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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_430"
                     title="HRT Linked to Asthma Risk (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Endocrinology/Menopause/tb/18342?impressionId=1265805553423"
                     
      &lt;p&gt;Estrogen-only hormone replacement therapy is associated with an increased risk of asthma in postmenopausal women, a large prospective observational cohort study showed.&lt;/p&gt;
&lt;p&gt;Recent and current users of estrogen had a 54% increase in the risk of being diagnosed with asthma, according to Isabelle Romieu, MD, ScD, of the National Institute of Public Health in Cuernavaca, Mexico, and colleagues.&lt;/p&gt;
&lt;p&gt;The risk was even higher in nonsmokers or those who reported an allergic disease before they developed asthma, the researchers reported online in &lt;em&gt;Thorax&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Epidemiological studies suggest that an endocrine mechanism  --  perhaps endogenous estrogen synthesis  --  is involved in asthma in women and girls, the researchers wrote.&lt;/p&gt;
&lt;p&gt;It&apos;s plausible that hormone replacement therapy &quot;might therefore play a role in asthma onset,&quot; they theorized in the journal.&lt;/p&gt;
&lt;p&gt;To delve into the question, Romieu and colleagues turned to the E3N cohort study, which is the French component of the continuing European Prospective Investigation into Cancer and Nutrition (EPIC) study.&lt;/p&gt;
&lt;p&gt;The study started in 1990 and includes 98,995 French women born between 1925 and 1950. The participants complete self-administered questionnaires every two years, giving details of their medical history, menopausal status, and a variety of lifestyle characteristics.&lt;/p&gt;
&lt;p&gt;Women were deemed to have a new case of asthma if  --  after being free of the disease at baseline  --  they later reported both that they had suffered asthma attacks and that the diagnosis had been confirmed by a physician.&lt;/p&gt;
&lt;p&gt;Among the participants, Romieu and colleagues found 57,664 women who were free of asthma at menopause. In that group, the researchers found, there were 569 incident cases of asthma during a total of 495,448 years of follow-up.&lt;/p&gt;
&lt;p&gt;Analysis showed that hormone replacement therapy in general was related to an increased risk of asthma onset among recent users, with a hazard ratio of 1.20. But the 95% confidence interval ranged from 0.98 to 1.46, so the finding was not statistically significant.&lt;/p&gt;
&lt;p&gt;Instead, the researchers found, the association only reached significance among women reporting the use of estrogen alone, where the hazard ratio was 1.54, with a 95% confidence interval from 1.13 to 2.09.&lt;/p&gt;
&lt;p&gt;The risk was particularly great in estrogen-using women who had never smoked or who had reported allergic disease before the asthma onset. Those hazard ratios were 1.80 and 1.84, respectively, and both reached significance.&lt;/p&gt;
&lt;p&gt;The increased risk among never smokers might reflect an anti-estrogen effect of tobacco smoke, the researchers speculated, or difficulty isolating the additional effect of the therapy in smokers.&lt;/p&gt;
&lt;p&gt;The strengths of the study include its large size, prospective design, and relatively low loss to follow-up of 3.8%, Romieu and colleagues said.&lt;/p&gt;
&lt;p&gt;They added that the results might be biased if users of hormone replacement therapy reported more asthma attacks or were diagnosed more often because of more frequent visits to the doctor.&lt;/p&gt;
&lt;p&gt;Indeed, hormone therapy users had more mammograms than nonusers, they noted, but added that the participants all had free medical care and &quot;there is no reason to believe&quot; that hormone users had more medical visits for non-gynecological reasons than nonusers.&lt;/p&gt;
&lt;p&gt;Hormone therapy has been controversial  --  and on the decline  --  since the landmark Women&apos;s Health Initiative study was stopped in 2002 when the researchers found that participants taking estrogen plus progestin had a greater incidence of coronary heart disease, breast cancer, stroke, and pulmonary embolism than those receiving placebo.&lt;/p&gt;
&lt;p&gt;In the current study, the combination hormone therapy was not associated with an increase in asthma incidence.&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 and researchers had support from Mutuelle G&amp;#233;n&amp;#233;rale de l&apos;Education Nationale, the Institut de Canc&amp;#233;rologie Gustave Roussy, the Institut National de la Sant&amp;#233; et de la Recherche M&amp;#233;dicale, the CDC, the Canc&amp;#233;rop&amp;#244;le R&amp;#233;gion Ile de France, and the GA&lt;sup&gt;2&lt;/sup&gt;LEN project.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_366"
                     title="Placental Infection Could Spur Asthma (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Pediatrics/Asthma/tb/18252?impressionId=1265805553423"
                     
      Preterm birth complicated by chorioamnionitis may modestly increase a child&apos;s risk of later asthma, researchers found.&lt;br&gt;
&lt;br&gt;Children born preterm after a pregnancy complicated by the bacterial infection of placenta and amniotic fluid (chorioamnionitis) were significantly more likely to develop asthma by age eight than preemies without such exposure, according to Darios Getahun, MD, MPH, of Kaiser Permanente Department of Research and Evaluation in Pasadena.&lt;br&gt;
&lt;br&gt;Asthma diagnosis was nearly threefold more common among chorioamnionitis-exposed children who had been born preterm than those carried to term, they wrote in the February &lt;em&gt;Archives of Pediatrics &amp;amp; Adolescent Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Premature birth may not give an infant&apos;s lungs a chance to fully develop, leading to early infection and inflammation that elevate risk of chronic lung disease, such as asthma.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;However, in utero exposures could be an important contributor as well, Getahun explained in an interview.&lt;/p&gt;
&lt;p&gt;Chorioamnionitis is thought to be associated with more than half of all preterm births.&lt;/p&gt;
&lt;p&gt;Fetal lungs stay in contact with the amniotic fluid which, when infected, may expose the developing lung to microorganisms, toxic substances, and inflammatory mediators, the researchers wrote.&lt;/p&gt;
&lt;p&gt;Animal model evidence suggests the condition may lead to scarring and fibrosis in the lung and damage to other fetal organs &quot;during a very critical time at preterm gestation,&quot; Getahun told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;So, his group retrospectively studied Kaiser&apos;s matched perinatal records on 510,216 singleton children born at the managed care group&apos;s hospitals in Southern California between 1991 and 2007.&lt;/p&gt;
&lt;p&gt;Physician-diagnosed asthma incidence by age 8 years, as expected, was significantly higher overall for preemies born at 23 to 36 weeks&apos; gestation than for those carried full-term (60.2 versus 40.0 per 1,000 person-years).&lt;/p&gt;
&lt;p&gt;But chorioamnionitis diagnosed during pregnancy substantially boosted this risk.&lt;/p&gt;
&lt;p&gt;Incidence of asthma rose to 100.7 per 1,000 person-years in exposed children born preterm, versus 39.6 per 1,000 among exposed, full-term children (IR 2.9, 95% CI 2.6 to 3.3).&lt;/p&gt;
&lt;p&gt;This association between chorioamnionitis and asthma in preemies persisted (HR 1.68, 95% CI 1.52 to 1.87) after adjustment for important confounding variables, including maternal age, race or ethnicity, smoking during pregnancy, prenatal care, and maternal asthma.&lt;/p&gt;
&lt;p&gt;Although the asthma risk appeared to rise with greater prematurity in exposed children, the elevated risk associated with chorioamnionitis exposure in utero was seen in every category of prematurity: &lt;ul&gt; &lt;li&gt; 1.23 times higher risk in children born at 23 to 28 weeks (95% CI 1.02 to 1.49)&lt;/li&gt; &lt;li&gt; 1.51 times higher risk in children born at 28 to 33 weeks (95% CI 1.26 to 1.80)&lt;/li&gt; &lt;li&gt; 1.20 times higher risk in children born at 34 to 36 weeks (95% CI 1.03 to 1.47)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Additional adjustment for bronchopulmonary dysplasia  --  &quot;one of the mechanisms through which preterm birth is presumably associated with respiratory problems in early childhood&quot;  --  had little impact on the findings.&lt;/p&gt;
&lt;p&gt;Thus, the bacterial infection appeared to be an independent risk factor for asthma in prematurely born children, the researchers concluded.&lt;/p&gt;
&lt;p&gt;The risks were particularly high for children born to African-American women who developed chorioamnionitis, suggesting this may be an at-risk group to single out for attention clinically, they suggested.&lt;/p&gt;
&lt;p&gt;Getahun cautioned, though, that his group&apos;s study could not prove causality. The researchers also noted that the study was limited by lack of data on parental atopy and smoking.&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 supported by Kaiser Permanente Direct Community Benefit funds. The researchers reported no conflicts of interest.&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="0.006"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/tb/18228?impressionId=1265805553423"
                     
      &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_320"
                     title="Low Vitamin D Worsens Asthma (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Pulmonology/Asthma/tb/18187?impressionId=1265805553423"
                     
      &lt;p&gt;Low levels of vitamin D correlated with poorer lung function, increased airway reactivity, and reduced response to steroid treatment in adult asthmatics, researchers said.&lt;/p&gt;
&lt;p&gt;For every 1-ng/mL increase in serum levels of 25-hydroxyvitamin D (25-OH-D), forced one-second expiratory volume (FEV&lt;sub&gt;1&lt;/sub&gt;) increased by 21 mL (&lt;em&gt;P&lt;/em&gt;=0.03, &lt;em&gt;r&lt;/em&gt;=0.8), reported E. Rand Sutherland, MD, MPH, of National Jewish Health in Denver, and colleagues online in the &lt;em&gt;American Journal of Respiratory and Critical Care Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The study of 54 adult patients with asthma also showed that airway hyperreactivity in those with serum 25-OH-D levels below 30 ng/mL  --  defined as vitamin D insufficiency  --  measured at almost twice the average levels seen in those with normal levels of 25-OH-D.&lt;/p&gt;
&lt;p&gt;The dose of methacholine required to induce a 20% drop in FEV&lt;sub&gt;1&lt;/sub&gt; was 1.03 mg/mL (SE 0.2) in those with low 25-OH-D levels, compared with 1.92 mg/mL (SD 0.2) in patients with higher serum vitamin D levels (&lt;em&gt;P&lt;/em&gt;=0.01), Sutherland and colleagues reported.&lt;/p&gt;
&lt;p&gt;Cellular responses in vitro to dexamethasone were also significantly correlated with 25-OH-D levels (&lt;em&gt;r&lt;/em&gt;=0.05, &lt;em&gt;P&lt;/em&gt;=0.02). Peripheral blood mononuclear cells from those with higher 25-OH-D levels demonstrated greater MAP kinase phosphatase expression after dexamethasone stimulation than cells from individuals with lower vitamin D levels.&lt;/p&gt;
&lt;p&gt;The effects observed were greater in those who had not received steroid treatment.&lt;/p&gt;
&lt;p&gt;&quot;In adults with persistent asthma, there is a significant and deleterious association between reduced serum vitamin D levels and lung function, airway hyperresponsiveness, and glucocorticoid sensitivity, which together constitute three important biomarkers of asthma severity, impairment, and prognosis,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues added that the findings suggest that vitamin D supplements might improve symptoms in some asthma patients, although they did not test the hypothesis.&lt;/p&gt;
&lt;p&gt;Their cross-sectional study included 54 patients with persistent asthma, mean age 38 and with FEV&lt;sub&gt;1&lt;/sub&gt; levels that were a mean 83% of predictions. Participants underwent a round of standard tests for lung function and asthma symptoms as well as laboratory measurements of 25-OH-D.&lt;/p&gt;
&lt;p&gt;Serum 25-OH-D levels averaged 28.1 ng/mL (SE 10.2), with 32 participants having levels below the insufficiency threshold of 30 ng/mL.&lt;/p&gt;
&lt;p&gt;The researchers found that vitamin D levels did not correlate only with asthma symptoms. Body mass index was also significantly and inversely associated with 25-OH-D.&lt;/p&gt;
&lt;p&gt;Each unit increase of BMI was associated with a decrease of 0.56 ng/mL (SE 0.18) in serum 25-OH-D (&lt;em&gt;r&lt;/em&gt;=0.4, &lt;em&gt;P&lt;/em&gt;=0.002) after adjusting for age, sex, and physical impairment.&lt;/p&gt;
&lt;p&gt;Sutherland and colleagues noted that earlier research had linked obesity with asthma risk, and also with reduced responses to corticosteroid treatment in asthmatic patients.&lt;/p&gt;
&lt;p&gt;They suggested that vitamin D &quot;may be one pathway by which obesity and reduced steroid response are related.&quot;&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;Funding for the study came from the National Institutes of Health.&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_288"
                     title="SSRIs Affect Breast Milk Production (CME/CE)"
                     score="0.001"
                     href="http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/tb/18149?impressionId=1265805553423"
                     
      &lt;p&gt;Women taking selective serotonin reuptake inhibitor (SSRI) antidepressants may experience delays in postpartum breast milk production, researchers said.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation occurred in 87.5% of a small group of women taking SSRIs, compared with 43.5% of those not taking the drugs (RR 2, 95% CI 1.51 to 2.67, &lt;em&gt;P&lt;/em&gt;=0.02), according to Aaron M. Marshall, PhD, of the University of Cincinnati.&lt;/p&gt;
&lt;p&gt;The relative risk of delayed activation remained significantly higher (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) among SSRI users after adjustment for maternal age, obesity, cesarean delivery, infant gestational age, and infant breastfeeding behavior, the researchers reported online in the &lt;em&gt;Journal of Clinical Endocrinology and Metabolism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;An early breastfeeding difficulty faced by many women, particularly those who are primiparous, is milk secretion delayed beyond 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;These women also are at risk of early cessation of breastfeeding. In fact, only 11% of mothers in the U.S. breastfeed exclusively for the recommended six months.&lt;/p&gt;
&lt;p&gt;Studies in animal models and cell cultures suggested that serotonin (5-HT) is an important local regulator of lactation homeostasis, and the 5-HT transporter is expressed in mammary tissue at the apical membrane of epithelial cells.&lt;/p&gt;
&lt;p&gt;Serotonin is controlled intracellularly by a balance between synthesis and degradation, while extracellularly its availability is controlled through recycling by the 5-HT transporter.&lt;/p&gt;
&lt;p&gt;The 5-HT transporter also is the target for the most commonly prescribed class of antidepressants in the U.S. and other developed countries. These SSRI antidepressants are typically used to treat postpartum depression.&lt;/p&gt;
&lt;p&gt;The investigators conducted in vitro and animal studies to establish that the 5-HT transporter is expressed in breast tissue, particularly in the apical membranes of mammary epithelial cells, and that pharmacologic inhibition of the transporter disrupts tight junctures leading to a local involution-like effect.&lt;/p&gt;
&lt;p&gt;To examine the potential effect of SSRI inhibition on milk production in women, Marshall and colleagues enrolled 431 mothers as part of a longitudinal cohort study examining barriers to early lactation success.&lt;/p&gt;
&lt;p&gt;All were expecting their first live-born infants, had no known absolute contraindication to breastfeeding, and were at least 19 years old.&lt;/p&gt;
&lt;p&gt;Women taking SSRIs were more likely to have scored higher on a depressive symptom scale (as expected), and were somewhat more likely to be obese or to have had a cesarean delivery.&lt;/p&gt;
&lt;p&gt;Participating mothers were visited between 72 and 96 hours after giving birth to assess their breastfeeding experience and to determine the timing of secretory activation, and then seen again one week later.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation was defined as initiation more than 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;Median onset of secretory activation among the SSRI-treated mothers was 85.8 hours compared with 69.1 hours in mothers not using the drugs (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;Eight women reported regular use of an SSRI medication. Seven experienced definite delayed secretory activation, and the eighth reported activation at 72 hours and therefore did not meet the defined cutoff for delayed activation.&lt;/p&gt;
&lt;p&gt;All women taking SSRIs had experienced secretory activation by their second visit a week after the first interview.&lt;/p&gt;
&lt;p&gt;The researchers noted that most studies on the effects of SSRI use during pregnancy and lactation have focused on the risks for developmental defects or whether the drugs passed into milk during lactation.&lt;/p&gt;
&lt;p&gt;This study, they said, is the first to report data on another important aspect of SSRI use during the peripartum, the effect on milk production.&lt;/p&gt;
&lt;p&gt;They concluded that the risk of delayed secretory activation was twice as great among primiparous women using an SSRI medication, and although the fraction of women taking the drugs was small, the risk was significant and remained so after adjustment for potential confounding factors.&lt;/p&gt;
&lt;p&gt;Further examination of this relationship is needed in larger groups of mothers, the researchers said, and in studies to determine if there are differences among the antidepressant medications.&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;This work was supported by the National Institutes of Health, the USDA Cooperative State Research, Education, and Extension Service, and the Department of Health and Human Services.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>