals and practitioners from diagnosis to death to ensure maximum quality of life and prevent unnecessary disability and suffering” (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Dementia patients live a median of 4.5 years following the estimated onset of the condition, with male, older, and disabled patients having a significantly shorter survival time, according to a population study published online in BMJ.

The large multicenter study of English and Welsh patients found that those who were aged 65–69 years at dementia onset survived a median of 10.7 years, nearly three times the 3.8 years seen in patients with disease onset at age 90 or later (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Researchers said their study provides the first estimate of survival times for dementia patients in England and Wales.

“Some of these results may seem self-evident but they answer questions asked by those caring for and advising people with dementia,” wrote the researchers, led by Jing Xie, research associate with the Cambridge (England) University Institute of Public Health.

The analysis involved 13,004 patients taking part in the Medical Research Council's longitudinal cognitive function and aging study in England and Wales in 1991–2003. Participants were assessed for dementia at regular intervals. A total of 438 patients developed dementia by 2003 and were followed until Dec. 31, 2005. Of these 438 patients, 70% were women. They had a median age of 84 at dementia onset. A total of 356 dementia patients had died by the end of 2005; their median age at death was 89.

The investigators found a greater adjusted risk of death for men, compared with women (hazard ratio 1.4). In addition, disability with dementia was associated with a 3-year reduction in survival between the most and least functionally impaired. (Those who scored in the bottom third of the Blessed dementia scale had a hazard ratio for death of 2.1, compared with those in the top third.)

Hazard ratios for death were 2.7 in those aged 80–89 years at dementia onset and 3.1 in those aged 90 and older, compared with those aged 65–69.

The researchers found no difference in survival based on marital status, accommodation type (living in the community or residential home), self-reported health, score on Mini-Mental State Examination, educational status, or socioeconomic class.

In an accompanying editorial Murna Downs, Ph.D., of the University of Bradford (England) Dementia Group and Barbara Bowers, Ph.D., of the University of Wisconsin, Madison, nursing school wrote, “The study provides clear evidence that people with dementia need coordinated care and support from a range of professionals and practitioners from diagnosis to death to ensure maximum quality of life and prevent unnecessary disability and suffering” (BMJ 2008 Jan. 11 [Epub doi:10.1136/bmj.39433.616678.25]).

Cranberry extracts—frequently used as a home remedy to treat and prevent urinary tract infection—have been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products—such as juice, tablets, or capsules—significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65).

Within these studies, cranberry products were most effective in women with recurrent UTIs, investigators reported in a review published Jan. 23 in the Cochrane Library.

The investigators, led by Ruth Jepson, senior research fellow at the University of Stirling, Scotland, searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI.

Ten studies, comprising 1,049 patients, met the data-quality standards set by the reviewers (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi:10.1002/14651858.CD001321.pub4]).

The evidence was “inconclusive” regarding whether cranberry products are effective in older men and women, the investigators wrote.

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria (odds ratio 0.42).

The authors added, however, that asymptomatic infections are “a condition which does not normally need treating in certain populations.”

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than were those in the placebo group (RR 0.61).

With catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections.

In a Canadian study of 40 children who had been intermittently catheterized, 89% (17 of 19) of the subjects in the intervention group drinking 15 mL/kg per day of a cranberry beverage dropped out, 9 of whom cited taste as a factor.

In addition, the researchers said, “the large number of dropouts/withdrawals from some of the studies indicates that cranberry juice may not be acceptable over long periods of time.”

The investigators noted that their analysis provided no clear evidence as to the amount and concentration of cranberry juice that needs to be consumed to be most effective in preventing UTIs.

In four trials, cranberry products such as juice, tablets, or capsules reduced the incidence of UTI. ©Kerioak/Fotolia.com

Cranberry extracts—frequently used as a home remedy to treat and prevent urinary tract infection—have been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products—such as juice, tablets, or capsules—significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65).

Within these studies, cranberry products were most effective in women with recurrent UTIs, investigators reported in a review published Jan. 23 in the Cochrane Library.

The investigators, led by Ruth Jepson, senior research fellow at the University of Stirling, Scotland, searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI.

Ten studies, comprising 1,049 patients, met the data-quality standards set by the reviewers (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi:10.1002/14651858.CD001321.pub4]).

The evidence was “inconclusive” regarding whether cranberry products are effective in older men and women, the investigators wrote.

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria (odds ratio 0.42).

The authors added, however, that asymptomatic infections are “a condition which does not normally need treating in certain populations.”

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than were those in the placebo group (RR 0.61).

With catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections.

In a Canadian study of 40 children who had been intermittently catheterized, 89% (17 of 19) of the subjects in the intervention group drinking 15 mL/kg per day of a cranberry beverage dropped out, 9 of whom cited taste as a factor.

In addition, the researchers said, “the large number of dropouts/withdrawals from some of the studies indicates that cranberry juice may not be acceptable over long periods of time.”

The investigators noted that their analysis provided no clear evidence as to the amount and concentration of cranberry juice that needs to be consumed to be most effective in preventing UTIs.

In four trials, cranberry products such as juice, tablets, or capsules reduced the incidence of UTI. ©Kerioak/Fotolia.com

Cranberry extracts—frequently used as a home remedy to treat and prevent urinary tract infection—have been shown in a meta-analysis to reduce significantly the incidence of symptomatic urinary tract infections in women.

An analysis of four randomized controlled trials, comprising 665 participants, showed that cranberry products—such as juice, tablets, or capsules—significantly reduced the incidence of symptomatic UTI at 12 months, compared with a placebo (relative risk 0.65).

Within these studies, cranberry products were most effective in women with recurrent UTIs, investigators reported in a review published Jan. 23 in the Cochrane Library.

The investigators, led by Ruth Jepson, senior research fellow at the University of Stirling, Scotland, searched medical databases to identify studies that used cranberry juice or tablets to prevent recurrences of UTI.

Ten studies, comprising 1,049 patients, met the data-quality standards set by the reviewers (Cochrane Database Syst. Rev. 2008 Jan. 23 [doi:10.1002/14651858.CD001321.pub4]).

The evidence was “inconclusive” regarding whether cranberry products are effective in older men and women, the investigators wrote.

In one Scottish study that focused on 376 men and women aged 60 years or older, there was no significant difference in the number of symptomatic UTIs between patients drinking 300 mL/day of cranberry juice and those drinking a placebo beverage.

In a second study of 192 elderly women in the United States randomized to a group drinking 300 mL/day of cranberry juice or a placebo, those in the intervention group were at a reduced risk of asymptomatic infections indicated by bacteriuria with pyuria (odds ratio 0.42).

The authors added, however, that asymptomatic infections are “a condition which does not normally need treating in certain populations.”

Of two randomized controlled trials that focused on women with symptomatic recurrent lower UTI or with a current UTI, subjects in the intervention arm were at a reduced risk of subsequent infections than were those in the placebo group (RR 0.61).

With catheterized patients, no statistical difference was found between patients in intervention groups or placebo arms either for symptomatic or asymptomatic infections.

In a Canadian study of 40 children who had been intermittently catheterized, 89% (17 of 19) of the subjects in the intervention group drinking 15 mL/kg per day of a cranberry beverage dropped out, 9 of whom cited taste as a factor.

In addition, the researchers said, “the large number of dropouts/withdrawals from some of the studies indicates that cranberry juice may not be acceptable over long periods of time.”

The investigators noted that their analysis provided no clear evidence as to the amount and concentration of cranberry juice that needs to be consumed to be most effective in preventing UTIs.

In four trials, cranberry products such as juice, tablets, or capsules reduced the incidence of UTI. ©Kerioak/Fotolia.com