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Latest Updates From The Alzheimer's Disease Neuroimaging Initiative (ADNI)
Alzheimer imaging aficionados thronged to back-to-back meetings held recently in Seattle for a preview of the latest data from the Alzheimer"s Disease Neuroimaging Initiative (ADNI). Launched in the fall of 2004 and set to conclude next year, the $64-million ADNI is comparing imaging methods and fluid biomarkers in the same set of people to determine which measures can best predict and track Alzheimer-disease clinical changes over time. The project is approaching the homestretch of data collection. By the fall of 2010, ADNI scientists will have collected three years of longitudinal data from more than 800 participants (about 200 normal, 400 with mild cognitive impairment (MCI), and 200 with Alzheimer disease) at 59 U.S. and Canadian sites. The Seattle meetings featured preliminary analysis of the one-year data.
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Obama Says He Supports 'Robust' Protections For Health Workers With Moral, Religious Objections
President Obama on Friday said that although he intends to reverse the Bush administration"s provider "conscience" rule, he still favors a "robust" federal policy that would enhance the rights of health care workers to refuse to perform certain procedures because of moral or religious objections, the Washington Post reports. In a session with reporters one week before his first meeting with Pope Benedict XVI, Obama said that he is a "believer in conscience clauses." He added that a new policy from his administration "may not meet the criteria of every possible critic of our approach, but it certainly will not be weaker than what existed before the changes were made." According to the Post, Obama"s comments aimed to reassure Roman Catholic health care workers that they would still be able to refuse to perform abortions and other procedures that go against the Church"s teachings. Several federal laws in place since the 1970s protect the rights of health care workers with moral or religious objections (Salmon, Washington Post, 7/3). Nancy Berlinger, deputy director of the Hastings Center, said that conscience laws also "are on the books in almost every state." She added, "The idea was that when abortion moved from being an illegal procedure, therefore something that you did not offer in a hospital, to being a legal procedure, therefore something that you might offer in a hospital, there was a move to protect providers ... from having to participate in abortions." However, not all conscience laws are specific to abortion, NPR"s "Morning Edition" reports. For example, some allow providers to refuse to provide birth control, in vitro fertilization or end-of-life care (Rovner, "Morning Edition," NPR, 7/6).The Bush administration said its 2008 policy was designed to ensure that the federal laws are enforced. The policy would cut off federal funding to health care facilities and other entities that did not accommodate workers who refused to participate in certain procedures (Washington Post, 7/3). Joxel Garcia, the assistant secretary for health in the Bush administration who helped write the policy, said that it is necessary because few health care workers are aware of the protections. He added that the policy gives health workers "a mechanism to seek help" through HHS.However, critics of the Bush administration"s policy contend that it would widely expand the scope of health care covered by the policy and the type of health care workers who could object to procedures. Berlinger said, "Words like belief, when you talk about them in the context of health care, aren"t just anything you might think of." She noted that a "false belief about science or the promotion of ambiguity where things can be disambiguated," such as the claim that birth control is equivalent to abortion, "is not ethical" ("Morning Edition," NPR, 7/6).Obama"s plan to replace the policy has stoked concern from Catholic health care providers that they would be forced to perform abortions, sterilizations and other procedures that go against Catholic teachings (Washington Post, 7/3). A recent survey conducted for the Christian Medical Association found that 90% of doctors surveyed said that "they will quit their practices before violating their conscience," according to David Stevens, executive director of CMA. Stevens said that repealing the Bush administration"s rule "sends a clear message: It"s open season on health care professionals of conscience -- discriminate at will" ("Morning Edition," NPR, 7/6).Obama on Friday also said that although he and the pope have areas of "deep agreement ... there are going to be some areas where we"ve got some disagreements," such as abortion rights and embryonic stem cell research. The president will meet with the pope on July 10, while he is in Europe for a summit of the Group of Eight industrialized nations. Obama Addresses Catholic Concerns on Pregnancy PreventionObama also discussed opposition to the inclusion of comprehensive sex education and contraception in any legislative pac
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Police Search Offices Of Michael Jackson's Doctor For Evidence Of Manslaughter
Police detectives searched the offices of one of Michael Jackson"s doctors for evidence of manslaughter on Wednesday, according to various US
Diagnostics

Need For Studies On People With Weakened Immune Systems: Vulnerability To Flu And Response To Vaccination

An article published in the August edition of The Lancet Infectious Diseases reports that additional research is required on the vulnerability to the new H1N1 flu strain of different immunosuppressed populations. The possible effectiveness and side-effects of future vaccines also need to be evaluated. The review is the work of Dr Ken M Kunisaki, Minneapolis VA Medical Center, USA, and University of Minnesota, USA, and Dr Edward N Janoff, Univeristy of Colorado Denver School of Medicine and Denver Veterans Affairs Medical Center, USA. The study evaluated susceptibility in individuals with HIV/AIDS, cancer, people who received a solid organ transplant (SOT), or bone-marrow transplant (BMT), and patients on haemodialysis. The authors say: "Although influenza vaccination is widely recommended for people that are immunosuppressed, the same immune dysfunction that can increase the risk and consequences of influenza infection might also compromise vaccine responses and effectiveness." Since the introduction of highly active antiretroviral therapy the numbers of HIV/AIDS patients admitted to hospital with flu have fallen considerably. But still, there are more admissions than for the general population. The US Centers for Disease Control and Prevention (CDC) recommends yearly flu vaccination. Vaccination appears safe, but it is not supported universally. In HIV/AIDS patients antibody responses to vaccination are generally lower. However, a number of studies suggest that vaccination leads to fewer and less severe cases of flu in HIV patients. There is a need for larger randomized trials to evaluate vaccination, mostly among those with low CD4+ cell counts. Due to the immunosuppressant drugs they take to avoid organ rejection, people who received SOT generally have higher flu infection rates. Lung transplant recipients appear mostly at risk as the lungs are the primary site of flu infection. Kidney transplant recipients can suffer rejection if they contract flu.Theoretically, vaccination in these populations could also stimulate a T-cell response, leading to rejection. But the majority of studies suggest this does not happen. A crucial issue seems to be timing. The American Society of Transplantation recommends flu vaccination every year for all recipients of SOTs, beginning about 6 months after transplantation. Similar recommendations apply for recipients of bone marrow transplant (BMT). However, US guidelines recommend lifelong annual vaccination. On the other hand, European guidelines recommend individual evaluation of each case. Chemotherapy can cause severe and intense immunosuppression for cancer patients. Between 21 to 33 percent of cancer patients have been estimated as being infected with flu when admitted to hospital with respiratory symptoms during a flu epidemic. Once more, timing of flu vaccination can be fundamental in cancer patients. The option might to vaccinate between chemotherapy cycles, or more than seven days before chemotherapy begins. At the end of 2006, there were more than 327,000 people receiving haemodialysis treatment in the USA. Infections are the second leading cause of death in these patients. Lung infections (such as flu) kill higher proportions of dialysis patients than in the general population. An examination of US Medicare information indicated that vaccinated patients on dialysis had a significantly lower chance of hospital admission or death than unvaccinated patients. In addition, the authors examined the use of corticosteroid. They mention that there is confirmation for patients taking these drugs that flu vaccination is both safe and often immunogenic. This applies for a patient taking these drugs either orally or by inhalation and either chronically or for a transitory period. However, the vaccine"s clinical effectiveness in this population has not been adequately tested. The authors call for further research into flu vaccination in all these particular populations. They also underline the value of other options to control flu infection, such as chemoprophylaxis using antiviral drugs. An observational study indicates that out of nineteen BMT patients with flu, none died. And 87 percent of them had taken oseltamivir (Tamiflu). The authors write in conclusion: "We would particularly welcome randomised trials comparing standard influenza vaccine with active comparators such as modified vaccines or antiviral prophylaxis with or without vaccination. Such data would greatly enhance our ability to make more informed vaccination recommendations for this population, particularly in situations of vaccine shortage or pandemic influenza." "Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses" Ken M Kunisaki, Edward N Janoff Lancet Infect Dis 2009; 9: 493-504 The Lancet Infectious Diseases Written by Stephanie Brunner (B.A.) Copyright: Medical News Today Not to be reproduced without permission of Medical News Today


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