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Perinatal antidepressant stunts brain development ...

ScienceDaily (Oct. 24, 2011) — Rats exposed to an antidepressant just before and after birth showed substantial brain abnormalities and behaviors, in a study funded by the National Institutes of Health.

After receiving citalopram, a serotonin-selective reuptake inhibitor (SSRI), during this critical period, long-distance connections between the two hemispheres of the brain showed stunted growth and degeneration. The animals also became excessively fearful when faced with new situations and failed to play normally with peers — behaviors reminiscent of novelty avoidance and social impairments seen in autism. The abnormalities were more pronounced in male than female rats, just as autism affects 3-4 times more boys than girls.

“Our findings underscore the importance of balanced serotonin levels — not too high or low — for proper brain maturation,” explained Rick Lin, Ph.D., of the University of Mississippi Medical Center, Jackson, a Eureka Award grantee of the NIH’s National Institute of Mental Health.

Lin and colleagues report on their discovery online during the week of Oct. 24, 2011, in the Proceedings of the National Academy of Sciences.

Last July, a study reported an association between mothers taking antidepressants and increased autism risk in their children. It found that children of mothers who took SSRI’s during the year prior to giving birth ran twice the normal risk of developing autism — with treatment during the first trimester of pregnancy showing the strongest effect. A study published last month linked the duration of a pregnant mother’s exposure to SSRIs to modest lags in coordination of movement — but within the normal range — in their newborns.

“While one must always be cautious extrapolating from medication effects in rats to medication effects in people, these new results suggest an opportunity to study the mechanisms by which antidepressants influence brain and behavioral development,” said NIMH Director Thomas R. Insel, M.D. “These studies will help to balance the mental health needs of pregnant mothers with possible increased risk to their offspring.”

Earlier studies had hinted that serotonin plays an important role in shaping the still-forming brain in the days just after a rat is born, which corresponds to the end of the third trimester of fetal development in humans. Experimental manipulations of the chemical messenger during this period interfered with formation of sensory-processing regions of the cortex, or outer mantle, and triggered aggressive and anxiety-related behaviors in rodents.

There is also recent evidence in humans that serotonin from the placenta helps shape development of the fetal brain early in pregnancy. Disrupted serotonin has been linked to mood and anxiety disorders. SSRIs, the mainstay medication treatment for these disorders, boost serotonin activity.

Lin and colleagues gave citalopram to male and female rat pups prenatally and postnatally and examined their brains and behavior as they grew up. Male, but not female, SSRI exposed rat pups abnormally froze when they heard an unfamiliar tone and balked at exploring their environment in the presence of unfamiliar objects or scents. These behaviors persisted into adulthood. The male pups especially also shunned normal juvenile play behavior — mimicking traits often seen in children with autism.

A key brain serotonin circuit, the raphe system, known to shape the developing brain during the critical period when the animals were exposed to the drug, showed dramatic reductions in density of neuronal fibers. Evidence of stunted development in the circuit coursed through much of the cortex and other regions important for thinking and emotion, such as the hippocampus.

The researchers also discovered miswiring in the structure responsible for communications between the brain’s left and right hemispheres, called the corpus collosum. Extensions of neurons, called axons, through which such long-distance communications are conducted, were deformed. A protective sheath, called myelin, that normally wraps and boosts axons’ efficiency– like insulation on an electrical wire — was reduced by one-third in the treated animals. This damage was three times worse in male than in female pups and would likely result in abnormal communication between the two hemispheres, say the researchers.

Moreover, the perinatally exposed animals showed evidence of neurons firing out of sync and other electrophysiological abnormalities, suggesting faulty organization of neuronal networks in the cortex.

The research also was supported by the NIH’s National Center for Research Resources, National Institute of Neurological Disorders and Stroke and National Institute of Child Health and Human Development.

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Journal Reference:

  1. Kimberly L. Simpson, Kristin J. Weaver, Etienne De Villers-Sidani, Jordan Y.-F. Lu, Zhengwei Cai, Yi Pang, Federico Rodriguez-Porcel, Ian A. Paul, Michael Merzenich, Rick C. S. Lin. Perinatal antidepressant exposure alters cortical network function in rodents. Proceedings of the National Academy of Sciences, 2011; DOI: 10.1073/pnas.1109353108

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Water disinfection byproducts linked to adverse he...

ScienceDaily (Oct. 24, 2011) — University of Illinois scientists report the first identification of a cellular mechanism linked to the toxicity of a major class of drinking water disinfection byproducts. This study, published in Environmental Science Technology, suggests a possible connection to adverse health effects, including neurological diseases such as Alzheimer’s.

“I’m not implying that drinking disinfected water will give you Alzheimer’s,” said Michael Plewa, lead scientist and professor of genetics in the U of I Department of Crop Sciences. “Certainly, the disinfection of drinking water was one of the most significant public health achievements of the 20th century. But the adverse effects of disinfection byproducts (DBPs) that are unintentionally formed during this process are causing concerns as researchers unveil their toxicity.”

More than 600 DBPs have been discovered. Although researchers know some DBPs are toxic, little biological information is available on the majority of these water contaminants. The Environmental Protection Agency regulates only 11 of these DBPs, he said.

Plewa’s laboratory investigated the biological mechanism, or the cellular target that leads to toxicity, in the second-most prevalent DBP class generated in disinfected water — haloacetic acids (HAAs).

“The EPA has regulated HAAs for nearly 15 years. However, we did not know how they caused toxicity before this study,” he said. “Now that we’ve uncovered the mechanism for HAAs, we can make sense of past data that can lead to new studies relating to adverse pregnancy outcomes, different types of cancer, and neurological dysfunction.”

Plewa believes this will assist the EPA in establishing regulations based on science. Their research will also help the water treatment community develop new methods to prevent the generation of the most toxic DBPs.

“It’s fairly simple,” Plewa said. “To increase the health benefits of disinfected water, we must reduce the most toxic DBPs. If we understand their biological mechanisms, we can come up with more rational ways to disinfect drinking water without generating toxic DBPs.”

In this study, researchers focused on three HAAs — iodoacetic acid, bromoacetic acid and chloroacetic acid. After they rejected their first hypothesis that the HAAs directly damaged DNA, they looked at research in a different area — neuroscience. Plewa’s graduate student, Justin Pals, discovered an amazing connection, Plewa said.

In neurotoxicology, iodoacetic acid reduces the availability of nutrients or oxygen in neurons by inhibiting glyceraldehyde-3-phosphate dehydrogenase (GAPDH).

“Researchers are interested in understanding how to prevent damage after a stroke or other neurological damage,” Plewa said. “Iodoacetic acid kills these cells. One of the targets they found was that iodoacetic acid inhibited GAPDH.”

Plewa’s lab conducted quantitative GAPDH enzyme kinetics and discovered that the data were highly correlated with a diversity of adverse health markers.

“All the pieces of the puzzle fell into place in an instant,” Plewa said. “We had discovered our cellular target — GAPDH. Never before had this type of research been done with this level of precision and associated with a large body of adverse biological impacts.”

They discovered that the HAA disinfection byproducts were toxic because the cells cannot make ATP, and this causes oxidative stress.

“Cells treated with HAAs experience DNA damage,” Plewa said. “So they start expressing DNA repair systems. HAAs are not directly damaging DNA, rather they are inhibiting GAPDH, which is involved in increasing the oxidative stress that we are observing.”

A growing body of information has shown that GAPDH is associated with the onset of neurological diseases.

“If you carry a natural mutation for GAPDH and are exposed to high levels of these disinfection byproducts, you could be more susceptible to adverse health effects such as Alzheimer’s,” he said.

More research is needed to study iodinated disinfection byproducts because they are the most reactive in inhibiting GAPDH function and are currently not regulated by the EPA, Plewa said.

“We replaced the standard working model of direct DNA damage with a new working model based on a cellular target molecule,” he said. “This discovery is a fundamental contribution to the field of drinking water science.”

This research was published in Environmental Science Technology. Scientists include Michael Plewa, Justin Pals, Justin Ang and Elizabeth Wagner, all of the University of Illinois. Research was supported by the WaterCAMPWS Center NSF Award CTS-0120978.

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The above story is reprinted from materials provided by University of Illinois College of Agricultural, Consumer and Environmental Sciences. The original article was written by Jennifer Shike.

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Journal Reference:

  1. Justin A. Pals, Justin K. Ang, Elizabeth D. Wagner, Michael J. Plewa. Biological Mechanism for the Toxicity of Haloacetic Acid Drinking Water Disinfection Byproducts. Environmental Science Technology, 2011; 45 (13): 5791 DOI: 10.1021/es2008159

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Math disability linked to problem relating quantit...

ScienceDaily (Oct. 24, 2011) — Children who start elementary school with difficulty associating small exact quantities of items with the printed numerals that represent those quantities are more likely to develop a math-related learning disability than are their peers, according to a study supported by the National Institutes of Health.

The children in the study who appeared to have difficulty grasping the fundamental concept of exact numerical quantities — that the printed numeral 3, for example, represents three dots on a page — went on to be diagnosed with math learning disability by fifth grade.

Other early factors correlated with a math learning disability were difficulty recalling answers to single-digit addition problems, distractibility in class, and difficulty understanding that more complex math problems can be broken down into smaller problems that can be solved individually.

Although the math learning disabled children did make limited progress in subsequent grades, by fifth grade they had not caught up to their typically achieving peers in the ability to recall number facts or in their ease of adding sets of dots and numerals together. The authors note that the math disabled students did catch up in other areas, such as the use of counting to solve problems.

The study was not designed to prove cause and effect, so the researchers do not know whether the factors they identified caused the children’s math learning disability or were linked to other, unidentified factors.

“The search for factors underlying difficulty learning mathematics is extremely important,” said Kathy Mann Koepke, Ph.D., of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. “Once we identify such factors, the hope is that we can modify them through appropriate teaching methods to help people who have difficulty learning and using math.”

Dr. Mann Koepke directs the NICHD’s Mathematics and Science Cognition and Learning Development and Disorders program.

“Math skills are important for higher education and for entry into many higher paying technical fields,” she said. “Math skills have many health implications. For example, many American adults lack even the basic math skills necessary to estimate the appropriate number of calories in their diets or to calculate the time intervals at which to take their medications.”

The study was conducted by Mary K. Hoard, Ph.D., Lara Nugent, Drew H. Bailey and David C. Geary, Ph.D., all of the University of Missouri, Columbia.

Their findings appear in the Journal of Educational Psychology.

The researchers’ analysis was based on a battery of tests they gave one to three times each year to 177 students at 12 Columbia, Mo., public schools. The testing process took place from kindergarten through fifth grade. The researchers measured several factors:

  • math achievement
  • reading ability
  • intelligence and general cognitive ability
  • paying attention in class
  • working memory, the ability to hold one idea or concept in mind while switching between tasks
  • an understanding of numbers and their relation to each other
  • understanding of the number line
  • aptitude for solving simple and complex addition problems

The researchers classified the students into three groups based on their early achievement and the subsequent progress they made in math from kindergarten to fifth grade. One group — referred to as typically achieving students — had average scores in kindergarten and developed their skills at an average rate during their early school years (132 students). Low-achieving students had an average score in kindergarten and made inconsistent and slow progress (29 students). Students with a low initial score and consistently slow progress were described as learning disabled with regard to math (16 students).

After their analysis, the researchers found that differences between groups in kindergarten scores were correlated with the result of one test in particular. For this test, students were asked to look at a series of rectangles, resembling dominoes, on a computer screen. Each domino was each divided into two or three areas; some areas contained one to nine dots, and others a written numeral. Students were asked to quickly circle any dominos in which the number of dots, together with the numeral, matched the target number and to not circle those that did not match.

The researchers found that the difference in scores from this test was linked to the overall gap in math scores between typically achieving and math learning disabled groups.

“Our findings suggest that children who generally struggle with math — the low achievers — may have a poor sense of numbers, but they can narrow the achievement gap in part because most of them can memorize new math facts and, thus, learn some aspects of math as quickly as their typically achieving peers,” said Dr. Geary.

Dr. Geary added that, in contrast to the low achievers, students with a math learning disability not only have a poor concept of numbers, but also have difficulty memorizing math facts.

Clarifying the factors that contribute to a math learning disability may lead to the development of teaching methods that help students overcome difficulties with number concepts and skills, Dr. Mann-Koepke said. It is important to identify potential difficulties early, when chances for successfully overcoming them are greatest.

Other NICHD-funded investigators have also identified basic risk factors for math learning disability. These researchers have shown that math skills are linked to the approximate number system, a person’s intuitive ability to estimate quantities or identify the approximate number in a set. One study of grade school children showed that this ability is impaired in children with a math learning disability. A related study showed that difficulty with estimating such quantities is apparent in children as young as 3 and is correlated with later poor math performance in school. Researchers do not yet know if the ability to distinguish between small, exact quantities is related to the approximate number system.

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Journal Reference:

  1. David C. Geary, Mary K. Hoard, Lara Nugent, Drew H. Bailey. Mathematical cognition deficits in children with learning disabilities and persistent low achievement: A five-year prospective study.. Journal of Educational Psychology, 2011; DOI: 10.1037/a0025398

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Exposure to chemical BPA before birth linked to be...

ScienceDaily (Oct. 24, 2011) — Exposure in the womb to bisphenol A (BPA) — a chemical used to make plastic containers and other consumer goods — is associated with behavior and emotional problems in young girls, according to a study led by researchers at Harvard School of Public Health (HSPH), Cincinnati Children’s Hospital and Medical Center, and Simon Fraser University in Vancouver, British Columbia.

BPA is found in many consumer products, including canned food linings, polycarbonate plastics, dental sealants, and some receipts made from thermal paper. Most people living in industrialized nations are exposed to BPA. BPA has been shown to interfere with normal development in animals and has been linked with cardiovascular disease and diabetes in people. In a 2009 study, HSPH researchers showed that drinking from polycarbonate bottles increased the level of urinary BPA.

In this study, published Oct. 24, 2011, in an advance online edition of Pediatrics, lead author Joe Braun, research fellow in environmental health at HSPH, and his colleagues found that gestational BPA exposure was associated with more behavioral problems at age 3, especially in girls.

The researchers collected data from 244 mothers and their 3-year-old children in the Health Outcomes and Measures of the Environment Study, conducted in the Cincinnati area. Mothers provided three urine samples during pregnancy and at birth that were tested for BPA; their children were tested each year from ages 1 to 3. When the children were 3 years old, the mothers completed surveys about their children’s behavior.”None of the children had clinically abnormal behavior, but some children had more behavior problems than others. Thus, we examined the relationship between the mom’s and children’s BPA concentrations and the different behaviors,” Braun said.

BPA was detected in over 85% of the urine samples from the mothers and over 96% of the children’s urine samples. The researchers found that maternal BPA concentrations were similar between the first sample and birth. The children’s BPA levels decreased from ages 1 to 3, but were higher and more variable than that of their mothers.

After adjusting for possible contributing factors, increasing gestational BPA concentrations were associated with more hyperactive, aggressive, anxious, and depressed behavior and poorer emotional control and inhibition in the girls. This relationship was not seen in the boys.

The study confirms two prior studies showing that exposure to BPA in the womb impacts child behavior, but is the first to show that in utero exposures are more important than exposures during childhood, Braun said. “Gestational, but not childhood BPA exposures, may impact neurobehavioral function, and girls appear to be more sensitive to BPA than boys,” he said.

Although more research is needed to fully understand the health effects of BPA exposure, clinicians can advise those concerned to reduce their BPA exposure by avoiding canned and packaged foods, thermal paper sales receipts, and polycarbonate bottles with the number 7 recycling symbol, the authors wrote. Bruce Lanphear of Simon Fraser University was senior author of the study.

The study was funded in part by the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency.

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  1. Joe M. Braun, Amy E. Kalkbrenner, Antonia M. Calafat, Kimberly Yolton, Xiaoyun Ye, Kim N. Dietrich, Bruce P. Lanphear. Impact of Early Life Bisphenol A Exposure on Behavior and Executive Function in Children. Pediatrics, Published online Oct. 24, 2011 DOI: 10.1542/peds.2011-1335

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More time outdoors may reduce kids’ risk for...

ScienceDaily (Oct. 24, 2011) — A new analysis of recent eye health studies shows that more time spent outdoors is related to reduced rates of nearsightedness, also known as myopia, in children and adolescents. Myopia is much more common today in the United States and many other countries than it was in the 1970s. In parts of Asia, more than 80 percent of the population is nearsighted. The analysis suggests that more exposure to natural light and/or time spent looking at distant objects may be key factors.

On Oct. 24, 2011, at the 115th Annual Meeting of the American Academy of Ophthalmology Dr. Anthony Khawaja of the University of Cambridge, will present a summary analysis of the evidence. The analysis was led by Dr. Justin Sherwin of the University of Cambridge.

The data included in the analysis was drawn from eight carefully selected studies on outdoor time and myopia in children and adolescents, representing 10,400 participants in total. Dr. Sherwin’s team concluded that for each additional hour spent outdoors per week, the chance of myopia dropped by approximately two percent. Nearsighted children spent on average 3.7 fewer hours per week outdoors than those who either had normal vision or were farsighted.

Though the reasons aren’t yet clear, the protective effect appears to result from simply being outdoors rather than performing a specific activity. Two of the eight studies examined whether children who spent more time outdoors were also those who spent less time performing near work, such as playing computer games or studying, but no such relationship was found in either study. The amount of time spent on near work is of interest to researchers as another potential cause for the recent uptick in nearsightedness.

“Increasing children’s outdoor time could be a simple and cost-effective measure with important benefits for their vision and general health” said Dr. Khawaja. “If we want to make clear recommendations, however, we’ll need more precise data. Future, prospective studies will help us understand which factors, such as increased use of distance vision, reduced use of near vision, natural ultra violet light exposure or physical activity, are most important.”

Another question, Dr. Khawaja considered is whether boosting outdoor time might stop nearsightedness from getting worse. He cited a recent Chinese study, not included in Dr. Sherwin’s analysis, of 80 nearsighted children between the ages of 7 and 11. Forty of them were assigned to spend less than 30 hours on near work and more than 14 hours on outdoor time per week. At the end of the two-year study, children in the intervention group were less nearsighted on average than the 40 control group children who did not follow the special schedule.

The 115th Annual Meeting of the American Academy of Ophthalmology is in session October 23 through 25 at the Orange County Convention Center in Orlando, Fla. It is the world’s largest, most comprehensive ophthalmic education conference. Approximately 25,000 attendees and more than 500 companies gather each year to showcase the latest in ophthalmic technology, products and services. To learn more about the place Where All of Ophthalmology Meets, visit www.aao.org/annual_meeting.

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Sleeping sickness drug may provide long-term prote...

ScienceDaily (Oct. 24, 2011) — An antiparasitic agent used to treat African sleeping sickness might someday be used to prevent nonmelanoma skin cancers. Researchers found that DFMO, or α-difluoromethylornithine, still appeared to protect against nonmelanoma skin cancers years after people stopped taking the drug, according to a poster presented at the 10th AACR International Conference on Frontiers in Cancer Prevention Research, held Oct. 22-25, 2011.

In this follow-up study, researchers evaluated prolonged evidence of a protective effect of DFMO among 209 people who had participated in an earlier study. The researchers also wanted to ensure there were no obvious deleterious effects associated with the drug, according to Howard H. Bailey, M.D., professor of medicine, and study presenter Sarah Lamont, a medical student, both from the University of Wisconsin School of Medicine and Public Health.

The original study was a phase III, randomized, double-blind, prospective study of 291 men and women with a history of nonmelanoma skin cancer. They were assigned to either DFMO or a placebo for four to five years. At the end of the study period, researchers found a reduced skin cancer incidence among those assigned to DFMO.

“We showed a significant protective effect against basal cell carcinoma, but not a significant amount of protection against squamous cell carcinoma of the skin,” Bailey said.

The main side effect was a slight ototoxicity that was found on testing, but this was not associated with a noticeable reduction in hearing by the subjects.

In the current retrospective study, researchers reviewed the electronic medical records of 209 of the original participants to establish cancer rates and to see if any other illnesses they might have developed could be attributed to DFMO.

“We found there is still evidence that the men and women assigned to DFMO for five years continued to have a lower incidence of nonmelanoma skin cancers compared with people assigned to placebo,” Bailey said. “What we saw was that the presumed benefit that people got in taking DFMO appeared to persist for years after stopping it.”

Study limitations include that participants may have been followed differently or changed their behaviors to limit sun exposure because of being in the original study, Bailey said.

“Our data suggest that the protective event that we saw in our prospective study appears to continue and there was no evidence of any rebound effect,” he said. “We did not find any evidence that the people who received DFMO were harmed [other than the original ototoxicity].”

However, Bailey cautioned, more studies are needed before DFMO can be recommended as a prophylaxis against nonmelanoma skin cancers.

He added that such prophylaxis measures are needed because public health efforts to teach people about limiting sun exposure have not resulted in fewer cases of skin cancer, with more than 2 million cases of nonmelanoma skin cancer diagnosed each year. “The incidence continues to rise despite public health efforts to get people to lessen their sun exposure,” Bailey said.

The study was sponsored by the University of Wisconsin Carbone Cancer Center and the University of Wisconsin School of Medicine and Public Health.

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Early HIV treatment dramatically increases surviva...

ScienceDaily (Oct. 20, 2011) — Timing is everything when treating patients with both HIV and tuberculosis. Starting HIV therapy in such patients within two weeks of TB treatment, rather than two months as is the current practice, increases survival by 33 percent, according to a large-scale clinical trial in Cambodia led by researchers at Children’s Hospital Boston and the Immune Disease Institute (IDI).

The study’s results — reported by Anne Goldfeld, MD, of the IDI and the Program in Cellular and Molecular Medicine at Children’s Hospital Boston, and the CAMELIA (Cambodian Early versus Late Introduction of Antiretrovirals) study team in the October 20 issue of the New England Journal of Medicine — definitively show that immunosuppressed HIV-TB co-infected patients should be started on ART rapidly at two weeks after beginning TB therapy. At the same time, the results strongly suggest that the World Health Organization (WHO) should be more aggressive in its recommendations for treating such patients.

A collaboration of Cambodian, French, and American physicians and researchers, the CAMELIA trial set out to settle a long-standing debate in the medical community over the relative timing of antiretroviral (ART) and anti-TB treatment regimens in co-infected patients. Some have advocated for delaying ART for upwards of two months after initiating anti-TB treatment, arguing that the toxicity of and difficulties in adhering to the two regimens (which together require patients to take seven pills every day), as well as the risk of severe inflammation as the immune system rebounds from HIV’s suppressive influence, create undue burden on patients. Those supporting early initiation of ART note that rapid restoration of immune function bolsters the effects of anti-TB treatment.

“Tuberculosis claims the lives of more than half a million people with HIV worldwide every year,” said Goldfeld, who holds professorships in medicine at Harvard Medical School and immunology and infectious diseases at Harvard School of Public Health and is co-founder of the Cambodian Health Committee. “This is a tragedy, because TB is completely curable when diagnosed and treated properly even in a patient with advanced HIV, especially if the patient also receives anti-retroviral therapy.”

The WHO, in its most recent guidelines, recommended that co-infected patients start ART as soon as possible within eight weeks of initiating anti-TB treatment, but at the time lacked any evidence-based research to provide more fine-grained guidance.

Upon enrollment in the CAMELIA trial, all participants started standard treatment for TB, followed either two weeks or two months later by ART. Patients, all of whom had very weak immune systems, were seen at one of five study sites across Cambodia and followed for as long as four and a half years. By the time enrollment closed, 661 patients had been recruited into the study.

The study’s results make a very strong case for starting ART treatment as early as two weeks after initiating treatment for TB. At the end of the study, the survival rate in the early ART arm was 33 percent greater than that in the late ART arm.

The study was also remarkable for its successful level of follow up: Of the trial’s 661 participants, only 12 were lost to follow-up over the study period, and participants only missed less than one percent of the study’s 8,955 scheduled visits.

“When we started, there was no research infrastructure for conducting such a trial in Cambodia. ART was just being introduced into the country, and HIV and TB were not being treated in an integrated fashion,” Goldfeld said. “As side benefits, over the course of the study we helped to establish a center of excellence for HIV and TB care, and a center for treating children with HIV. We also created a national framework in Cambodia for treating patients with multi-drug resistant TB, which is now being replicated in Ethiopia.

“We also want to understand how the immune system is restored when you give HIV drugs while treating TB at the same time,” Goldfeld continued. “This trial has created an unprecedented opportunity to gain fundamental insights into the workings of the immune system in the context of HIV and TB. It has many fruits yet to bear.”

The study, which was previously reported at the 18th Annual AIDS Meeting in Viennea in 2010, was supported by the National Institute of Allergy and Infectious Diseases and the French National Agency for Research on AIDS and Viral Hepatitis.

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Journal Reference:

  1. François-Xavier Blanc, Thim Sok, Didier Laureillard, Laurence Borand, Claire Rekacewicz, Eric Nerrienet, Yoann Madec, Olivier Marcy, Sarin Chan, Narom Prak, Chindamony Kim, Khemarin Kim Lak, Chanroeurn Hak, Bunnet Dim, Chhun Im Sin, Sath Sun, Bertrand Guillard, Borann Sar, Sirenda Vong, Marcelo Fernandez, Lawrence Fox, Jean-François Delfraissy, Anne E. Goldfeld. Earlier versus Later Start of Antiretroviral Therapy in HIV-Infected Adults with Tuberculosis. New England Journal of Medicine, 2011; 365 (16): 1471 DOI: 10.1056/NEJMoa1013911

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Future-Directed Therapy helps depression patients ...

ScienceDaily (Oct. 20, 2011) — Patients with major depression do better by learning to create a more positive outlook about the future, rather than by focusing on negative thoughts about their past experiences, researchers at Cedars-Sinai say after developing a new treatment that helps patients do this.

While Major Depressive Disorder patients traditionally undergo cognitive-behavior therapy care that seeks to alter their irrational, negative thoughts about past experiences, patients who were treated with the newly-developed Future-Directed Therapy™ demonstrated significant improvement in depression and anxiety, as well as improvement in overall reported quality of life, the researchers found.

Results were published recently in the peer-reviewed journal CNS Neuroscience Therapeutics.

“Recent imaging studies show that depressed patients have reduced functioning in the regions of the brain responsible for optimism,” said Jennice Vilhauer, PhD, study author and clinical director of Adult Outpatient Programs for the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences. “Also, people with depression tend to have fewer skills to help them develop a better future. They have less ability to set goals, problem solve or plan for future events.”

According to the U.S. Centers for Disease Control and Prevention, an estimated one in 10 American adults meet the diagnostic criteria for depression.

Anand Pandya, MD, interim chair of Cedars-Sinai’s Department of Psychiatry and Behavioral Neurosciences, said, “Future-Directed Therapy is designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences. This is the first study that demonstrates this intervention intended to increase positive expectations about the future can reduce symptoms of Major Depressive Disorder.”

When people talk only about the negative aspects of their lives, it causes them to focus more attention on what makes them unhappy, Vilhauer said. “Talking about what makes you unhappy in life doesn’t generate the necessary thinking patterns or action needed to promote a state of thriving and create a more positive future,” Vilhauer said. “Future-Directed Therapy helps people shift their attention constructing visions of what they want more of in the future and it helps them develop the skills that they will need to eventually get there.”

In the study conducted at Cedars-Sinai, 16 adult patients diagnosed with Major Depressive Disorder attended future-directed group therapy sessions led by a licensed psychologist twice a week for 10 weeks. Each week, patients read a chapter from a Future-Directed Therapy manual and completed worksheets aimed at improving certain skills, such as goal-setting. Another group of 17 patients diagnosed with depression underwent standard cognitive group therapy. The study team measured the severity of depression and anxiety symptoms, and quality of life before and after treatment, using the Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form.

Results include:

  • Patients in the Future-Directed Therapy group experienced on average a 5.4 point reduction in their depressive symptoms on the Quick Inventory of Depressive Symptoms scale, compared to a two point reduction in the cognitive therapy group.
  • Patients in the Future-Directed Therapy group on average reported a 5.4 point reduction in anxiety symptoms on the Beck Anxiety Inventory, compared to a reduction of 1.7 points in the cognitive therapy group.
  • Patients in the Future-Directed Therapy group reported on average an 8.4 point improvement in their self-reported quality of life on the Quality of Life Enjoyment and Satisfaction scale, compared to a 1.2 point improvement in the cognitive therapy group.

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