JPND is a transnational initiative that aims to address the growing societal challenge presented by age-related neurodegenerative diseases. It involves research funders from 26 member countries. Spanning biomedical, healthcare and social science research, JPND aims to increase coordinated investment between participating countries in research aimed at finding causes, developing cures, and identifying appropriate ways to care for those with neurodegenerative diseases. Further details and information on the initiative.
This transnational call, co-funded by the ESRC, aims to establish a limited number of ambitious, innovative, multi-national and multi-disciplinary collaborative research projects that will add value to existing research by assessing and comparing pathways to care, through evaluating access to, the quality and the cost effectiveness of care provision and support for patients with neurodegenerative diseases across different care settings.
Proposals should be for up to three years in duration and proposals that span more than one neurodegenerative disease area are encouraged. The countries involved in the JPND initiative have agreed a central process for peer review of proposals throughout which the ESRC and ESRC nominated social scientists will be represented. Funding for successful UK applicants will be provided by the ESRC. The ESRC is contributing a total of €1 million and anticipates that this sum will contribute to the UK partners of between three and five transnational research groups.
For enquiries relating to the ESRC call please contact: jpnd@esrc.ac.uk.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign UpBy Charles Bankhead, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San FranciscoChildren with cyanotic congenital heart disease derived no benefit from prophylactic clopidogrel (Plavix) for shunt thrombosis.Note that subgroup analysis failed to identify any patients who benefited more or less from clopidogrel.
Children with cyanotic congenital heart disease derived no benefit from prophylactic clopidogrel (Plavix) for shunt thrombosis, a large, randomized trial showed.
The composite endpoint of death plus three types of clinical events occurred in 19.1% of clopidogrel-treated patients and 20.5% of the placebo group. Separate analyses of each component of the endpoint also showed no significant differences between treatment groups.
Subgroup analysis failed to identify any patients who benefited more or less from clopidogrel, as reported in the June 20 issue of the New England Journal of Medicine.
"We found no benefit of clopidogrel, as compared with placebo, in reducing the rate of death for any cause or shunt-related morbidity, particularly shunt thrombosis, among infants with congenital heart disease palliated with a systemic-to-pulmonary-artery shunt," David L. Wessel, MD, of Children's National Medical Center in Washington, and co-authors concluded.
Placement of a systemic-to-pulmonary-artery shunt for palliation increases the risk of shunt thrombosis and death among infants with congenital heart disease. Prophylactic anti-thrombotic therapy had not been evaluated in a randomized trial, but data from a prospective registry showed a significant reduction in the risk of death and shunt thrombosis among infants treated with aspirin, the authors noted.
As an approved medication for adults, clopidogrel use has spread into pediatric populations, absent sound evidence of efficacy. Retrospective, single-center reviews have suggested clopidogrel is safe and effective in infants.
Wessel and collaborators at 134 sites in Europe, Asia, North America, South America, and Africa prospectively evaluated the safety and efficacy of prophylactic clopidogrel in a randomized trial involving children with congenital heart disease. Eligible patients were 92 days or younger at randomization and had received a palliative systemic-to-pulmonary-artery shunt. Patients with active bleeding or with an increased risk of bleeding were excluded.
Patients were randomized to weight-based clopidogrel or matching placebo and were followed by telephone or clinic visits at weeks 4, 12, 24, and 36. A final visit occurred on a patient's first birthday, the common study end date, or first occurrence of a qualifying event for termination: shunt thrombosis, elective surgery to correct the congenital heart defect, or death.
The primary endpoint was the composite of death, heart transplantation, shunt thrombosis requiring intervention, or a cardiac procedure performed before 120 days of age because of thrombotic event. The final analysis included 906 patients, 88% of whom were receiving aspirin in addition to the study drug.
The trial had a median duration of follow-up of 5.8 months. Administration of study drug was stopped temporarily (for median of 8 days) in 53.6% of patients, and study drug was permanently discontinued in significantly more patients in the clopidogrel group (24.0% versus 18.2%, P=0.03). Median time to permanent discontinuation was 96 days, and reasons for discontinuation did not differ significantly between groups.
A primary-endpoint event occurred in 89 patients in the clopidogrel group and 90 patients in the placebo group. The combination of death and heart transplantation occurred slightly less often in the clopidogrel group (11.8% versus 13.9%, NS); death accounted for all but one of the events. Causes of death did not differ significantly between groups, nor did the remaining components of the composite endpoint.
A post-hoc analysis showed that patients receiving concomitant aspirin had a significantly lower rate of the composite endpoint when treated with clopidogrel (18.6% versus 28.2%, P=0.009).
Adverse events occurred more often with clopidogrel than with placebo, whether assessed in all randomized patients (76.1% versus 71.1%, P=0.09) or per protocol (73.9% versus 66.9%, P=0.04). Bleeding occurred in 18.8% of clopidogrel patients and 20.2% of the placebo group and severe bleeding in 4.1% and 3.4%, respectively, neither of which achieved statistical significance.
The study was supported by sanofi-aventis and Bristol-Myers Squibb.
Wessel disclosed a relationship with sanofi-aventis. One or more co-authors disclosed relationships with AGA, Actelion, Pfizer, sanofi-aventis, Daiichi Sankyo, Bristol-Myers Squibb, and Merck. Investigators included current or former employees of sanofi-aventis and Bristol-Myers Squibb.
Charles Bankhead
Staff Writer
Working from Houston, home to one of the world's largest medical complexes, Charles Bankhead has more than 20 years of experience as a medical writer and editor. His career began as a science and medical writer at an academic medical center. He later spent almost a decade as a writer and editor for Medical World News, one of the leading medical trade magazines of its era. His byline has appeared in medical publications that have included Cardio, Cosmetic Surgery Times, Dermatology Times, Diagnostic Imaging, Family Practice, Journal of the National Cancer Institute, Medscape, Oncology News International, Oncology Times, Ophthalmology Times, Patient Care, Renal and Urology News, The Medical Post, Urology Times, and the International Medical News Group newspapers. He has a BA in journalism and MA in mass communications, both from Texas Tech University.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign Up By Kathleen Struck, Senior Editor, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San FranciscoCertain eating behaviors in small children, including eating in front of the TV, were significantly associated with a surrogate marker for heart disease later in life.Note that although the cross-sectional study could not show causality, the results raise the possibility that eating behaviors are more closely related to health outcomes than dietary intake.
Certain eating behaviors in small children, including chowing down in front of the TV, were significantly associated with a surrogate marker for heart disease later in life, researchers found.
In a cross-sectional study of kids, ages 3 to 5, each unit increase in an eating behavior score suggested greater nutritional risk indicated by an increase of 0.02 mmol/L (95% CI, 0.002 to 0.05, P=0.03) in serum non-high density lipoprotein (non-HDL) cholesterol, according to Navindra Persaud, MD, of St. Michael's Hospital and the University of Toronto, and colleagues reported in CMAJ.
The authors pointed out that serum concentration of non-HDL cholesterol, which includes LDL cholesterol, is an "emerging surrogate marker for cardiovascular risk ... the American Academy of Pediatrics recommends non-HDL cholesterol concentration as the key measure for screening for cardiovascular risk in children."
They added that an earlier study that included a subgroup of children, ages 2 to 15, "found an association between LDL cholesterol concentration (which is highly correlated with non-HDL cholesterol) and asymptomatic atherosclerosis at autopsy" (N Engl J Med 1998; 338: 1650-1656).
While the authors cautioned that their cross-sectional study could not show causality, "these results raise the possibility that eating behaviors are more closely related to health outcomes than dietary intake. The relations between eating behaviors and LDL cholesterol and apolipoprotein B are not surprising given the correlation of these indices with serum non-HDL cholesterol concentration. In addition, apolipoprotein B is known to be correlated with cardiometabolic risk factors in adolescents."
They assessed 1,076 children from seven primary care practices in Toronto between 2008 and 2011. They administered the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire, which asked about eating behaviors, dietary intake, parental concerns about food and activity, eating habits while engaged in screen time, and supplement use.
They used nonfasting blood samples from the children to assess lipid profile, insulin level, blood glucose level, and apolipoprotein A1 and B levels.
Finally, the authors collected body mass index (BMI) data from the children and the parents. They had parental BMI from 17.2% of the fathers and 75% of the mothers.
Based on a regression model, the authors found an association between serum non-HDL cholesterol level and NutriSTEP subscores for eating behaviors (0.02) and screen time (0.09).
The eating behaviors subscore was significantly associated with LDL cholesterol and apolipoprotein B concentration, both of which are correlated with serum non-HDL cholesterol (correlation co-efficients of 0.90 and 0.89, respectively, P<0.001).
Male sex and parental BMI were significantly related to serum non-HDL cholesterol levels.
However, the dietary intake subscore was not associated with non-HDL cholesterol and neither was parental concern or supplement use.
"I think this is an important study because it brings to fore something that we already know, which is children's behavior learned early in life can translate into results that affect all of their future health," Rae-Ellen Kavey, MD, MPH, of the University of Rochester Medical Center in New York, told Medpage Today.
"One of the most important things they brought up is ... watching television while eating. That's a behavior that's very common now, and it's a very difficult one to break," Kavey said. "If you grew up with the habit of eating in front of the television -- and that's strongly associated with the development of obesity -- that's a behavior that parents can eliminate."
The authors acknowledged some study limitations: The Toronto cohort may not represent children in other settings, and the participants' mothers had high levels of education. Also, food records might have been a better measurement of food intake than recall.
Kavey added that Canadian children are more active and have lower obesity rates than children in the U.S.
"Our results support previous arguments for interventions aimed at improving the eating behaviors of preschool-aged children," the authors concluded. "To do so, evidence suggests promoting responsive feeding, where adults provide appropriate access to healthy foods and children use internal cues -- not parent-directed cues or cues from the television -- to determine the timing, pace, and amount they consume."
Persaud is an associate Editor for CMAJ. One co-author received grant funding from the Canadian Institutes of Health Research (CIHR), is a board member for the Danone Institute of Canada, consultant for Dietitians of Canada, receives royalties for NutriSTEP licenses, and has been reimbursed for travel expenses by the CIHR. Another co-author is a board member for Medpace, consultant for Eli Lilly, Merck, and Bristol-Myers-Squibb, and has received grant funding from AstraZeneca. Other co-authors work for institutions that have received grants from the CIHR. No other competing interests were declared.
Kathleen Struck
Senior Editor
Kathleen Struck joined MedPage Today after serving as Managing Editor for EverydayHealth.com, Stars and Stripes and MediaNews Group. She lived and traveled internationally for more than 15 years and has written and edited for publications including, Washington Post, Baltimore Sun, Newsday and Regulatory Affairs Professional Society. At MedPage Today, she reports and edits on general news and information.
Register TodayEarn Free CME Credits by reading the latest medical news in your specialty.Sign Up By David Pittman, Washington Correspondent, MedPage Today
CHICAGO -- Obesity is hard to define and diagnose, and partly because of that is not a disease, an American Medical Association (AMA) council said in a report issued here Monday.
The report from the AMA's Council on Science and Public Health, released at the organization's annual meeting, angered many medical specialties who do consider obesity a disease.
The report panned body mass index as a proxy for obesity, saying it's limited as a stand-alone. Furthermore, calling obesity a disease may undermine prevention efforts and will do little to impact its treatment, the report said.
"Without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine conclusively whether or not obesity is a medical disease state," the council told the AMA's policy-making House of Delegates. "Similarly, a sensitive and clinically practical diagnostic indicator of obesity remains elusive."
Delegates here are considering that report along with a conflicting resolution from the New York delegation that would change AMA policy to call obesity a disease. They will try to resolve the AMA's stance later in the meeting, which ends Wednesday. Current AMA policy calls obesity a major public health problem, but stops short of calling it a disease.
The topic drew about 45 minutes of back-and-forth discussion during Sunday's public health reference committee session.
Supporters of defining obesity as a disease disagreed with the report and said if the AMA were to agree with them, it would help highlight the epidemic in this country and spur health insurers to take greater responsibility for obesity.
"A condition leads to one set of solutions. A disease might lead to another," said John Armstrong, MD, a delegate of the American College of Surgeons, which co-sponsored the resolution that would call obesity a disease.
"I would like to move away from the tyranny of 'Is it a condition or is it a disease?' and simply define obesity as a chronic disease, combine public health and clinical approaches, and work to bend the weight curve in the U.S."
The obesity-is-a-disease contingent also included the American Academy of Family Physicians and the American Association of Clinical Endocrinologists, who said evidence shows obesity is a multimetabolic and hormonal disease.
Those in support of the council report not calling obesity a disease noted obesity rates have risen along with sugar intake in diets and reduced activity -- which are not indicative of a disease. If obesity is called a disease, they said employers would have to give obese workers special considerations.
"We cannot say just because you are obese you will experience harm and morbidity from this, and that is part of a definition of a disease," said AMA public health council member Ilse Levin, DO, of the American Society of Addiction Medicine.
Defining obesity as a disease will do little to actually change treatment management, she continued. "In this case, I don't really see how it will at this point."
Changing the definition to a disease could have negative public health consequences and worsen the epidemic, others argued.
"I believe telling people they have a disease allows people to throw up their arms and surrender and do nothing," Texas delegate Russ Kridel, MD, said.
Payers already recognize obesity as a serious medical condition and Medicare covers bariatric surgery, he said, noting that people with a BMI greater than 40 can be considered disabled if it's called a disease.
David Pittman
David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.
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By David Pittman, Washington Correspondent, MedPage Today 