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    <recommendedItem id="20100101_19_425"
                     title="AAN: Industrial Cleaner Again Tied to Parkinson Risk (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18338?impressionId=1265805892017"
                     
      TORONTO  --  The degreasing agent trichloroethylene (TCE) has been linked to increased rates of Parkinson&apos;s disease among industrial workers in yet another study, this time involving a large, well-studied group of World War II veterans.&lt;br&gt;
&lt;br&gt;Parkinson&apos;s disease developed in individuals with occupational exposure to TCE at more than five times the rate seen in those without such exposure (odds ratio 5.5, 95% CI 1.02 to 30), reported Samuel Goldman, MD, of the Parkinson&apos;s Institute in Sunnyvale, Calif.&lt;br&gt;
&lt;br&gt;Goldman described the research in a phone interview with &lt;em&gt;MedPage Today&lt;/em&gt;. It&apos;s scheduled for presentation here in April at the American Academy of Neurology&apos;s annual meeting.&lt;br&gt;
&lt;br&gt;A previous study in 2008 had fingered TCE as the most likely culprit behind a cluster of Parkinson&apos;s disease cases afflicting workers at a single industrial plant. (See &lt;a href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; mce_href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; target=&quot;_blank&quot;&gt;Trichloroethylene Implicated as Risk for Parkinsonism&lt;/a&gt;)&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Also, Goldman said, animal studies have found that TCE is selectively toxic to nigral dopaminergic neurons, the same type of nerve cell that progressively dies off in Parkinson&apos;s disease. He said the chemical&apos;s activity in rodent brains is very similar to that of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), a dopaminergic neurotoxin commonly used to simulate Parkinson&apos;s disease in preclinical research.&lt;/p&gt;
&lt;p&gt;Goldman said the new study was the first population-based analysis to link TCE to the disease.&lt;/p&gt;
&lt;p&gt;It focused on 198 twin pairs in the National Academy of Sciences-National Research Council&apos;s World War II Twins Cohort, which comprises some 16,000 twin pairs overall.&lt;/p&gt;
&lt;p&gt;Members of the all-male cohort, who were born from 1917 to 1927 and served in the war, have been followed since the 1960s. Occupational histories for participants are available along with medical records from the VA healthcare system.&lt;/p&gt;
&lt;p&gt;In those pairs chosen for the current study, records showed that one twin had developed Parkinson&apos;s disease and the other had not. This design largely eliminates genetics as a confounding factor in the analysis.&lt;/p&gt;
&lt;p&gt;Goldman explained that occupational histories for each participant were reviewed by a blinded industrial hygienist and a preventive medicine physician to identify likely exposures to TCE and four other industrial chemicals: xylene, toluene, carbon tetrachloride, and tetrachloroethylene.&lt;/p&gt;
&lt;p&gt;As a single source of exposure, only TCE was significantly associated with development of Parkinson&apos;s disease, Goldman said.&lt;/p&gt;
&lt;p&gt;People working as aircraft mechanics, machinists, plumbers, and electricians likely had regular exposure to TCE, Goldman said. The chemical was commonly used as a &quot;spot&quot; cleaner to remove grease and oils from metal surfaces. It was also used for a time as a dry cleaning solvent, although tetrachloroethylene was more common for that purpose.&lt;/p&gt;
&lt;p&gt;Goldman said no increased risk was seen with xylene or toluene, but there were near-significant trends toward increased Parkinson&apos;s disease risk from carbon tetrachloride and tetrachloroethylene: &lt;ul&gt; &lt;li&gt;Carbon tetrachloride: OR 2.8 (95% CI 0.97 to 7.8)&lt;/li&gt; &lt;li&gt;Tetrachloroethylene: OR 9.0 (95% CI 0.78 to 103)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Twins exposed to either TCE or tetrachloroethylene were at significantly increased risk, with an odds ratio of 8.1 (95% CI 1.43 to 43) relative to individuals with no exposure to either chemical.&lt;/p&gt;
&lt;p&gt;Goldman said the analysis also examined whether duration of exposure was associated with increased risk. He said the results were in the same pattern as for the yes-no exposure analysis, but the findings were very uncertain because of the relatively small sample size.&lt;/p&gt;
&lt;p&gt;Occupational histories were available for only 99 of the 198 discordant twin pairs and some of the information was obtained by proxy rather than from the participant himself.&lt;/p&gt;
&lt;p&gt;Because of the wide confidence intervals even for the yes-no exposure analysis, the findings need confirmation in a larger study, he said, noting that the best approach would be a cohort study involving people with known, long-term exposure to TCE, compared with well-chosen controls.&lt;/p&gt;
&lt;p&gt;&quot;The study wouldn&apos;t have to be large,&quot; Goldman said. He estimated that 1,000 to 2,000 participants would be adequate to determine if the connection to Parkinson&apos;s disease is real.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Neurological Disorders and Stroke, the Valley Foundation, and the James and Sharron Clark Family Fund.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_343"
                     title="U.S. Marshals Seize Unapproved Ozone Generators"
                     score="0.009"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18228?impressionId=1265805892017"
                     
      &lt;p&gt;WASHINGTON  --  U.S. Marshals have seized 77 unapproved ozone generators, valued at almost $76,000 from a California device manufacturer, the FDA announced.&lt;/p&gt;
&lt;p&gt;The devices were advertised as treatments for various conditions, including cancer, AIDS, hepatitis, herpes, and other diseases, but lacked approval or efficacy data to support the claims made on their behalf, an FDA release said.&lt;/p&gt;
&lt;p&gt;The raid came after the company, Applied Ozone Systems (AOS) of Auburn, Calif., failed to respond to a voluntary recall request last December, the agency said.&lt;/p&gt;
&lt;p&gt;The FDA raised concerns that patients using AOS-IM and AOS-IMD devices will consider it an appropriate treatment for an affliction and delay or stop FDA-approved and proven medical treatments. Patients using the devices may risk infection from contamination of the applicator or catheter, the release said.&lt;/p&gt;
&lt;p&gt;The FDA recommended that healthcare professionals and consumers cease use of the devices.&lt;/p&gt;
&lt;p&gt;The agency said it obtained an inspection warrant for the company&apos;s manufacturing facilities after the owner refused to admit FDA inspectors. It said the inspection revealed several breaches of the FDA&apos;s good manufacturing practice requirements for medical devices, which had never been approved in the first place.&lt;/p&gt;
&lt;p&gt;Ozone is an unstable allotrope of oxygen with three atoms, instead of the normal two. Ozone generators produce ozone from oxygen and have consumer and industrial applications, but ozone itself is harmful to the respiratory system, even at relatively low concentrations.&lt;/p&gt;
&lt;p&gt;Instructions with the Applied Ozone Systems devices suggest blowing ozoned air into the rectal and vaginal areas.&lt;/p&gt;
&lt;p&gt;Friday&apos;s seizure was part of a joint effort of the FDA and the California Department of Public Health to remove or prevent unapproved or unsafe medical devices from entering the market.&lt;/p&gt;
&lt;p&gt;A statement on the company&apos;s Web site said the two ozone generator models, which sold for $750 and $1,200 respectively, were no longer available by order of the FDA and California authorities.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_250"
                     title="Cancer Research &quot;Giant&quot; Lawrence Garfinkel Dies at 88"
                     score="-0"
                     href="http://www.medpagetoday.com/Pulmonology/Smoking/tb/18108?impressionId=1265805892017"
                     
      &lt;p&gt;Epidemiologist Lawrence Garfinkel, MA, a legendary researcher for the American Cancer Society whose work helped establish a link between cancer and smoking and other activities, died of cardiovascular disease Thursday in Seattle, Washington at 88.&lt;/p&gt;
&lt;p&gt;&quot;The American Cancer Society today mourns the loss of one of its most important historical figures,&quot; said John R. Seffrin, PhD, the society&apos;s chief executive officer.&lt;/p&gt;
&lt;p&gt;&quot;Larry Garfinkel joined the American Cancer Society as a young scientist in 1947, and for more than four decades played an instrumental role in expanding knowledge of and reducing death from smoking.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel&apos;s 1982 Cancer Prevention Study-II (CPS-II) is the largest contemporary study of tobacco and mortality, with 1.2 million participants and 77,000 data-compiling volunteers across 50 states, the District of Columbia, and Puerto Rico.&lt;/p&gt;
&lt;p&gt;CPS-II uncovered the effects of lifestyle factors, such as obesity, alcohol consumption, medications, genetic elements, that affect cancer and other chronic diseases, the analysis of which still reveals important clues about cancer today.&lt;/p&gt;
&lt;p&gt;The study also found lung cancer mortality rates in women increased five-fold from data collected in the original Cancer Prevention Study, while cancer rates among non-smoking women remained the same. This information provided strong evidence that lung cancer was almost exclusively a disease found in smokers.&lt;/p&gt;
&lt;p&gt;Garfinkel was born on January 11, 1922 in Manhattan&apos;s Lower East Side and was raised in the South Bronx.&lt;/p&gt;
&lt;p&gt;He served in the army during World War II, where he was seriously injured in northern France in August, 1944.&lt;/p&gt;
&lt;p&gt;Ultimately, Garfinkel graduated from the City College of New York and received a Masters Degree from Columbia University. He also received several honorary doctorates.&lt;/p&gt;
&lt;p&gt;Garfinkel began work for the ACS in 1947.&lt;/p&gt;
&lt;p&gt;He assisted E. Cuyler Hammond, MD, and Daniel Horn, MD, in the first ACS prospective mortality study of 187,783 males in the late 1940&apos;s by coordinating much of the field work, including training thousands of ACS volunteers in data collection techniques.&lt;/p&gt;
&lt;p&gt;Garfinkel acted as the co-principal investigator of the larger Cancer Prevention Study I (CPS-I) in 1959. The study enrolled 1 million participants across 25 states and required over 68,000 volunteers to collect data.&lt;/p&gt;
&lt;p&gt;In the 1960s, he contributed to more than two dozen major papers on the relation between smoking and health. He was co-author of one of the first reports combining epidemiology with pathology and provided some of the first direct evidence of lung damage related to smoking.&lt;/p&gt;
&lt;p&gt;Garfinkel also contributed to issuance of the landmark 1964 Surgeon General&apos;s report on smoking and health.&lt;/p&gt;
&lt;p&gt;He was appointed director of ACS research in 1979 after Hammond&apos;s retirement.&lt;/p&gt;
&lt;p&gt;Garfinkel retired from the ACS in 1989. Over the course of his career, he had contributed to more than 100 journal articles.&lt;/p&gt;
&lt;p&gt;Richard D. Klausner, MD, then-director of the National Cancer Institute, said at the time: &quot;Few individuals have contributed as much to our present-day knowledge about the disease consequences of smoking.&lt;/p&gt;
&lt;p&gt;&quot;His remarkable achievement is an important reminder what a tremendous impact an individual can make, and inspires all of us to continue the fight against cancer.&quot;&lt;/p&gt;
&lt;p&gt;Garfinkel continued to volunteer with the ACS after his retirement and taught biostatistics at the New York University Dental School.&lt;/p&gt;
&lt;p&gt;He is survived by his brothers, Harold and Melvin; his sons, Martin and Herb; a daughter-in-law, Margaret Cary, and two grandchildren.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_170"
                     title="Gov&apos;t Touts BPA Research Effort"
                     score="-0.004"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18005?impressionId=1265805892017"
                     
      Federal health officials said the government will spend $30 million on research to pin down health risks associated with bisphenol A (BPA), a chemical used to soften plastics in baby bottles, cups, and plastic packaging that has come under increasing scrutiny in recent years.&lt;br&gt;
&lt;br&gt;William Corr, deputy secretary of Health and Human Services (HHS), told reporters in a press call that the agency was investing the money in &quot;short- and longer-term studies&quot; to provide better guidance on the safety of BPA in infant food containers.&lt;br&gt;
&lt;br&gt;Most of the funding will pass through the National Institute of Environmental Health Sciences. Its director, Linda Birnbaum, PhD, said $15 million in economic stimulus money had been earmarked for BPA studies, on top of $15 million in the agency&apos;s existing research portfolio.&lt;/p&gt;
&lt;p&gt;Corr also announced plans to form an interagency task force to address the general topic of environmental health risks to children, though he provided no details.&lt;/p&gt;
&lt;p&gt;Studies have shown that BPA can mimic the action of female reproductive hormones and may be linked to cardiovascular disease, diabetes, and liver abnormalities. Infants&apos; exposure is a particular concern because they may be more sensitive to these effects than adults.&lt;/p&gt;
&lt;p&gt;Corr noted that HHS has posted a list of manufacturers who have assured the FDA that they have not used BPA in baby bottles and infant feeding cups manufactured since January 2009. These include Avent, Doctor Brown&apos;s Natural Flow, Evenflow, First Essentials, Gerber, Munchkin, Nuk, and Playtex. Together, these firms account for more than 90% of the U.S. market, according to HHS.&lt;/p&gt;
&lt;p&gt;FDA Commissioner Margaret Hamburg, MD, said in the press call that the agency now accepts that BPA is of &quot;some concern&quot;  --  words she emphasized repeatedly.&lt;/p&gt;
&lt;p&gt;They&apos;re a quote from a 2008 report by the National Toxicology Program, part of the National Institutes of Health (and also directed by Birnbaum). The toxicology program report appeared to contradict the FDA&apos;s own 2008 assessment that BPA was acceptably safe.&lt;/p&gt;
&lt;p&gt;The FDA evaluation, which relied on published studies, drew withering criticism from Congress and the agency&apos;s own science advisory board. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/11568&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/11568&quot; target=&quot;_blank&quot;&gt;FDA Spanked by Full Science Board on Bisphenol A Safety Stance&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Hamburg said the National Toxicology Program analysis used different methods and outcomes than the FDA&apos;s initial review. She stopped short of repudiating the FDA assessment, but said the agency shared the National Toxicology Program&apos;s conclusions.&lt;/p&gt;
&lt;p&gt;She said the FDA was also performing its own studies of BPA, cooperating with the National Institutes of Health on research expected to wind up in 18 to 24 months.&lt;/p&gt;
&lt;p&gt;The FDA is also working with manufacturers to change product designs to eliminate BPA and, where necessary, to remove BPA-containing products from the market, Hamburg said.&lt;/p&gt;
&lt;p&gt;Both Hamburg and Corr emphasized that parents should not change their infants&apos; feeding regimes based on potential risks from BPA.&lt;/p&gt;
&lt;p&gt;&quot;Good nutrition outweighs any risk from exposure to BPA,&quot; Corr said, though he noted that breastfeeding is preferred for infants in any case.&lt;/p&gt;
&lt;p&gt;Corr also outlined four recommendations for parents of infants: &lt;ul&gt; &lt;li&gt;Follow published recommendations for infant feeding, starting with breastfeeding&lt;/li&gt; &lt;li&gt;Avoid scratched or torn bottles, as these are more likely to release BPA into foods&lt;/li&gt; &lt;li&gt;Don&apos;t put boiling liquids into infant bottles, for the same reason&lt;/li&gt; &lt;li&gt;Put food containers into microwave ovens or dishwashers only if the labels indicate that they&apos;re safe for such environments&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The FDA is also continuing to study the safety of BPA in medical devices. (See &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/13022&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/13022&quot; target=&quot;_blank&quot;&gt;FDA to Test BPA Exposure from Medical Devices&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;However, in the press call, Hamburg and her deputy, Joshua Sharfstein, MD, declined to answer questions about the status of this effort. Sharfstein said they were only prepared to talk about food containers at this point.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_2543"
                     title="Spacecraft May Give Early Heads-Up on Infection Trends"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/15509?impressionId=1265805892017"
                     
      &lt;p&gt;Satellite technology could give public health officials advance warning of disease outbreaks likely to occur as a result of global climate change, researchers said.&lt;/p&gt;
&lt;p&gt;Preliminary efforts have already produced models that predict spikes in diseases ranging from cholera to hantavirus on the basis of remote sensing data, according to Timothy Ford, PhD, of the University of New England in Biddeford, Maine, and colleagues.&lt;/p&gt;
&lt;p&gt;Writing in the September issue of the CDC&apos;s &lt;em&gt;Emerging Infectious Diseases, &lt;/em&gt;Ford and colleagues  --  including Rita Colwell, PhD, former director of the National Science Foundation  --  said novel patterns of infectious disease are likely to accompany the regional temperature and hydrological trends that add up to climate change.&lt;/p&gt;
&lt;p&gt;&quot;If climatologic data can be used to predict future disease outbreaks, public health interventions can be mobilized in a more timely and proactive manner,&quot; they said.&lt;/p&gt;
&lt;p&gt;&quot;Successful predictive modeling of disease and the establishment of early warning systems have reached a critical junction in development. As we improve our understanding of the biology and ecology of the pathogen, vectors, and hosts, our ability to accurately link environmental variables, particularly those related to climate change, will improve.&quot;&lt;/p&gt;
&lt;p&gt;They added, &quot;We cannot stress too strongly our belief that a strong global satellite program is essential for future disease prediction.&quot;&lt;/p&gt;
&lt;p&gt;They noted that the 2001 report from the Intergovernmental Panel on Climate Change predicted that the average number of people exposed annually to storm surges  --  which frequently carry &lt;em&gt;Salmonella&lt;/em&gt;, &lt;em&gt;Vibrio&lt;/em&gt;, &lt;em&gt;Cryptosporidium&lt;/em&gt;, and hepatitis pathogens  --  will probably rise from 50 million people worldwide today to 250 million in the 2080s.&lt;/p&gt;
&lt;p&gt;Altered frequencies and tracks of storm systems are also likely to mean inland flooding of areas that aren&apos;t exposed to it now. Ford and colleagues said areas of increasing drought may also be at risk for novel disease outbreaks. On example is meningococcal meningitis, which is endemic in sub-Saharan Africa during dry conditions and disappears at the start of the rainy season.&lt;/p&gt;
&lt;p&gt;New patterns of vector-born diseases are another expected consequence of climate change.&lt;/p&gt;
&lt;p&gt;Ford and colleagues pointed to several projects that have shown preliminary success in relating satellite data to disease: &lt;ul&gt; &lt;li&gt;Distribution of five out of six Anopheles gambiae mosquito species, vectors for the malaria parasite in Africa, has been modeled from remote sensing data on land use and climate parameters&lt;/li&gt; &lt;li&gt;Remote sensing data in the southwestern U.S. correlated significantly with subsequent outbreaks of rodent-borne hantavirus pulmonary syndrome&lt;/li&gt; &lt;li&gt;Eight of nine spikes in Bangladeshi cholera rates from 1998 to 2002 were successfully modeled on the basis of satellite data on sea surface height and temperature and chlorophyll A levels&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Ford and colleagues cautioned that the predictive power of these models is still weak. For example, 2005 Landsat imagery showing higher-than-normal rainfall in northern New Mexico and southern Colorado led health officials to warn of increased risk of hantavirus in those areas.&lt;/p&gt;
&lt;p&gt;(The hypothesis is that rain promotes plant growth in the region, leading to a population boom in deer mice who carry the virus.)&lt;/p&gt;
&lt;p&gt;Cases indeed spiked in New Mexico during early 2006. But no increase occurred in Colorado, which actually saw fewer hantavirus infections than the previous year.&lt;/p&gt;
&lt;p&gt;On the other hand, Ford and colleagues said, &quot;these results are not necessarily a failure of prediction.&quot; Instead, they suggested that people may have heeded the health warnings prompted by the prediction, avoiding deer mice habitats and hence the virus.&lt;/p&gt;
&lt;p&gt;Public health officials would dearly love to be able to predict influenza outbreaks, and the seasonality of the disease has raised hopes that environmental data will somehow be used in predictive models, the researchers said. Unfortunately, scientists still don&apos;t understand the specific factors underlying the flu&apos;s seasonal nature.&lt;/p&gt;
&lt;p&gt;If science can isolate the environmental drivers of seasonal diseases like influenza, better prediction will likely become a reality, they suggested.&lt;/p&gt;
&lt;p&gt;&quot;As we improve our understanding of the biology and ecology of the pathogen, vectors, and hosts, our ability to accurately link environmental variables, particularly those related to climate change, will improve,&quot; Ford and colleagues wrote. &quot;What has become clear over the past few years is that satellite imaging can play a critical role in disease prediction and, therefore, inform our response to future outbreaks.&quot;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>