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Spike In Australian H1N1 Cases Could Lead WHO To Declare Pandemic
The H1N1 (swine flu) outbreak could soon be declared the first flu pandemic in 41 years after a recent jump in the number of confirmed cases in Australia, WHO officials said Tuesday, the AP/Google.com reports (Jordans, AP/Google.com, 6/9).
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Boston Globe Examines Hospital's Attempt To Reduce Emergency Department Visits, Hospital Stays Among Elderly
Efforts by Massachusetts General Hospital to reduce health spending could be indicative of the difficulty the health industry faces in trying to reduce spending growth, the Boston Globe reports. Industry groups last week pledged to seek a 1.5% overall reduction in health care spending over the next 10 years.Massachusetts General"s program, which began in 2006, aims to reduce hospitalizations among the elderly by 15% to 20%, as well as to improve the quality of care the elderly receive. A study looking at 35 efforts to improve elderly care found that only six, including Massachusetts General"s program, saved money or covered their costs, the Globe reports. Massachusetts General"s program relies on nurses in primary care practices to be in regular contact with patients and provide assistance with nonmedical services. The program also uses electronic health records to coordinate care. The hospital spent $8 million to $9 million over the first three years of the program to provide enhanced services to patients. Hospital readmissions fell by 19%, admissions decreased by 17% and ED visits dropped by 15% between 2007 and 2008, according to preliminary research. The program saved enough by reducing hospital admissions and emergency department visits to cover its costs and also to generate savings of $7 million to $10 million. The overall cost for the program was about 5% less than for a group of other patients treated in a more traditional way.According to Harvard University health care economist David Cutler, improving care and reducing costs among the elderly is a necessary component of health reform. He said, "If we can"t do this, it doesn"t bode well for health reform." Eric Weil, a primary care physician and medical director of the program at Massachusetts General, said, "Medicare is looking for any and every way to save money," adding, "This is a population of patients who are sick and will get sicker over time. Any opportunity to demonstrate savings in this group of patients is good, and 5% is very good" (Kowalczyk, Boston Globe, 5/17).
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RCP President Reponds To New ONS Figures Suggesting That School Pupils Are More Likely To Drink Alcohol If They Live With Other Drinkers, UK
Responding to data in Smoking, drinking and drug use among young people in England, 2008 that suggests the likelihood of a pupil drinking alcohol increases with the number of drinkers per household, Professor Ian Gilmore, President of the Royal College of Physicians said:
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C-Section Births Cause Genetic Changes That May Increase Odds For Developing Diseases In Later Life

Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica. It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers. Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNAmethylation in the white blood cells - a vital part of the immune system. This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by Csection so that there were no longer significant differences between the two groups. "Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks" says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. "Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life. "That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells." The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed. "Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNAmethylation that we found in human infants are linked to differences in birth stress. "We know that the stress of being born is fundamentally different after planned Csection compared to normal vaginal delivery. When babies are delivered by Csection, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb." The authors point out that the surgical procedure itself may play a role in DNAmethylation and that factors other than the delivery method need to be explored in more detail. "In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation" says Professor Norman. "However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues." Professor Norman states that the Karolinska study clearly shows that geneenvironment interaction through DNA-methylation is more dynamic around birth than previously known. "The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications" he says. "C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early "epigenetic" programming of the immune system may have a role to play." The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries. "Although we do not know yet how specific gene expression is affected after Csection deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research" concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet. Wiley-Blackwell http://www.wileyblackwell.com or http://www.interscience.wiley.com


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