Jennie Smith

The National Institute for Health and Clinical Excellence said September 9 that not enough bariatric surgery is being performed in England. The agency cited a report commissioned by the Royal College of Surgeons, showing that only a small fraction of people eligible for weight loss surgery in England are actually receiving it.

About a quarter of Britons are obese, with obesity a rising trend despite numerous public health campaigns aimed at addressing it. Obesity-related disorders cost the National Health Service an estimated £4.3 billion annually, according to the U.K. Department of Health. Yet the report commissioned by the surgeons warns that English primary care trusts (PCT) are not following established clinical guidelines on bariatric surgery, which, if followed, would reduce health care costs systematically.

“If NICE guidelines on bariatric surgery were followed, direct NHS cost savings would be around £56 million a year,” NICE said in a press statement about the report. “PCTs are either ignoring NICE guidelines and rationing care for all but the most severely ill patients, or offering no service at all.”

The NICE statement stood in some contrast to the U.K. Department of Health’s response to the report, in which Public Health Minister Anne Milton said surgery “should always be a last resort” and that “it is up to individual trusts to commission a range of services to meet their local community’s needs.”

NICE officials contacted said they refused to speculate as to why their agency’s obesity guideline wasn’t being followed. However, the agency’s clinical guidelines, which include its obesity and bariatric surgery guideline, differ from its technical appraisals in that PCTs are not mandated to adhere to them.

The surgeons’ report – carried out by the Office of Health Economics, an independent research firm, and published Sept 8. – estimated that as many as many as 140,000 people in England qualified for bariatric surgery in 2009 and 2010 under guidelines published by NICE. Yet the actual number of surgeries performed at trusts in England in that time period was 3,607. This, the report concluded, was largely the result of different practices among different primary care trusts: “Adherence is generally sub-optimal but the number of procedures commissioned by PCTs ranged from one to 194 in 2009-10,” the report stated, “indicating a wide variation in practice.”

The 2006 NICE clinical guideline on obesity offers tiered recommendations on interventions based on the severity of a patient’s disease and the presence of comorbidities, with surgery as a last option following lifestyle and other interventions. According to the guideline, people with a body mass index of 40 or higher, and who have failed to lose weight through other means, qualify for surgery. People with a body mass index as low as 35 may quality for surgery if they have comorbidities, such as diabetes or high blood pressure.

Yet the trusts themselves seem to have decided to make surgery rarer, implementing the guidelines more stringently, according to the surgeons’ report, which used findings from other reports, a self-reported questionnaire to all 152 PCTs in England about their practices (81 responses were considered in the analysis), and additional records to gain a picture of how much bariatric surgery was really being performed.

The surveys revealed that the self-rationing was likely to continue in the current cost-cutting mood: “Although only one in ten PCTs that responded said that they would be reducing funding for obesity services, one third said that they would be applying the NICE guidance more stringently and none that the guidance would be applied less stringently,” the report said.

The National Institute for Health and Clinical Excellence said September 9 that not enough bariatric surgery is being performed in England. The agency cited a report commissioned by the Royal College of Surgeons, showing that only a small fraction of people eligible for weight loss surgery in England are actually receiving it.

About a quarter of Britons are obese, with obesity a rising trend despite numerous public health campaigns aimed at addressing it. Obesity-related disorders cost the National Health Service an estimated £4.3 billion annually, according to the U.K. Department of Health. Yet the report commissioned by the surgeons warns that English primary care trusts (PCT) are not following established clinical guidelines on bariatric surgery, which, if followed, would reduce health care costs systematically.

“If NICE guidelines on bariatric surgery were followed, direct NHS cost savings would be around £56 million a year,” NICE said in a press statement about the report. “PCTs are either ignoring NICE guidelines and rationing care for all but the most severely ill patients, or offering no service at all.”

The NICE statement stood in some contrast to the U.K. Department of Health’s response to the report, in which Public Health Minister Anne Milton said surgery “should always be a last resort” and that “it is up to individual trusts to commission a range of services to meet their local community’s needs.”

NICE officials contacted said they refused to speculate as to why their agency’s obesity guideline wasn’t being followed. However, the agency’s clinical guidelines, which include its obesity and bariatric surgery guideline, differ from its technical appraisals in that PCTs are not mandated to adhere to them.

The surgeons’ report – carried out by the Office of Health Economics, an independent research firm, and published Sept 8. – estimated that as many as many as 140,000 people in England qualified for bariatric surgery in 2009 and 2010 under guidelines published by NICE. Yet the actual number of surgeries performed at trusts in England in that time period was 3,607. This, the report concluded, was largely the result of different practices among different primary care trusts: “Adherence is generally sub-optimal but the number of procedures commissioned by PCTs ranged from one to 194 in 2009-10,” the report stated, “indicating a wide variation in practice.”

The 2006 NICE clinical guideline on obesity offers tiered recommendations on interventions based on the severity of a patient’s disease and the presence of comorbidities, with surgery as a last option following lifestyle and other interventions. According to the guideline, people with a body mass index of 40 or higher, and who have failed to lose weight through other means, qualify for surgery. People with a body mass index as low as 35 may quality for surgery if they have comorbidities, such as diabetes or high blood pressure.

Yet the trusts themselves seem to have decided to make surgery rarer, implementing the guidelines more stringently, according to the surgeons’ report, which used findings from other reports, a self-reported questionnaire to all 152 PCTs in England about their practices (81 responses were considered in the analysis), and additional records to gain a picture of how much bariatric surgery was really being performed.

The surveys revealed that the self-rationing was likely to continue in the current cost-cutting mood: “Although only one in ten PCTs that responded said that they would be reducing funding for obesity services, one third said that they would be applying the NICE guidance more stringently and none that the guidance would be applied less stringently,” the report said.

The National Institute for Health and Clinical Excellence said September 9 that not enough bariatric surgery is being performed in England. The agency cited a report commissioned by the Royal College of Surgeons, showing that only a small fraction of people eligible for weight loss surgery in England are actually receiving it.

About a quarter of Britons are obese, with obesity a rising trend despite numerous public health campaigns aimed at addressing it. Obesity-related disorders cost the National Health Service an estimated £4.3 billion annually, according to the U.K. Department of Health. Yet the report commissioned by the surgeons warns that English primary care trusts (PCT) are not following established clinical guidelines on bariatric surgery, which, if followed, would reduce health care costs systematically.

“If NICE guidelines on bariatric surgery were followed, direct NHS cost savings would be around £56 million a year,” NICE said in a press statement about the report. “PCTs are either ignoring NICE guidelines and rationing care for all but the most severely ill patients, or offering no service at all.”

The NICE statement stood in some contrast to the U.K. Department of Health’s response to the report, in which Public Health Minister Anne Milton said surgery “should always be a last resort” and that “it is up to individual trusts to commission a range of services to meet their local community’s needs.”

NICE officials contacted said they refused to speculate as to why their agency’s obesity guideline wasn’t being followed. However, the agency’s clinical guidelines, which include its obesity and bariatric surgery guideline, differ from its technical appraisals in that PCTs are not mandated to adhere to them.

The surgeons’ report – carried out by the Office of Health Economics, an independent research firm, and published Sept 8. – estimated that as many as many as 140,000 people in England qualified for bariatric surgery in 2009 and 2010 under guidelines published by NICE. Yet the actual number of surgeries performed at trusts in England in that time period was 3,607. This, the report concluded, was largely the result of different practices among different primary care trusts: “Adherence is generally sub-optimal but the number of procedures commissioned by PCTs ranged from one to 194 in 2009-10,” the report stated, “indicating a wide variation in practice.”

The 2006 NICE clinical guideline on obesity offers tiered recommendations on interventions based on the severity of a patient’s disease and the presence of comorbidities, with surgery as a last option following lifestyle and other interventions. According to the guideline, people with a body mass index of 40 or higher, and who have failed to lose weight through other means, qualify for surgery. People with a body mass index as low as 35 may quality for surgery if they have comorbidities, such as diabetes or high blood pressure.

Yet the trusts themselves seem to have decided to make surgery rarer, implementing the guidelines more stringently, according to the surgeons’ report, which used findings from other reports, a self-reported questionnaire to all 152 PCTs in England about their practices (81 responses were considered in the analysis), and additional records to gain a picture of how much bariatric surgery was really being performed.

The surveys revealed that the self-rationing was likely to continue in the current cost-cutting mood: “Although only one in ten PCTs that responded said that they would be reducing funding for obesity services, one third said that they would be applying the NICE guidance more stringently and none that the guidance would be applied less stringently,” the report said.

People with hypertension trained to monitor their own blood pressure and adjust their medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings underscore earlier research (JAMA 2008;299:2857-67) suggesting that with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for reducing hypertension.

The current study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after 6 months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote (Lancet 2010 July 8 [doi:10.1016/S0140-6736(10)60964-6]).

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings. When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the U.K. population—i.e., more than 2 million individuals.”

Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes.

In an editorial (doi:10.1016/S0140-6736[10]61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, nonacademic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale. Dr. Ogedegbe declared no conflicts of interest.

People with hypertension trained to monitor their own blood pressure and adjust their medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings underscore earlier research (JAMA 2008;299:2857-67) suggesting that with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for reducing hypertension.

The current study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after 6 months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote (Lancet 2010 July 8 [doi:10.1016/S0140-6736(10)60964-6]).

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings. When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the U.K. population—i.e., more than 2 million individuals.”

Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes.

In an editorial (doi:10.1016/S0140-6736[10]61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, nonacademic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale. Dr. Ogedegbe declared no conflicts of interest.

People with hypertension trained to monitor their own blood pressure and adjust their medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings underscore earlier research (JAMA 2008;299:2857-67) suggesting that with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for reducing hypertension.

The current study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after 6 months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote (Lancet 2010 July 8 [doi:10.1016/S0140-6736(10)60964-6]).

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings. When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the U.K. population—i.e., more than 2 million individuals.”

Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes.

In an editorial (doi:10.1016/S0140-6736[10]61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, nonacademic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale. Dr. Ogedegbe declared no conflicts of interest.

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise.

“Regular physical exercise … may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” investigators at the Norwegian University of Science and Technology in Trondheim hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described, Paul J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are not well understood. Fibromyalgia and obesity share characteristics, such as elevated serum levels of certain proinflammatory cytokines.

The investigators used data from the Nord-Trøndelag Health study, a two-part, government-sponsored cohort conducted between 1984 and 1986, and again between 1995 and 1997. They identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the study follow-up. Each study phase included a series of physical examinations and measurements and detailed self-reported questionnaires. At follow-up, the study comprised 9,942 normal-weight, 4,245 overweight, and 1,481 obese women.

Women who reported that they exercised four or more times a week were 29% less likely to develop fibromyalgia than were women who described themselves as inactive. Obese women (body mass index of at least 30 kg/m

In overweight and obese women (BMI of at least 25 kg/m

The authors said the study was limited because information about exercise habits was self-reported and not followed up in the second part of the cohort. They acknowledged that “genetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” but had not been included in their analysis.

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise.

“Regular physical exercise … may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” investigators at the Norwegian University of Science and Technology in Trondheim hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described, Paul J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are not well understood. Fibromyalgia and obesity share characteristics, such as elevated serum levels of certain proinflammatory cytokines.

The investigators used data from the Nord-Trøndelag Health study, a two-part, government-sponsored cohort conducted between 1984 and 1986, and again between 1995 and 1997. They identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the study follow-up. Each study phase included a series of physical examinations and measurements and detailed self-reported questionnaires. At follow-up, the study comprised 9,942 normal-weight, 4,245 overweight, and 1,481 obese women.

Women who reported that they exercised four or more times a week were 29% less likely to develop fibromyalgia than were women who described themselves as inactive. Obese women (body mass index of at least 30 kg/m

In overweight and obese women (BMI of at least 25 kg/m

The authors said the study was limited because information about exercise habits was self-reported and not followed up in the second part of the cohort. They acknowledged that “genetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” but had not been included in their analysis.

Being overweight or obese is associated with a woman's higher risk of developing fibromyalgia, as is lack of exercise.

“Regular physical exercise … may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of [fibromyalgia],” investigators at the Norwegian University of Science and Technology in Trondheim hypothesized. “However, the results of this study do not indicate a strong effect of physical exercise” on development of the disorder.

Links between obesity and fibromyalgia have been described, Paul J. Mork, Ph.D., and colleagues noted, though the reasons for such associations are not well understood. Fibromyalgia and obesity share characteristics, such as elevated serum levels of certain proinflammatory cytokines.

The investigators used data from the Nord-Trøndelag Health study, a two-part, government-sponsored cohort conducted between 1984 and 1986, and again between 1995 and 1997. They identified 15,990 women 20 years and older who initially reported no fibromyalgia or physical impairment. Of these, 380 reported physician-diagnosed fibromyalgia 11 years later during the study follow-up. Each study phase included a series of physical examinations and measurements and detailed self-reported questionnaires. At follow-up, the study comprised 9,942 normal-weight, 4,245 overweight, and 1,481 obese women.

Women who reported that they exercised four or more times a week were 29% less likely to develop fibromyalgia than were women who described themselves as inactive. Obese women (body mass index of at least 30 kg/m

In overweight and obese women (BMI of at least 25 kg/m

The authors said the study was limited because information about exercise habits was self-reported and not followed up in the second part of the cohort. They acknowledged that “genetic predisposition, sociopsychological factors, adverse life events and occupational exposures (eg., work stress), could be of importance,” but had not been included in their analysis.

The World Health Organization began a campaign in July to inoculate children in war-torn southern Kyrgyzstan against the type-1 poliovirus that has infected a confirmed 413 people in neighboring Tajikistan.

However, dissimilarly from Tajikistan, where strong public response to the well-coordinated vaccination campaigns has resulted in more than 90% vaccine uptake among targeted groups, the ongoing violence and displacement will make the job in Kyrgyzstan extremely difficult, Dr. Mark Witschi, a medical officer at WHO's office in Bishek, Kyrgyzstan, said in an interview.

An estimated 670,000 Kyrgyz children aged 5 years and younger are estimated to be in urgent need of polio vaccine, and UNICEF has already provided two rounds of vaccine per child. “In the south, there are whole communities in hiding,” according to Dr. Witschi, referring to the ethnic Uzbeks who have borne the brunt of the violence that began in April—around the same time, coincidentally, that polio was detected in Tajikistan.

The United Nations estimated in June 2010 that 400,000 people had become homeless as a result of the southern Kyrgyzstan violence. Many victims have crossed the border into Uzbekistan, seeking refuge, only to be forcibly returned to Kyrgyzstan.

Now, mobile vaccination teams will have to go from house to house to find these families and inoculate their children. “We don't know how [this campaign] will turn out,” Dr. Witschi said, “and we need to do some close monitoring.”

The threat of a polio outbreak in Kyrgyzstan comes not just from Tajikistan, where the most recent case was reported June 6 and which may already have successfully stopped the outbreak. WHO officials suspect that there have been unreported polio cases in Uzbekistan.

“The fact that Uzebekistan is planning a third and fourth round [of vaccinations] tells us indirectly that they have cases, and we know that they have never reported a case,” Dr. Witschi said. “It would be very strange if they would really have had no cases.”

The first round of polio vaccinations in Kyrgyzstan will be completed by the end of July; the second round is scheduled to be implemented in late August. The World Health Organization said on its Web site that storage facilities in Kyrgyzstan are functioning, with vaccines stored properly and the cold chain intact.

Dr. Witschi reported that so far, of 26 recent cases of acute flaccid paralysis reported in Kyrgyzstan, none has tested positive for wild polio-virus.

The World Health Organization began a campaign in July to inoculate children in war-torn southern Kyrgyzstan against the type-1 poliovirus that has infected a confirmed 413 people in neighboring Tajikistan.

However, dissimilarly from Tajikistan, where strong public response to the well-coordinated vaccination campaigns has resulted in more than 90% vaccine uptake among targeted groups, the ongoing violence and displacement will make the job in Kyrgyzstan extremely difficult, Dr. Mark Witschi, a medical officer at WHO's office in Bishek, Kyrgyzstan, said in an interview.

An estimated 670,000 Kyrgyz children aged 5 years and younger are estimated to be in urgent need of polio vaccine, and UNICEF has already provided two rounds of vaccine per child. “In the south, there are whole communities in hiding,” according to Dr. Witschi, referring to the ethnic Uzbeks who have borne the brunt of the violence that began in April—around the same time, coincidentally, that polio was detected in Tajikistan.

The United Nations estimated in June 2010 that 400,000 people had become homeless as a result of the southern Kyrgyzstan violence. Many victims have crossed the border into Uzbekistan, seeking refuge, only to be forcibly returned to Kyrgyzstan.

Now, mobile vaccination teams will have to go from house to house to find these families and inoculate their children. “We don't know how [this campaign] will turn out,” Dr. Witschi said, “and we need to do some close monitoring.”

The threat of a polio outbreak in Kyrgyzstan comes not just from Tajikistan, where the most recent case was reported June 6 and which may already have successfully stopped the outbreak. WHO officials suspect that there have been unreported polio cases in Uzbekistan.

“The fact that Uzebekistan is planning a third and fourth round [of vaccinations] tells us indirectly that they have cases, and we know that they have never reported a case,” Dr. Witschi said. “It would be very strange if they would really have had no cases.”

The first round of polio vaccinations in Kyrgyzstan will be completed by the end of July; the second round is scheduled to be implemented in late August. The World Health Organization said on its Web site that storage facilities in Kyrgyzstan are functioning, with vaccines stored properly and the cold chain intact.

Dr. Witschi reported that so far, of 26 recent cases of acute flaccid paralysis reported in Kyrgyzstan, none has tested positive for wild polio-virus.

The World Health Organization began a campaign in July to inoculate children in war-torn southern Kyrgyzstan against the type-1 poliovirus that has infected a confirmed 413 people in neighboring Tajikistan.

However, dissimilarly from Tajikistan, where strong public response to the well-coordinated vaccination campaigns has resulted in more than 90% vaccine uptake among targeted groups, the ongoing violence and displacement will make the job in Kyrgyzstan extremely difficult, Dr. Mark Witschi, a medical officer at WHO's office in Bishek, Kyrgyzstan, said in an interview.

An estimated 670,000 Kyrgyz children aged 5 years and younger are estimated to be in urgent need of polio vaccine, and UNICEF has already provided two rounds of vaccine per child. “In the south, there are whole communities in hiding,” according to Dr. Witschi, referring to the ethnic Uzbeks who have borne the brunt of the violence that began in April—around the same time, coincidentally, that polio was detected in Tajikistan.

The United Nations estimated in June 2010 that 400,000 people had become homeless as a result of the southern Kyrgyzstan violence. Many victims have crossed the border into Uzbekistan, seeking refuge, only to be forcibly returned to Kyrgyzstan.

Now, mobile vaccination teams will have to go from house to house to find these families and inoculate their children. “We don't know how [this campaign] will turn out,” Dr. Witschi said, “and we need to do some close monitoring.”

The threat of a polio outbreak in Kyrgyzstan comes not just from Tajikistan, where the most recent case was reported June 6 and which may already have successfully stopped the outbreak. WHO officials suspect that there have been unreported polio cases in Uzbekistan.

“The fact that Uzebekistan is planning a third and fourth round [of vaccinations] tells us indirectly that they have cases, and we know that they have never reported a case,” Dr. Witschi said. “It would be very strange if they would really have had no cases.”

The first round of polio vaccinations in Kyrgyzstan will be completed by the end of July; the second round is scheduled to be implemented in late August. The World Health Organization said on its Web site that storage facilities in Kyrgyzstan are functioning, with vaccines stored properly and the cold chain intact.

Dr. Witschi reported that so far, of 26 recent cases of acute flaccid paralysis reported in Kyrgyzstan, none has tested positive for wild polio-virus.

People with hypertension trained to monitor their own blood pressure and adjust their own medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings, published online in the Lancet (doi:10.1016/S0140-6736(10)60964-6), underscore earlier research (JAMA 2008;299:2857-67) suggesting that, with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for the reduction of hypertension.

The study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after six months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote.

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all of the study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings.

When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the UK population—i.e., more than 2 million individuals.”

In an editorial (doi:10.1016/S0140-6736(10)61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale.

Disclosures: Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes. Dr. Ogedegbe declared no conflicts of interest.

People with hypertension trained to monitor their own blood pressure and adjust their own medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings, published online in the Lancet (doi:10.1016/S0140-6736(10)60964-6), underscore earlier research (JAMA 2008;299:2857-67) suggesting that, with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for the reduction of hypertension.

The study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after six months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote.

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all of the study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings.

When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the UK population—i.e., more than 2 million individuals.”

In an editorial (doi:10.1016/S0140-6736(10)61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale.

Disclosures: Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes. Dr. Ogedegbe declared no conflicts of interest.

People with hypertension trained to monitor their own blood pressure and adjust their own medication achieve greater control over their disease than do patients whose hypertension is managed through conventional care, according to new research.

The findings, published online in the Lancet (doi:10.1016/S0140-6736(10)60964-6), underscore earlier research (JAMA 2008;299:2857-67) suggesting that, with appropriate clinical support and feedback—in this case, through telemonitoring of home blood pressure measurements—self-management can be an effective strategy for the reduction of hypertension.

The study's lead author, Dr. Richard J. McManus of the Primary Care Clinical Sciences and Health Economics Unit of the University of Birmingham, England, attributed the results to more changes, often including the addition of medications, to the treatment plans of self-monitoring patients.

For their research, funded by government grants, Dr. McManus and colleagues enrolled 527 men and women with blood pressure higher than 140/90 mm Hg (but less than 200/100 mm Hg) despite treatment with up to two antihypertensive drugs, who were able to participate in a self-monitoring program.

A total of 263 patients were then randomly assigned to self-management and 264 to conventional care under their primary care physicians. Of these, 480 patients (234 self-managed and 246 control) were included in the analysis. Neither investigators nor patients could be blinded to treatment assignment; the treatment group underwent initial training sessions in the use of a sphygmomanometer and in transmitting their readings to the research team using a modem. This group could titrate its medications according to a fixed scheme, and also was able to demand prescriptions according to the results of their self-monitoring, bypassing their general practitioners.

After adjustment for factors including diabetes, chronic kidney disease, and sex, mean systolic blood pressure decreased after six months by a mean of 12.9 mm Hg from baseline in the self-management group and by 9.2 mm Hg in the control group. From baseline to 12 months, mean systolic blood pressure in the two groups decreased by 17.6 mm Hg and 12.2 mm Hg, respectively.

However, the decrease in mean diastolic blood pressure did not differ as much between the intervention and control groups, with smaller differences from baseline to 6 months (decreases of 5.2 mm Hg and 3.9 mm Hg) and baseline to 12 months (7.6 mm Hg and 5.0 mm Hg). “This finding might be caused by lack of power,” the investigators wrote.

Adverse effects were similar between the groups—except for leg swelling, which was higher in the self-management group, “probably caused by increased use of calcium antagonists” in that group, the researchers wrote.

The self-management group, after 12 months, was using more varied medication than the control group, which the investigators saw as an important factor in the results. Though all of the study subjects were taking only one or two antihypertensive drugs at baseline, by 12 months more participants had been prescribed at least three drugs in the self-monitoring group than in the control group, and were more likely to have been prescribed thiazides and calcium antagonists.

One related issue, not addressed in the study, was cost, as the self-management group received more prescriptions. Dr. McManus and colleagues wrote that they had investigated the cost-effectiveness of the intervention and would report it separately.

Compliance was good in the self-management group, with approximately three-quarters of patients completing at least 90% of the expected number of readings.

When readings were particularly high or low (over 200/100 mm Hg or systolic under 100 mm Hg), as 60% of the self-management group experienced at least once, most contacted the research team, as instructed. Only 3% of the self-monitoring patients had to be contacted by researchers about a high or low reading.

But the study's authors acknowledged that such compliance would be difficult to attain in the hypertension population at large and that a weakness of the study was its paucity of low-income and ethnic minority patients.

“Self-management will not be suitable for all patients,” they wrote. “However, even if only 20% of individuals with hypertension self-managed their disorder, this proportion would still represent around 4% of the UK population—i.e., more than 2 million individuals.”

In an editorial (doi:10.1016/S0140-6736(10)61050-1) accompanying the study, Dr. Gbenga Ogedegbe of New York University cautioned that until these findings “are replicated by other investigators, especially in low-income, low-literate patients who receive care in low-resource, non-academic settings,” it would be premature to advocate self-monitoring strategies for hypertension on a wide scale.

Disclosures: Dr. McManus acknowledged having received a consultancy fee from the firm Tplus Medical to advise on telemonitoring services. One of his coauthors on the study acknowledged receiving donations of blood pressure devices from Microlife and BpTRU for research purposes. Dr. Ogedegbe declared no conflicts of interest.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings showed that seropositivity to more than one of a host of 16 beta-HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections (BMJ 2010 July 9 [doi:10.1136/bmj.c2986]).

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta-HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta-HPVs and basal cell cancers.

For their research, the largest study to date to associate beta-HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, N.H., and her colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta-HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and her colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had shown links between immunosuppressed organ transplant recipients, beta-HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas' team identified cases and controls who had never had a transplant but had taken systemic glucocorticoids to treat other conditions to determine if glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta-HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta-HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The findings, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings showed that seropositivity to more than one of a host of 16 beta-HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections (BMJ 2010 July 9 [doi:10.1136/bmj.c2986]).

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta-HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta-HPVs and basal cell cancers.

For their research, the largest study to date to associate beta-HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, N.H., and her colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta-HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and her colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had shown links between immunosuppressed organ transplant recipients, beta-HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas' team identified cases and controls who had never had a transplant but had taken systemic glucocorticoids to treat other conditions to determine if glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta-HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta-HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The findings, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings showed that seropositivity to more than one of a host of 16 beta-HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections (BMJ 2010 July 9 [doi:10.1136/bmj.c2986]).

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta-HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta-HPVs and basal cell cancers.

For their research, the largest study to date to associate beta-HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, N.H., and her colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta-HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and her colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had shown links between immunosuppressed organ transplant recipients, beta-HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas' team identified cases and controls who had never had a transplant but had taken systemic glucocorticoids to treat other conditions to determine if glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta-HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta-HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The findings, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

Tranexamic acid, a cheap and widely available generic drug, has been shown to safely improve the chances of trauma patients' surviving bleeding injuries, according to findings from a trial enrolling more than 20,000 patients in 40 countries.

The findings suggest that infusions of tranexamic acid, an antifibrinolytic agent used in surgery, also could be used in trauma care settings to help counter deaths from vehicular accidents and violence. Middle and lower-income countries account for more than 90% of the world's trauma deaths, the study's authors noted.

For their research, an international group of investigators, coordinated by Ian Roberts, Ph.D., of the London School of Hygiene and Tropical Medicine, recruited 20,211 adult trauma patients from 274 hospitals, all of whom had, or were at risk of developing, significant bleeding. Many of the study centers were located in India, Latin America, and Africa, as “that's where so much of the trauma is,” Dr. Roberts said in an interview.

Patients were randomized to receive either tranexamic acid (a loading dose of 1 g over 10 minutes followed by an infusion of 1 g over 8 hours) or placebo, with patients and clinicians blinded to treatment allocation. Although the dosing of tranexamic acid in surgery is adjusted according to a patient's body weight, the study investigators decided on a fixed dose of 2 g, which is effective over a range of body weights, because of the difficulty of weighing patients in a trauma setting (doi:10.1016/S0140-6736[10]60835-5).

Tranexamic acid had been shown to reduce the need for blood transfusions by a third in patients undergoing elective surgery (Cochrane Database Syst Rev 2007; CD001886), without increasing the risk of postoperative complications, and the study investigators hypothesized that because the hemostatic responses to surgery and trauma are similar, tranexamic acid might reduce bleeding-related mortality in trauma patients as well.

The study's primary outcome was death within 4 weeks of injury, whether from bleeding, vascular occlusion (myocardial infarction, stroke, and pulmonary embolism), multi-organ failure, head injury, or other causes, and analysis was by intention to treat.

All-cause mortality was shown to be significantly reduced with tranexamic acid: 1,463 (14.5%) of patients in the treatment group died within 4 weeks compared with 1,613 (16%) in the placebo group. The risk of death caused by bleeding was significantly reduced: 489 (4.9%) in the treatment arm compared with 574 (5.7%) in the placebo arm.

“The results show that the early administration of tranexamic acid to trauma patients with, or at risk of, significant bleeding reduces the risk of death from hemorrhage with no apparent increase in fatal or nonfatal vascular occlusive events,” the investigators concluded in their analysis. The investigators did not see statistically significant differences in transfusion rates between the two groups—transfusions were given to 50.4% of patients in the treatment arm and 51.3% in the placebo arm.

One of the trial's limitations, the investigators acknowledged, was its “limited insight into how tranexamic acid reduces the risk of death in bleeding trauma patients.” However, they said, it is the first scientific evidence that it can save lives and, at about £3 (U.S. $9) per 2-mg dose, “it would be considered a good buy in Boston or Bangalore,” Dr. Roberts said.

But despite the drug's affordability and generic status, it is still little known in trauma settings, Dr. Roberts said. “There has been off-label use of this drug [for trauma] in the past but not a lot. … If they do this tomorrow they could save millions of lives,” he said.

In an accompanying editorial, anesthesiologist Jerrold H. Levy of Emory University in Atlanta called the study “an important example of the complex relations between coagulation, fibrinolysis, inflammation, and outcomes after tissue injury … The similarities of tissue injury after trauma and surgery create a novel model for antifibrinolytic therapy with tranexamic acid.” However, Dr. Levy cautioned, the trauma findings from the tranexamic acid should not be extrapolated to other antifibrinolytic agents “until they have been studied in a similarly robust manner” (doi:10.1016/S0140-6736[10]60939-7).

Disclosures: The study was funded by the United Kingdom's National Institute for Health Research, Pfizer, BUPA Foundation, and the J.P. Moulton Charitable Foundation. Its investigators declared no conflicts of interest. Dr. Levy said that he has received grants from and been an adviser to Novo Nordisk.

My Take

Details Lacking

The use of tranexamic acid may hold promise as a way to reduce bleeding in injured patients. The authors showed lower mortality for patients who received the medication vs. a placebo, but there was no statistically significant difference in the transfusion requirements. This may seem unexpected, but details for this huge patient population are lacking. For example, factors that contribute to bleeding include hypothermia, crush injury, metabolic acidosis, and medications such as aspirin or clopidogrel. And about a third of the patients at high risk for bleeding received tranexamic acid more than 3 hours after injury, so it's likely that bleeding was an ongoing process during that time. Without knowing patients' details, it is difficult to tell who will most benefit from tranexamic acid.

DR. GRACE S. ROZYCKI is chief of the division of trauma/surgical critical care, department of surgery, Emory University, Atlanta.

Tranexamic acid, a cheap and widely available generic drug, has been shown to safely improve the chances of trauma patients' surviving bleeding injuries, according to findings from a trial enrolling more than 20,000 patients in 40 countries.

The findings suggest that infusions of tranexamic acid, an antifibrinolytic agent used in surgery, also could be used in trauma care settings to help counter deaths from vehicular accidents and violence. Middle and lower-income countries account for more than 90% of the world's trauma deaths, the study's authors noted.

For their research, an international group of investigators, coordinated by Ian Roberts, Ph.D., of the London School of Hygiene and Tropical Medicine, recruited 20,211 adult trauma patients from 274 hospitals, all of whom had, or were at risk of developing, significant bleeding. Many of the study centers were located in India, Latin America, and Africa, as “that's where so much of the trauma is,” Dr. Roberts said in an interview.

Patients were randomized to receive either tranexamic acid (a loading dose of 1 g over 10 minutes followed by an infusion of 1 g over 8 hours) or placebo, with patients and clinicians blinded to treatment allocation. Although the dosing of tranexamic acid in surgery is adjusted according to a patient's body weight, the study investigators decided on a fixed dose of 2 g, which is effective over a range of body weights, because of the difficulty of weighing patients in a trauma setting (doi:10.1016/S0140-6736[10]60835-5).

Tranexamic acid had been shown to reduce the need for blood transfusions by a third in patients undergoing elective surgery (Cochrane Database Syst Rev 2007; CD001886), without increasing the risk of postoperative complications, and the study investigators hypothesized that because the hemostatic responses to surgery and trauma are similar, tranexamic acid might reduce bleeding-related mortality in trauma patients as well.

The study's primary outcome was death within 4 weeks of injury, whether from bleeding, vascular occlusion (myocardial infarction, stroke, and pulmonary embolism), multi-organ failure, head injury, or other causes, and analysis was by intention to treat.

All-cause mortality was shown to be significantly reduced with tranexamic acid: 1,463 (14.5%) of patients in the treatment group died within 4 weeks compared with 1,613 (16%) in the placebo group. The risk of death caused by bleeding was significantly reduced: 489 (4.9%) in the treatment arm compared with 574 (5.7%) in the placebo arm.

“The results show that the early administration of tranexamic acid to trauma patients with, or at risk of, significant bleeding reduces the risk of death from hemorrhage with no apparent increase in fatal or nonfatal vascular occlusive events,” the investigators concluded in their analysis. The investigators did not see statistically significant differences in transfusion rates between the two groups—transfusions were given to 50.4% of patients in the treatment arm and 51.3% in the placebo arm.

One of the trial's limitations, the investigators acknowledged, was its “limited insight into how tranexamic acid reduces the risk of death in bleeding trauma patients.” However, they said, it is the first scientific evidence that it can save lives and, at about £3 (U.S. $9) per 2-mg dose, “it would be considered a good buy in Boston or Bangalore,” Dr. Roberts said.

But despite the drug's affordability and generic status, it is still little known in trauma settings, Dr. Roberts said. “There has been off-label use of this drug [for trauma] in the past but not a lot. … If they do this tomorrow they could save millions of lives,” he said.

In an accompanying editorial, anesthesiologist Jerrold H. Levy of Emory University in Atlanta called the study “an important example of the complex relations between coagulation, fibrinolysis, inflammation, and outcomes after tissue injury … The similarities of tissue injury after trauma and surgery create a novel model for antifibrinolytic therapy with tranexamic acid.” However, Dr. Levy cautioned, the trauma findings from the tranexamic acid should not be extrapolated to other antifibrinolytic agents “until they have been studied in a similarly robust manner” (doi:10.1016/S0140-6736[10]60939-7).

Disclosures: The study was funded by the United Kingdom's National Institute for Health Research, Pfizer, BUPA Foundation, and the J.P. Moulton Charitable Foundation. Its investigators declared no conflicts of interest. Dr. Levy said that he has received grants from and been an adviser to Novo Nordisk.

My Take

Details Lacking

The use of tranexamic acid may hold promise as a way to reduce bleeding in injured patients. The authors showed lower mortality for patients who received the medication vs. a placebo, but there was no statistically significant difference in the transfusion requirements. This may seem unexpected, but details for this huge patient population are lacking. For example, factors that contribute to bleeding include hypothermia, crush injury, metabolic acidosis, and medications such as aspirin or clopidogrel. And about a third of the patients at high risk for bleeding received tranexamic acid more than 3 hours after injury, so it's likely that bleeding was an ongoing process during that time. Without knowing patients' details, it is difficult to tell who will most benefit from tranexamic acid.

DR. GRACE S. ROZYCKI is chief of the division of trauma/surgical critical care, department of surgery, Emory University, Atlanta.

Tranexamic acid, a cheap and widely available generic drug, has been shown to safely improve the chances of trauma patients' surviving bleeding injuries, according to findings from a trial enrolling more than 20,000 patients in 40 countries.

The findings suggest that infusions of tranexamic acid, an antifibrinolytic agent used in surgery, also could be used in trauma care settings to help counter deaths from vehicular accidents and violence. Middle and lower-income countries account for more than 90% of the world's trauma deaths, the study's authors noted.

For their research, an international group of investigators, coordinated by Ian Roberts, Ph.D., of the London School of Hygiene and Tropical Medicine, recruited 20,211 adult trauma patients from 274 hospitals, all of whom had, or were at risk of developing, significant bleeding. Many of the study centers were located in India, Latin America, and Africa, as “that's where so much of the trauma is,” Dr. Roberts said in an interview.

Patients were randomized to receive either tranexamic acid (a loading dose of 1 g over 10 minutes followed by an infusion of 1 g over 8 hours) or placebo, with patients and clinicians blinded to treatment allocation. Although the dosing of tranexamic acid in surgery is adjusted according to a patient's body weight, the study investigators decided on a fixed dose of 2 g, which is effective over a range of body weights, because of the difficulty of weighing patients in a trauma setting (doi:10.1016/S0140-6736[10]60835-5).

Tranexamic acid had been shown to reduce the need for blood transfusions by a third in patients undergoing elective surgery (Cochrane Database Syst Rev 2007; CD001886), without increasing the risk of postoperative complications, and the study investigators hypothesized that because the hemostatic responses to surgery and trauma are similar, tranexamic acid might reduce bleeding-related mortality in trauma patients as well.

The study's primary outcome was death within 4 weeks of injury, whether from bleeding, vascular occlusion (myocardial infarction, stroke, and pulmonary embolism), multi-organ failure, head injury, or other causes, and analysis was by intention to treat.

All-cause mortality was shown to be significantly reduced with tranexamic acid: 1,463 (14.5%) of patients in the treatment group died within 4 weeks compared with 1,613 (16%) in the placebo group. The risk of death caused by bleeding was significantly reduced: 489 (4.9%) in the treatment arm compared with 574 (5.7%) in the placebo arm.

“The results show that the early administration of tranexamic acid to trauma patients with, or at risk of, significant bleeding reduces the risk of death from hemorrhage with no apparent increase in fatal or nonfatal vascular occlusive events,” the investigators concluded in their analysis. The investigators did not see statistically significant differences in transfusion rates between the two groups—transfusions were given to 50.4% of patients in the treatment arm and 51.3% in the placebo arm.

One of the trial's limitations, the investigators acknowledged, was its “limited insight into how tranexamic acid reduces the risk of death in bleeding trauma patients.” However, they said, it is the first scientific evidence that it can save lives and, at about £3 (U.S. $9) per 2-mg dose, “it would be considered a good buy in Boston or Bangalore,” Dr. Roberts said.

But despite the drug's affordability and generic status, it is still little known in trauma settings, Dr. Roberts said. “There has been off-label use of this drug [for trauma] in the past but not a lot. … If they do this tomorrow they could save millions of lives,” he said.

In an accompanying editorial, anesthesiologist Jerrold H. Levy of Emory University in Atlanta called the study “an important example of the complex relations between coagulation, fibrinolysis, inflammation, and outcomes after tissue injury … The similarities of tissue injury after trauma and surgery create a novel model for antifibrinolytic therapy with tranexamic acid.” However, Dr. Levy cautioned, the trauma findings from the tranexamic acid should not be extrapolated to other antifibrinolytic agents “until they have been studied in a similarly robust manner” (doi:10.1016/S0140-6736[10]60939-7).

Disclosures: The study was funded by the United Kingdom's National Institute for Health Research, Pfizer, BUPA Foundation, and the J.P. Moulton Charitable Foundation. Its investigators declared no conflicts of interest. Dr. Levy said that he has received grants from and been an adviser to Novo Nordisk.

My Take

Details Lacking

The use of tranexamic acid may hold promise as a way to reduce bleeding in injured patients. The authors showed lower mortality for patients who received the medication vs. a placebo, but there was no statistically significant difference in the transfusion requirements. This may seem unexpected, but details for this huge patient population are lacking. For example, factors that contribute to bleeding include hypothermia, crush injury, metabolic acidosis, and medications such as aspirin or clopidogrel. And about a third of the patients at high risk for bleeding received tranexamic acid more than 3 hours after injury, so it's likely that bleeding was an ongoing process during that time. Without knowing patients' details, it is difficult to tell who will most benefit from tranexamic acid.

DR. GRACE S. ROZYCKI is chief of the division of trauma/surgical critical care, department of surgery, Emory University, Atlanta.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings, published online July 9 in BMJ (BMJ2010 July 9 [doi:10.1136/bmj.c2986]), showed that seropositivity to more than one of a host of 16 beta HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections.

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta HPVs and basal cell cancers.

For their research, the largest study to date to associate beta HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, New Hampshire, and colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had demonstrated links between immunosuppressed organ transplant recipients, beta HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas’ team identified cases and controls who had never had an organ transplant but had taken systemic glucocorticoids to treat other conditions to determine whether glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The finding, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings, published online July 9 in BMJ (BMJ2010 July 9 [doi:10.1136/bmj.c2986]), showed that seropositivity to more than one of a host of 16 beta HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections.

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta HPVs and basal cell cancers.

For their research, the largest study to date to associate beta HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, New Hampshire, and colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had demonstrated links between immunosuppressed organ transplant recipients, beta HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas’ team identified cases and controls who had never had an organ transplant but had taken systemic glucocorticoids to treat other conditions to determine whether glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The finding, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

A new population-based study has demonstrated an association between a group of human papillomaviruses viruses and an increased incidence of squamous cell carcinomas, adding weight to the emerging body of evidence that one genus of HPV may play a role in nonmelanocytic skin cancers.

The findings, published online July 9 in BMJ (BMJ2010 July 9 [doi:10.1136/bmj.c2986]), showed that seropositivity to more than one of a host of 16 beta HPV types increased the likelihood of being diagnosed with a squamous cell carcinoma. Moreover, the risk increased with the number of beta-HPV types to which a person tested positive. No particular type among the 16 examined was found to increase the risk more than another; the risk merely increased with the number of infections.

People with antibodies to two or three types of beta-HPVs were 1.4 times more likely to have been diagnosed with a squamous cell carcinoma than were healthy controls, after adjustment for factors such as age, sex, and smoking. People positive for more than eight types of beta HPV were 1.7 times more likely to have been diagnosed with a skin SCC. However, no link was found between seropositivity to beta HPVs and basal cell cancers.

For their research, the largest study to date to associate beta HPV and squamous cell skin cancer in a general population, epidemiologist Margaret Karagas, Ph.D., of Dartmouth Medical School, Lebanon, New Hampshire, and colleagues identified and analyzed, from an existing cohort in and around the state, 663 previously diagnosed cases of squamous cell carcinoma and 898 cases of basal cell carcinoma, along with 805 randomly chosen healthy controls from the same region.

Study participants were aged between 25 and 75 years and nearly all were white. None of their carcinomas occurred in genital regions. All were interviewed and had venous blood drawn and analyzed for the presence of beta HPV antibodies. A handful of cases—seven squamous cell and two basal cell, along with seven healthy controls—could not be included in the analysis because of problems with their samples.

Dr. Karagas and colleagues performed subanalyses to identify confounding factors that would influence the risk of developing the cancers. “All risk estimates ultimately were adjusted for or stratified by age, sex, and sun sensitivity, and additionally for cigarette smoking for cases of squamous cell carcinoma,” they wrote. “No other factors appreciably influenced the results.”

Of particular interest to the investigators, though, was one subgroup of people taking glucocorticoids. Previous research had demonstrated links between immunosuppressed organ transplant recipients, beta HPV positivity, and another type of nonmelanocytic skin cancer (Transplantation 1996;61:715-21), so Dr. Karagas’ team identified cases and controls who had never had an organ transplant but had taken systemic glucocorticoids to treat other conditions to determine whether glucocorticoid use, and not transplantation, might be the factor affecting the association.

They found that people who reported having taken glucocorticoids for at least a month did in fact have a higher incidence of squamous cell carcinoma with beta HPV positivity. Notably, the investigators wrote, the odds ratio for squamous cell carcinoma with beta HPV positivity was 3.21 among participants with a history of prolonged glucocorticoid use, and 1.23 among those without such a history.

The finding, they wrote, “suggest that the known association between the human papillomavirus and occurrence of skin cancer in the presence of immunosuppression extends to drugs more commonly used by the general population.”

Another potential risk factor Dr. Karagas and colleagues identified was ultraviolet exposure. Though cases with a history of severe sunburn did not evidence higher cancer risk than that of controls with the same history, the findings that sun-sensitive people were at higher risk “provide some evidence of an interaction between exposure to ultraviolet light and human papillomavirus related risk of squamous cell carcinoma,” they wrote.

However, the investigators cautioned, the findings related to the sun-sensitive and glucocorticoid subgroups had limited statistical power. They also noted that because the vast majority of subjects were white, the findings could not necessarily be generalized further.

Neither Dr. Karagas nor her colleagues declared any conflicts of interest.

Laparoscopic surgery to treat diverticulitis is associated with half as many complications as open surgery, according to a study of nearly 7,000 surgeries performed over a 3-year period, reported Dr. Andrew Russ and colleagues.

Investigators at the University of Wisconsin, Madison, led by Dr. Gregory D. Kennedy, examined records from the American College of Surgeons' National Surgical Quality Improvement Program, a database of information on surgeries performed in participating U.S. hospitals (Gastroenterology 2010 June [doi:10.1053/j.gastro.2010.02.048]).

The research team identified records from all patients who had undergone any of 11 coded surgical procedures for diverticular disease from 2005 to 2008. Patients who had emergency surgeries were omitted Of the 6,970 patients remaining, 3,468 underwent an open resection procedure and 3,502 underwent a laparoscopic procedure.

The incidence of complications—including infections, pneumonia, deep vein thrombosis or pulmonary embolism, and postoperative sepsis or septic shock—was markedly lower in the laparoscopic group, with overall complications in the month after surgery reduced by nearly half, from 21.7% in the open group to 11.0% in the laparoscopic group. Hospital stays were reduced by more than a third, from an average of 7.8 days in the open group to 4.8 days for the laparoscopic patients.

However, the patients undergoing laparoscopic surgeries also happened to be younger (mean age 55.6 vs. 59.2 years for open surgery) and had fewer comorbidities, and this “is the crux of the difficulty with this paper,” Dr. Kennedy said in an interview. The nonrandomization of the study was another limitation, he said, as was the fact that most of the surgeries were performed in academic hospitals with high-volume colorectal surgery centers.

Also, poor wound condition was evident in more than 20% of the open surgeries. Although they investigators did not include any emergency surgeries (defined as those initiated within 12 hours of hospital admission), the fact that one-fifth of wounds in the open surgery group were classed as “dirty” or “infected,” compared with only 5.1% in the laparoscopic group, suggests that many of the open surgeries “could be considered on some level urgent,” Dr. Kennedy said.

But when the investigators used statistical models to correct for complication risks, such as wound condition, American Society of Anesthesiologists physical status classification, bond recent surgeries, theynonund that the risk of developing complications was roughly 50% lower after a laparoscopic procedure, compared with an open procedure.

“What we saw was that laparoscopy at least correlated with an improved outcome,” Dr. Kennedy said. “It is at least contributing to a 50% reduction” in complications.

He and his colleagues noted that, despite a growing body of research suggesting laparoscopy to be the safer option, it remains far from surgeons' first choice for diverticulitis. Currently, in the United States, Dr. Kennedy said, the availability of the procedure “depends largely on the market; if you're in Chicago and go for a colon surgery, nearly every surgeon will offer it. In other states, and in many rural areas, people are not performing or even offering laparoscopy.”

One reason for the hesitation, the investigators speculated, could be that laparoscopic surgeries for diverticular disease had been previously associated with high rates of conversion to open surgeries. But currently, they wrote, conversion rates are between 20% and 26%, “not dissimilar to current large series reports on conversion rates for neoplastic disease.”

Another reason, they said, could be the longer operating times associated with laparoscopic surgery.

The study was funded by the University of Wisconsin. Neither Dr. Kennedy nor any of his coauthors cited competing interests.

Laparoscopic surgery to treat diverticulitis is associated with half as many complications as open surgery, according to a study of nearly 7,000 surgeries performed over a 3-year period, reported Dr. Andrew Russ and colleagues.

Investigators at the University of Wisconsin, Madison, led by Dr. Gregory D. Kennedy, examined records from the American College of Surgeons' National Surgical Quality Improvement Program, a database of information on surgeries performed in participating U.S. hospitals (Gastroenterology 2010 June [doi:10.1053/j.gastro.2010.02.048]).

The research team identified records from all patients who had undergone any of 11 coded surgical procedures for diverticular disease from 2005 to 2008. Patients who had emergency surgeries were omitted Of the 6,970 patients remaining, 3,468 underwent an open resection procedure and 3,502 underwent a laparoscopic procedure.

The incidence of complications—including infections, pneumonia, deep vein thrombosis or pulmonary embolism, and postoperative sepsis or septic shock—was markedly lower in the laparoscopic group, with overall complications in the month after surgery reduced by nearly half, from 21.7% in the open group to 11.0% in the laparoscopic group. Hospital stays were reduced by more than a third, from an average of 7.8 days in the open group to 4.8 days for the laparoscopic patients.

However, the patients undergoing laparoscopic surgeries also happened to be younger (mean age 55.6 vs. 59.2 years for open surgery) and had fewer comorbidities, and this “is the crux of the difficulty with this paper,” Dr. Kennedy said in an interview. The nonrandomization of the study was another limitation, he said, as was the fact that most of the surgeries were performed in academic hospitals with high-volume colorectal surgery centers.

Also, poor wound condition was evident in more than 20% of the open surgeries. Although they investigators did not include any emergency surgeries (defined as those initiated within 12 hours of hospital admission), the fact that one-fifth of wounds in the open surgery group were classed as “dirty” or “infected,” compared with only 5.1% in the laparoscopic group, suggests that many of the open surgeries “could be considered on some level urgent,” Dr. Kennedy said.

But when the investigators used statistical models to correct for complication risks, such as wound condition, American Society of Anesthesiologists physical status classification, bond recent surgeries, theynonund that the risk of developing complications was roughly 50% lower after a laparoscopic procedure, compared with an open procedure.

“What we saw was that laparoscopy at least correlated with an improved outcome,” Dr. Kennedy said. “It is at least contributing to a 50% reduction” in complications.

He and his colleagues noted that, despite a growing body of research suggesting laparoscopy to be the safer option, it remains far from surgeons' first choice for diverticulitis. Currently, in the United States, Dr. Kennedy said, the availability of the procedure “depends largely on the market; if you're in Chicago and go for a colon surgery, nearly every surgeon will offer it. In other states, and in many rural areas, people are not performing or even offering laparoscopy.”

One reason for the hesitation, the investigators speculated, could be that laparoscopic surgeries for diverticular disease had been previously associated with high rates of conversion to open surgeries. But currently, they wrote, conversion rates are between 20% and 26%, “not dissimilar to current large series reports on conversion rates for neoplastic disease.”

Another reason, they said, could be the longer operating times associated with laparoscopic surgery.

The study was funded by the University of Wisconsin. Neither Dr. Kennedy nor any of his coauthors cited competing interests.

Laparoscopic surgery to treat diverticulitis is associated with half as many complications as open surgery, according to a study of nearly 7,000 surgeries performed over a 3-year period, reported Dr. Andrew Russ and colleagues.

Investigators at the University of Wisconsin, Madison, led by Dr. Gregory D. Kennedy, examined records from the American College of Surgeons' National Surgical Quality Improvement Program, a database of information on surgeries performed in participating U.S. hospitals (Gastroenterology 2010 June [doi:10.1053/j.gastro.2010.02.048]).

The research team identified records from all patients who had undergone any of 11 coded surgical procedures for diverticular disease from 2005 to 2008. Patients who had emergency surgeries were omitted Of the 6,970 patients remaining, 3,468 underwent an open resection procedure and 3,502 underwent a laparoscopic procedure.

The incidence of complications—including infections, pneumonia, deep vein thrombosis or pulmonary embolism, and postoperative sepsis or septic shock—was markedly lower in the laparoscopic group, with overall complications in the month after surgery reduced by nearly half, from 21.7% in the open group to 11.0% in the laparoscopic group. Hospital stays were reduced by more than a third, from an average of 7.8 days in the open group to 4.8 days for the laparoscopic patients.

However, the patients undergoing laparoscopic surgeries also happened to be younger (mean age 55.6 vs. 59.2 years for open surgery) and had fewer comorbidities, and this “is the crux of the difficulty with this paper,” Dr. Kennedy said in an interview. The nonrandomization of the study was another limitation, he said, as was the fact that most of the surgeries were performed in academic hospitals with high-volume colorectal surgery centers.

Also, poor wound condition was evident in more than 20% of the open surgeries. Although they investigators did not include any emergency surgeries (defined as those initiated within 12 hours of hospital admission), the fact that one-fifth of wounds in the open surgery group were classed as “dirty” or “infected,” compared with only 5.1% in the laparoscopic group, suggests that many of the open surgeries “could be considered on some level urgent,” Dr. Kennedy said.

But when the investigators used statistical models to correct for complication risks, such as wound condition, American Society of Anesthesiologists physical status classification, bond recent surgeries, theynonund that the risk of developing complications was roughly 50% lower after a laparoscopic procedure, compared with an open procedure.

“What we saw was that laparoscopy at least correlated with an improved outcome,” Dr. Kennedy said. “It is at least contributing to a 50% reduction” in complications.

He and his colleagues noted that, despite a growing body of research suggesting laparoscopy to be the safer option, it remains far from surgeons' first choice for diverticulitis. Currently, in the United States, Dr. Kennedy said, the availability of the procedure “depends largely on the market; if you're in Chicago and go for a colon surgery, nearly every surgeon will offer it. In other states, and in many rural areas, people are not performing or even offering laparoscopy.”

One reason for the hesitation, the investigators speculated, could be that laparoscopic surgeries for diverticular disease had been previously associated with high rates of conversion to open surgeries. But currently, they wrote, conversion rates are between 20% and 26%, “not dissimilar to current large series reports on conversion rates for neoplastic disease.”

Another reason, they said, could be the longer operating times associated with laparoscopic surgery.

The study was funded by the University of Wisconsin. Neither Dr. Kennedy nor any of his coauthors cited competing interests.

Hidden among the millions of vuvuzela-blowing spectators in South Africa for the 2010 World Cup games may be a surprising number of medical and scientific researchers: The tournament has attracted not merely die-hard fans but people interested in the physics, physiology, psychology, and even epidemiology of the globally beloved sport.

Anyone who is curious about the physical and psychosocial profiles of Mexican soccer referees, the effects of a traditional Islamic sports uniform on the performance of women players, the potential effects of various caffeinated sports drinks on World Cup performance, or the “anthropometric and physiological parameters of Cameroon elite championship soccer players” need have looked no further last week than Nelson Mandela Metropolitan University in Port Elizabeth, South Africa, where the second annual World Conference of Science and Soccer took place.

Copyright Axel Buehrmann

Although the science that was presented was diverse and representative of many disciplines, it shared a common goal: improving the game, said conference organizer Richard Stretch, Ph.D., the university’s director of sport. “The focus is in particular on the training for the game and a huge part is preventing injuries,” Dr. Stretch said in an interview. “There are people who complain that the game has gotten too technical; that’s a very dangerous attitude. Technology with a scientific basis allows for improved performance and health.”

Many of the conference’s presenters focused on aspects of the sport that might, to the average fan, seem arcane, yet their findings were not without real-life implications. When one U.K. sportswriter mocked French players this week for allegedly consuming some 120 baguettes per day at their hotel – “Maybe all these carbs are to blame for their stodgy performance against Uruguay?” mused the Telegraph’s Steve Wilson – it was clear that he had not received an advance copy of “Recovery of Muscle Glycogen After a Soccer Match: Effect of a High Carbohydrate Diet” by T.P. Gunnarsson and colleagues at the University of Copenhagen, who concluded that a high-carb diet actually improves performance.

For researchers who are interested in health issues that affect soccer spectators, the World Cup is also providing a living lab.

One team of researchers, led by Dr. Marc Mendelson of the University of Cape Town (South Africa), used 13 years’ worth of surveillance data to predict disease threats to visitors during the World Cup games. In an article published in June, Dr. Mendelson and colleagues determined that “systemic febrile illness [and dermatologic and] acute diarrheal illness” were the most common illnesses among visitors to South Africa, as was spotted fever group rickettsiosis (Am. J. Trop. Med. Hyg. 2010;82:991-5). Malaria was far less common than was believed, the team found, with only six cases documented among travelers. “Advice for the travelers to the 2010 World Cup should be individualized according to these findings,” they concluded.

Meanwhile, two North American epidemiologists, John Brownstein, Ph.D., of Children’s Hospital Boston and Dr. Kamran Khan of St. Michael’s Hospital in Toronto, have combined their respective reporting systems to figure out what’s happening right at this moment, disease-wise, around the World Cup games: HealthMap maps real-time reports of emerging-disease activity, and BIO.DIASPORA uses air transport data to trace disease patterns.

On June 15, their public Web project mapped a measles outbreak in nearby Malawi; meanwhile, another linked map provided current data on rift valley fever outbreaks, conveniently juxtaposed with soccer balls marking proximity to World Cup stadiums.

The World Cup project, Dr. Brownstein said in an interview, “is really about the risks associated with mass gatherings.”

Dr. Brownstein and Dr. Khan teamed up for a similar project during the Vancouver Olympic Games in 2009, and found that it accurately predicted an importation of measles. As with the Olympic project, Dr. Brownstein said, this one will also be followed up to see how predictive the monitoring was.

Dr. Brownstein and Dr. Khan’s system deals only with newly reported disease outbreaks, and thus cannot reflect the ongoing risks associated with, for example, HIV, with which as many as 20% of adult South Africans are infected. Preventing the spread of HIV through sexual contact is a large – perhaps the largest – health concern for the event organizers, the South African government, and foreign governments such as Great Britain, which have donated and are distributing tens of millions of condoms during the games. The epidemiology of HIV and the 2010 World Cup will remain a mystery for some time, although it seems likely that some researcher, somewhere, is working on it already.

Medical research on South Africa’s notorious vuvuzela horns and their potentially deafening effects has so far proved to be scarce, although medical opportunism has not: On June 15, one Irish firm, Restored Hearing of Dublin, announced that it had developed “a low frequency therapy for people who are suffering from temporary tinnitus,” with a 99% success rate. Also, the firm pointed out helpfully in a news release, World Cup fans don’t have to return home before they begin using it: “This unexpected new customer base can conveniently access our therapy online so that they can continue to enjoy their sporting events without the annoyance of ringing in the ears.”

Hidden among the millions of vuvuzela-blowing spectators in South Africa for the 2010 World Cup games may be a surprising number of medical and scientific researchers: The tournament has attracted not merely die-hard fans but people interested in the physics, physiology, psychology, and even epidemiology of the globally beloved sport.

Anyone who is curious about the physical and psychosocial profiles of Mexican soccer referees, the effects of a traditional Islamic sports uniform on the performance of women players, the potential effects of various caffeinated sports drinks on World Cup performance, or the “anthropometric and physiological parameters of Cameroon elite championship soccer players” need have looked no further last week than Nelson Mandela Metropolitan University in Port Elizabeth, South Africa, where the second annual World Conference of Science and Soccer took place.

Copyright Axel Buehrmann

Although the science that was presented was diverse and representative of many disciplines, it shared a common goal: improving the game, said conference organizer Richard Stretch, Ph.D., the university’s director of sport. “The focus is in particular on the training for the game and a huge part is preventing injuries,” Dr. Stretch said in an interview. “There are people who complain that the game has gotten too technical; that’s a very dangerous attitude. Technology with a scientific basis allows for improved performance and health.”

Many of the conference’s presenters focused on aspects of the sport that might, to the average fan, seem arcane, yet their findings were not without real-life implications. When one U.K. sportswriter mocked French players this week for allegedly consuming some 120 baguettes per day at their hotel – “Maybe all these carbs are to blame for their stodgy performance against Uruguay?” mused the Telegraph’s Steve Wilson – it was clear that he had not received an advance copy of “Recovery of Muscle Glycogen After a Soccer Match: Effect of a High Carbohydrate Diet” by T.P. Gunnarsson and colleagues at the University of Copenhagen, who concluded that a high-carb diet actually improves performance.

For researchers who are interested in health issues that affect soccer spectators, the World Cup is also providing a living lab.

One team of researchers, led by Dr. Marc Mendelson of the University of Cape Town (South Africa), used 13 years’ worth of surveillance data to predict disease threats to visitors during the World Cup games. In an article published in June, Dr. Mendelson and colleagues determined that “systemic febrile illness [and dermatologic and] acute diarrheal illness” were the most common illnesses among visitors to South Africa, as was spotted fever group rickettsiosis (Am. J. Trop. Med. Hyg. 2010;82:991-5). Malaria was far less common than was believed, the team found, with only six cases documented among travelers. “Advice for the travelers to the 2010 World Cup should be individualized according to these findings,” they concluded.

Meanwhile, two North American epidemiologists, John Brownstein, Ph.D., of Children’s Hospital Boston and Dr. Kamran Khan of St. Michael’s Hospital in Toronto, have combined their respective reporting systems to figure out what’s happening right at this moment, disease-wise, around the World Cup games: HealthMap maps real-time reports of emerging-disease activity, and BIO.DIASPORA uses air transport data to trace disease patterns.

On June 15, their public Web project mapped a measles outbreak in nearby Malawi; meanwhile, another linked map provided current data on rift valley fever outbreaks, conveniently juxtaposed with soccer balls marking proximity to World Cup stadiums.

The World Cup project, Dr. Brownstein said in an interview, “is really about the risks associated with mass gatherings.”

Dr. Brownstein and Dr. Khan teamed up for a similar project during the Vancouver Olympic Games in 2009, and found that it accurately predicted an importation of measles. As with the Olympic project, Dr. Brownstein said, this one will also be followed up to see how predictive the monitoring was.

Dr. Brownstein and Dr. Khan’s system deals only with newly reported disease outbreaks, and thus cannot reflect the ongoing risks associated with, for example, HIV, with which as many as 20% of adult South Africans are infected. Preventing the spread of HIV through sexual contact is a large – perhaps the largest – health concern for the event organizers, the South African government, and foreign governments such as Great Britain, which have donated and are distributing tens of millions of condoms during the games. The epidemiology of HIV and the 2010 World Cup will remain a mystery for some time, although it seems likely that some researcher, somewhere, is working on it already.

Medical research on South Africa’s notorious vuvuzela horns and their potentially deafening effects has so far proved to be scarce, although medical opportunism has not: On June 15, one Irish firm, Restored Hearing of Dublin, announced that it had developed “a low frequency therapy for people who are suffering from temporary tinnitus,” with a 99% success rate. Also, the firm pointed out helpfully in a news release, World Cup fans don’t have to return home before they begin using it: “This unexpected new customer base can conveniently access our therapy online so that they can continue to enjoy their sporting events without the annoyance of ringing in the ears.”

Hidden among the millions of vuvuzela-blowing spectators in South Africa for the 2010 World Cup games may be a surprising number of medical and scientific researchers: The tournament has attracted not merely die-hard fans but people interested in the physics, physiology, psychology, and even epidemiology of the globally beloved sport.

Anyone who is curious about the physical and psychosocial profiles of Mexican soccer referees, the effects of a traditional Islamic sports uniform on the performance of women players, the potential effects of various caffeinated sports drinks on World Cup performance, or the “anthropometric and physiological parameters of Cameroon elite championship soccer players” need have looked no further last week than Nelson Mandela Metropolitan University in Port Elizabeth, South Africa, where the second annual World Conference of Science and Soccer took place.

Copyright Axel Buehrmann

Although the science that was presented was diverse and representative of many disciplines, it shared a common goal: improving the game, said conference organizer Richard Stretch, Ph.D., the university’s director of sport. “The focus is in particular on the training for the game and a huge part is preventing injuries,” Dr. Stretch said in an interview. “There are people who complain that the game has gotten too technical; that’s a very dangerous attitude. Technology with a scientific basis allows for improved performance and health.”

Many of the conference’s presenters focused on aspects of the sport that might, to the average fan, seem arcane, yet their findings were not without real-life implications. When one U.K. sportswriter mocked French players this week for allegedly consuming some 120 baguettes per day at their hotel – “Maybe all these carbs are to blame for their stodgy performance against Uruguay?” mused the Telegraph’s Steve Wilson – it was clear that he had not received an advance copy of “Recovery of Muscle Glycogen After a Soccer Match: Effect of a High Carbohydrate Diet” by T.P. Gunnarsson and colleagues at the University of Copenhagen, who concluded that a high-carb diet actually improves performance.

For researchers who are interested in health issues that affect soccer spectators, the World Cup is also providing a living lab.

One team of researchers, led by Dr. Marc Mendelson of the University of Cape Town (South Africa), used 13 years’ worth of surveillance data to predict disease threats to visitors during the World Cup games. In an article published in June, Dr. Mendelson and colleagues determined that “systemic febrile illness [and dermatologic and] acute diarrheal illness” were the most common illnesses among visitors to South Africa, as was spotted fever group rickettsiosis (Am. J. Trop. Med. Hyg. 2010;82:991-5). Malaria was far less common than was believed, the team found, with only six cases documented among travelers. “Advice for the travelers to the 2010 World Cup should be individualized according to these findings,” they concluded.

Meanwhile, two North American epidemiologists, John Brownstein, Ph.D., of Children’s Hospital Boston and Dr. Kamran Khan of St. Michael’s Hospital in Toronto, have combined their respective reporting systems to figure out what’s happening right at this moment, disease-wise, around the World Cup games: HealthMap maps real-time reports of emerging-disease activity, and BIO.DIASPORA uses air transport data to trace disease patterns.

On June 15, their public Web project mapped a measles outbreak in nearby Malawi; meanwhile, another linked map provided current data on rift valley fever outbreaks, conveniently juxtaposed with soccer balls marking proximity to World Cup stadiums.

The World Cup project, Dr. Brownstein said in an interview, “is really about the risks associated with mass gatherings.”

Dr. Brownstein and Dr. Khan teamed up for a similar project during the Vancouver Olympic Games in 2009, and found that it accurately predicted an importation of measles. As with the Olympic project, Dr. Brownstein said, this one will also be followed up to see how predictive the monitoring was.

Dr. Brownstein and Dr. Khan’s system deals only with newly reported disease outbreaks, and thus cannot reflect the ongoing risks associated with, for example, HIV, with which as many as 20% of adult South Africans are infected. Preventing the spread of HIV through sexual contact is a large – perhaps the largest – health concern for the event organizers, the South African government, and foreign governments such as Great Britain, which have donated and are distributing tens of millions of condoms during the games. The epidemiology of HIV and the 2010 World Cup will remain a mystery for some time, although it seems likely that some researcher, somewhere, is working on it already.

Medical research on South Africa’s notorious vuvuzela horns and their potentially deafening effects has so far proved to be scarce, although medical opportunism has not: On June 15, one Irish firm, Restored Hearing of Dublin, announced that it had developed “a low frequency therapy for people who are suffering from temporary tinnitus,” with a 99% success rate. Also, the firm pointed out helpfully in a news release, World Cup fans don’t have to return home before they begin using it: “This unexpected new customer base can conveniently access our therapy online so that they can continue to enjoy their sporting events without the annoyance of ringing in the ears.”