As lifestyles get busier and waistlines get bigger; many people are turning to online nutrition programs. In promotion of healthful nutrition behaviors, computer-tailored nutrition education has been identified as a promising health education strategy, especially in the promotion of lower fat intake. However, a study in the September/October 2011 issue of the Journal of Nutrition Education and Behavior reveals no evidence of the efficacy of such computer-tailored education using empirical data based on blood cholesterol and lipids.

Investigators from the Vrije Universiteit Amsterdam, Maastricht University, and Erasmus University in the Netherlands assessed 442 healthy Dutch adults to determine the effectiveness of a computer-tailored intervention aimed at the reduction of fat intake. Instead of just looking at self-reported dietary recalls to evaluate dietary fat intake, which can be skewed by portion size errors, underreporting, and socially desirable answers, the researchers evaluated a more reliable outcome – blood lipids (total, HDL, and LDL cholesterol and triglycerides). The computer program aimed at reducing saturated fat intake had no effect on the blood values.

Drs. Willemieke Kroeze, PhD, and Johannes Brug, PhD, Assistant Professor and Professor, respectively, at the Vrije Universiteit, state, “Computer- tailored intervention with a single dose, aimed at reduction of (saturated) fat intake, for which meaningful effects based on self-reports have been reported, was not sufficient to produce detectable changes in blood lipids in the current study.” When asked how to improve outcomes from consulting online nutrition advice websites, Dr. Kroeze suggests exploring methods “to increase the feasibility of objectively assessing the impact of computer-tailored nutrition education interventions aimed at primary prevention in real-life settings. In addition, strategies should be developed to improve the intensity and duration of computer-tailored interventions, and to incorporate social interaction in the intervention.”

This study documents the importance of identifying key factors that influence an individual’s ability to change dietary behaviors especially through online nutrition education. It also illustrates the importance of critical evaluation of nutrition education efforts, as interventions often are developed online as a cost-savings and venue to increase the program’s reach. Continue reading →

Women who drink coffee regularly have a significantly lower risk of developing antiestrogen-resistant estrogen-receptor (ER)-negative breast cancer, researchers from the Karolinska Institute, Sweden, revealed in Breast Cancer Research.

Breast cancer may be sub-divided into hormone-responsive (estrogen receptor (ER) positive) and non-hormone-responsive subtypes (ER-negative).

The scientists compared the lifestyles of females with breast cancer and those without. They were matched for age. They also gathered data on their coffee consumption.

They discovered that regular coffee drinkers were less likely to develop breast cancer compared to women who either never or rarely drank coffee.

Other factors also impact on breast cancer risk, the authors added, such as the woman’s age when she reaches menopause, physical activity, her bodyweight, education, and family history of breast cancer.

After taking all these breast cancer risk factors into account, coffee only reduced the risk of developing ER-negative breast cancer.

The authors wrote:

“There is often conflicting information about the beneficial effects of coffee – when we compared our results to that of a German study we discovered that their data showed the same trend, but the relationship was much weaker.

We suggest that this may have something to do with the way the coffee was prepared, or the type of bean preferred. It is unlikely that the protective effect is due to phytoestrogens present in coffee since there was no reduction in the incidence of ER-positive cancer in this study.”

Even though it is clear coffee consumption does protect women from ER negative breast cancer, nobody is sure why this happens – we still do not know what the exact mechanisms are and what compounds are involved.

“Coffee consumption modifies risk of estrogen-receptor negative breast cancer” (PDF)
Jingmei Li, Petra Seibold, Jenny Chang-Claude, Dieter Flesch-Janys, Jianjun Liu, Kamila Czene, Keith Humphreys and Per Hall
Breast Cancer Research, May 2011

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Phantom limbs, often described after amputation, are also experienced as an extra limb in patients who are paralyzed on one side following a stroke. Referred to as supernumerary phantom limb (SPL), patients can usually perceive these limbs as a vivid somatosensory presence of an extra limb, but generally cannot see or intentionally move them. In some unusual cases, however, patients have reported seeing their phantom limb or feeling objects or body parts with it, which indicates that multiple areas of the brain may be involved in SPLs.

A new study on a patient who experienced an SPL which she could feel, see and intentionally move is published in Annals of Neurology, the official journal of the American Neurological Association and the Child Neurology Society. It is one of the very few studies to investigate brain activity connected to SPLs.

The study involved a 64-year-old woman who suffered a stroke and was subsequently paralyzed on her left side. A few days after the stroke, she experienced an SPL starting from the elbow of her paralyzed left arm, which she described as “pale,” “milk-white” and “transparent.” She claimed she could move, see and even use the SPL to touch parts of her body such as her head and right shoulder, but that she experienced it only when she decided to “trigger” it intentionally. She even claimed to be able to use it to scratch an itch on her head, with an actual sense of relief. She also reported that the phantom limb could not penetrate solid objects.

Led by Asaid Khateb of Geneva University Hospitals, researchers conducted functional magnetic resonance imaging scans to analyze the patient’s brain activity during actual and imagined movements of her healthy right hand, imagined movements of her paralyzed left hand and movements of the SPL.

The real movements of the right hand were associated the dominant activation of left areas of the brain associated with movement, perception of stimuli and visual processing, as expected. Similar but less extensive activations were seen with imaginary movements of the right hand. In contrast, imaginary movements of the paralyzed left hand showed dominant activation in areas associated with movement in right side of the brain. When asked to scratch her cheek with the SPL, areas of the brain associated with movement and vision were activated, which confirmed her report that she could see and move her SPL. In addition, a measurable sensory response was also detected when she scratched her left cheek with the SPL.

The authors note that there are probably different types of SPLs that differ in how they are manifested, the extent of motor control, the sensitivity to sensory feedback and patients’ mental framework and that it is unlikely that a single explanation will suffice for such clinically complex and diverse conditions. The current study is the first to demonstrate the neural correlates of the multimodal SPL, particularly the visual and somesthesic activation that accompanied the intentional SPL movements.

“Existing evidence from stroke-elicited SPLs convincingly implicates the mismatch between the subject’s well-established sensorimotor representations and a suddenly aberrant pattern of communication between the brain and the paralyzed limb,” the authors state, adding that the current case may represent a missing link between classical phantom limbs and autoscopic phenomena such as out of body experiences.

“Ultimately, however,” they conclude, “these conditions might offer a unique way to understand how the brain constructs a normal experience of bodily awareness and the self.”

Notes:

This study is published in Annals of Neurology.

To view the abstract for this article, please click here.

Asaid Khateb is neuropsychologist at Geneva University Hospitals.

Annals of Neurology publishes articles of broad interest with potential for high impact in understanding the mechanisms and treatment of diseases of the human nervous system. All areas of clinical and basic neuroscience, including new technologies, cellular and molecular neurobiology, population sciences, and studies of behavior, addiction, and psychiatric diseases are of interest to the journal.

Source:
Sean Wagner

Wiley-Blackwell Continue reading →

Scientists have created a diamond-like lattice composed of gold nanoparticles and viral particles, woven together and held in place by strands of DNA. The structure – a distinctive mix of hard, metallic nanoparticles and organic viral pieces known as capsids, linked by the very stuff of life, DNA – marks a remarkable step in scientists’ ability to combine an assortment of materials to create infinitesimal devices.

The research, done by scientists at the University of Rochester Medical Center, Scripps Research Institute, and Massachusetts Institute of Technology, was published recently in Nature Materials.

While people commonly think of DNA as a blueprint for life, the team used DNA instead as a tool to guide the precise positioning of tiny particles just one-millionth of a centimeter across, using DNA to chaperone the particles.

Central to the work is the unique attraction of each of DNA’s four chemical bases to just one other base. The scientists created specific pieces of DNA and then attached them to gold nanoparticles and viral particles, choosing the sequences and positioning them exactly to force the particles to arrange themselves into a crystal lattice.

When scientists mixed the particles, out of the brew emerged a sodium thallium crystal lattice. The device “self assembled” or literally built itself.

The research adds some welcome flexibility to the toolkit that scientists have available to create nano-sized devices.

“Organic materials interact in ways very different from metal nanoparticles. The fact that we were able to make such different materials work together and be compatible in a single structure demonstrates some new opportunities for building nano-sized devices,” said Sung Yong Park, Ph.D., a research assistant professor of Biostatistics and Computational Biology at Rochester.

Park and M.G Finn, Ph.D., of Scripps Research Institute are corresponding authors of the paper.

Such a crystal lattice is potentially a central ingredient to a device known as a photonic crystal, which can manipulate light very precisely, blocking certain colors or wavelengths of light while letting other colors pass. While 3-D photonic crystals exist that can bend light at longer wavelengths, such as the infrared, this lattice is capable of manipulating visible light. Scientists foresee many applications for such crystals, such as optical computing and telecommunications, but manufacturing and durability remain serious challenges.

It was three years ago that Park, as part of a larger team of colleagues at Northwestern University, first produced a crystal lattice with a similar method, using DNA to link gold nanospheres. The new work is the first to combine particles with such different properties – hard gold nanoparticles and more flexible organic particles.

Within the new structure, there are actually two distinct forces at work, Park said. The gold particles and the viral particles repel each other, but their deterrence is countered by the attraction between the strategically placed complementary strands of DNA. Both phenomena play a role in creating the rigid crystal lattice. It’s a little bit like how countering forces keep our curtains up: A spring in a curtain rod pushes the rod to lengthen, while brackets on the window frame counter that force, creating a taut, rigid device.

Other authors of the paper include Abigail Lytton-Jean, Ph.D., of MIT, Daniel Anderson, Ph.D., of Harvard and MIT, and Petr Cigler, Ph.D., formerly of Scripps Research Institute and now at the Academy of Sciences of the Czech Republic. Park’s work was supported by the National Institute of Allergy and Infectious Diseases.

Source:
Tom Rickey
University of Rochester Medical Center Continue reading →

The aged care workforce – comprised of 98% women workers – is one of the most unfairly remunerated in Australia.

The Australian Nursing Federation federal secretary, Ged Kearney, said nurses, assistants in nursing (AINs) and personal care workers (PCWs), who care for vulnerable elderly residents in nursing homes suffer pay discrimination because it is a largely female dominated industry.

Ms Kearney said research released this week from The National Centre for Social and Economic Modeling, which showed women workers were paid 17 per cent less than men, was very disturbing.

“It’s a very disturbing figure but unfortunately not surprising,” she said.

“Pay inequity is alive and well in Australia and no one understands this more than an aged care nurse who, in fact, experience a double barrel loss.”

“Not only are aged care nurses paid less than men who have similar qualifications and do comparable work, they are also paid less than other nurses in the public hospital system.”

“This research shows the average woman worker earns $3394 a year less than a male employee. But aged care nurses earn about $15,000 less than other nurses – almost 5 times more than pay disparity of women workers generally.”

Ms Kearney said the pay disadvantage suffered by women who work in caring roles, such as nurses, AINs and PCWs in the aged care industry, is outdated and must be addressed by the federal government and the community as a matter of urgency.

“Severe pay inequity is not only hurting aged care nurses, whose wages are on average $300 per week less than public sector nurses, it is also damaging to the aged care sector because the industry will not be able to attract these highly educated and dedicated workers. Nurses and care workers in aged care are saying that enough is enough.”

Source
Australian Nursing Federation Continue reading →

Scientists from the Medical Research Council’s Anatomical Neuropharmacology Unit (ANU) at the University of Oxford have discovered evidence that sleep is important for the stabilisation of memory.

In a study published in Nature Neuroscience, Dr Jozsef Csicsvari and colleagues describe how memory traces of the latest waking experiences could be reactivated during sleep, helping the formation of long-lasting memories.

The team has discovered that, during sleep, a recent conscious experience can control how neuronal (nerve cell) activity patterns are reactivated in the hippocampus, the brain region responsible for memory.

The research was carried out by observing rats as they explored an environment and then as they slept. The activity of neurons in the animals’ hippocampus was recorded to establish which waking neuronal patterns were stored for reactivation during sleep and the mechanism for such storage.

The scientists studied pairs of neurons and looked for brief intervals in which both neurons fired messages to each other. They found that the more frequently these cells fired together during exploration, the stronger their correlated firing became during the sleep period afterwards, when compared to sleep prior to this exploring behaviour.

Dr Csicsvari said: “Neuronal patterns during exploration can lead to changes in neuronal connections that temporarily store reactivated memory traces. The recurrence of these events was governed by where the animal explored and how long it spent there: factors which are required for autobiographical memory.”

The ANU team also discovered that reactivation of memories of waking experience were more pronounced after the animal had explored a new environment: suggesting that sleep is vital to the storage of new information and the processing of memory.

Original research paper: Reactivation of experience-dependent cell assembly patterns in the hippocampus is published in Nature Neuroscience, 2008: aop.

The mission of the MRC Anatomical Neuropharmacology Unit is to define the molecular, spatial and temporal organisational principles of networks in the brain at the synaptic and cellular level by analysing a variety of brain regions affected in disease. The ability to develop an understanding of the cellular mechanisms underlying activity in a range of neuronal centres is essential, since insight from one area provides hypotheses and facilitates progress in another. This strategy also aids the discovery of general principles of operation and the definition of local adaptations. Brain areas studied at present include the cerebellum, the basal ganglia, the cerebral cortex and, in particular, the hippocampal formation.

Medical Research Council Continue reading →

Two studies published early online and in an upcoming edition of The
Lancet find that when antibiotics are given to pregnant women
experiencing premature labor, even with intact membranes and no
infection, there is an increase in risk of functional impairment and/or
cerebral palsy. These unexpected findings are the results of a study of
long-term follow-up data from the ORACLE Children’s Study, authored by
Dr Sara Kenyon (University of Leicester, UK) and colleagues from the
ORACLE study group.

Completed in 2001, the original ORACLE I and II trials were designed to
see if the antibiotics erythromycin and co-amoxiclav could halt
underlying infections in women threatening to give birth prematurely,
and therefore delay or prevent premature birth and possibly improve
outcomes in the first four weeks of life. The experiment was structured
as a factorial randomized design, where mothers received placebo and
erythromycin, placebo and co-amoxiclav, both antibiotics, or
double-placebo. The ORACLE Children Study I and II were
designed to analyze the long-term effects of the antibiotics on the
children at 7 years of age that were born to these mothers.

In the ORACLE Children Study II, researchers looked at mothers who had
spontaneous premature labor with intact membranes surrounding the
unborn children and no obvious infection signs. Seven years after
birth, a structured parental questionnaire was used to gather
follow-up data on the health status of the children of the 4,221 women
who had completed the study. The researchers were able to recover data
for 71% (3196) of eligible children. The study revealed that in
children whose mothers received erythromycin, there was an increase in
functional impairment compared to children of mothers who had not
received erythromycin – 42?·3% to 38.3%, respectively. This
translates to an increase in relative risk of 18% for receiving
erythromycin. The researchers found no effect on children whose mothers
received Co-amoxiclav – with or without erythromycin – concerning
functional impairment.

Further, the investigators discovered that children were more likely to
develop cerebral palsy who were born to mothers who had received the
antibiotics – an unexpected finding. Specifically, 3.3% of children
with mothers who received erythromycin (with or without co-amoxiclav)
and 1.7% of children with mothers who did not receive the antibiotic
had cerebral palsy. Similar numbers were found for children of mothers
given co-amoxiclav (with or without erythromycin) – 3.2% and 1.9%
developed cerebral palsy, respectively. For children of mothers given
both antibiotics, the risk of cerebral palsy was highest
- 4.4% of children had the disease compared to 1.6% of
children with mothers who received double placebo. This is a tripling
of risk.

The researchers did not conclude that either antibiotic had an effect
on the number of deaths, other medical conditions, behavioral
patterns, or educational attainment. “The prescription of erythromycin
for women in spontaneous preterm labour with intact membranes was
associated with an increase in functional impairment among their
children at seven years of age. The risk of cerebral palsy was
increased by either antibiotic, although the overall risk of this
condition was low,” conclude Dr Kenyon and colleagues.

In the ORACLE Children Study I, researchers followed up 4,148 eligible
children whose mothers joined the trial with preterm rupture of the
membranes without obvious infection signs. Erythromycin is currently
the recommended treatment since the original trial found that this
antibiotic resulted in reductions in short term neonatal death.
Seventy-five percent of eligible children (3,298) were assessed in The
Children Study, and the researchers found no differences in functional
impairment, behavioral difficulties, medical conditions, or
educational achievement with either antibiotic. The researchers
conclude that: “The prescription of antibiotics for women with preterm
rupture of the membranes seems to have little effect on the health of
children at seven years of age.”

Professor Philip J Steer (Chelsea and Westminster Hospital, London, UK)
and Dr Alison Bedford Russell (Warwick Medical School and Heart of
England NHS Trust, UK) write in an accompanying editorial that: “The
lessons to be learned seem clear; contrary to popular opinion (‘might
as well give them, they don’t do any harm’), antibiotics are not
risk-free. There are good reasons not to give them in association with
threatened preterm labour unless there is clear evidence of infection.
It is vital the practice is not extended by stealth beyond that which
is justified by the evidence, and interventions given in pregnancy
should always be evaluated with proper long-term follow-up.”

Childhood outcomes after prescription of antibiotics to pregnant women
with preterm rupture of the membranes: 7-year follow-up of the ORACLE I
trial
S Kenyon, K Pike, D R Jones, P Brocklehurst, N Marlow, A
Salt, D J Taylor
The Lancet (2008).
DOI:10.1016/S0140-6736(08)61202-7
Click
Here to View Journal Web Site

: Peter M Crosta

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Arkansas has halted the progression of childhood obesity, says Governor Mike Huckabee. In the state’s third annual assessment of childhood and adolescent obesity, Huckabee said “We have stopped the locomotive train of childhood obesity in it’s tracks, now it’s time to turn the train around and move full speed ahead to healthier living.”

Research was carried out on all students’ body mass index (BMI) in about 99% of the state’s public schools. The Arkansas Act 1220 of 2003 requires that all public school students have an annual BMI screening. The act also calls for increased access to healthier foods in schools and local communities. The aim is also to help local communities encourage physical activity.

Huckabee added “I attribute the positive results in large part to the Healthy Arkansas initiative which has been instrumental in changing the attitudes of many Arkansans when it comes to good health. The emphasis on exercising, eating right and quitting smoking is taking hold and paying off in healthy dividends.”

Huckabee thanked parents and teachers for their support in recent initiatives that limited access to vending machines in schools, while at the same time providing healthier alternatives. He praised parents’ and teachers’ efforts to increase physical activity in schools.

Measuring kids’ BMI did not go down well in some communities. Several parents felt it was an invasion of privacy. However, it was decided that as parents were no longer providing good child nutrition, it became the responsibility of schools.

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The Centre for Maternal and Child Enquiries (CMACE) releases its report Maternal obesity in the UK: Findings from a national project today after its three-year UK-wide national enquiry into Obesity in Pregnancy.

This major national study, which collected information from every maternity unit in the UK, has revealed for the first time the prevalence of severe maternal obesity (body mass index 35+) in the UK. The report also details the complications and consequences of obesity during pregnancy, and outlines the implications for the care of obese pregnant women.

This study found that around 5% of the UK maternity population were severely obese. In real terms, this equates to around 38,478 (1 in 20) pregnant women each year, and, with growing levels of obesity in the general population, this number is expected to increase. Wales was found to have the highest rate (6.5%, 1 in every 15 pregnant women) of severe maternal obesity in the UK. In England, the region with the highest rate was East of England (6.2%, 1 in every 16 pregnant women), while London had the lowest rates (3.5%, 1 in every 29 pregnant women).

The report highlighted that pregnancy outcomes for severely obese women are poorer when compared to the general population. The study found that the stillbirth rate in women with a BMI 35+ (8.6 per 1000 singleton births) was twice as high as the overall national stillbirth rate (3.9/1000 singleton births), and that the risk of stillbirth increases with increasing obesity. Also, in women with a BMI 35+, stillbirths occurring during labour and birth were three times higher than the overall national rate in England, Wales and Northern Ireland.

The risks of obesity in pregnancy extend to the mother too. Pregnant women, and especially obese pregnant women, are more at risk of developing venous thromboembolism (VTE), which is a potentially fatal condition that involves a blood clot forming in a vein which may break away, travel through the circulatory system and obstruct a blood vessel. The CMACE study revealed how VTE risk was poorly documented for obese pregnant women at their first antenatal appointment and fewer than 50% of the women at moderate or high risk of VTE were offered treatment to prevent the condition. For those women who did receive treatment antenatally, the prescribed doses were considered to be insufficient for their body weight, according to current guidelines published by the Royal College of Obstetricians and Gynaecologists (RCOG). Similar findings were found for postnatal treatment for the prevention of VTE, with only 55% of eligible women being prescribed the appropriate medication. These findings highlight that improvements in this area are required to reduce the risk of VTE in obese women during and after pregnancy.

The CMACE report also revealed that obese women have an increased risk of medical conditions both before and during pregnancy. Thirty-eight per cent of women in the study had at least one medical condition diagnosed prior to and/or during pregnancy. The most common conditions were gestational diabetes and pregnancy induced hypertension, which affect 8-9% of women with a BMI 35+; these conditions affect approximately 2-2.5% of women in the general maternity population. The presence of medical conditions increases the risk of complications for both the mother and baby, and increased surveillance and medical intervention are therefore required.

Only 55% of women with a BMI 35+ gave birth naturally. The caesarean section rate for singleton babies was 37%, which is 1.5 times higher than the rate in the general maternity population. In addition, severely obese women were at least four times more likely to suffer from postpartum haemorrhage within 24 hours of birth than women in the general maternity population.

The CMACE study also identified gaps in anaesthetic care for obese women. According to current joint CMACE/RCOG guidance, women with a BMI ?‰?40 (morbidly obese) should receive an antenatal consultation with an obstetric anaesthetist so that potential problems can be identified and an anaesthetic management plan for labour and delivery can be made. Only 45% of eligible women had such a plan.

A set of ten key recommendations has been developed by CMACE in response to the findings in the report. The purpose of providing these recommendations is to highlight areas requiring better clinical practice. The general points are:

– Better preconception care and advice is needed for women with overweight and obese BMIs. The joint CMACE/RCOG guideline on managing women with obesity in pregnancy, issued in March 2010, notes that women of childbearing age with a BMI 30+ should be provided with good information and advice on the risks of obesity during pregnancy and childbirth; and they should be supported to lose weight before conception and in the postnatal period. Pre-pregnancy counselling must also include taking an accurate height and weight measurement for a BMI calculation to identify women who may be at further risk or require additional services or care.

- Women with obesity have an increased risk of pregnancy complications such as gestational diabetes and pre-eclampsia. CMACE recommends that surveillance and screening according to existing guidelines occur so that referrals for specialist care can be made early in pregnancy.

– Women with a BMI 40+ should have a consultation with an obstetric anaesthetist, as recommended by the joint CMACE/RCOG guideline on obesity in pregnancy, so that potential problems such as venous access can be identified before the birth.

Professor James Walker, Chair of CMACE said, “The numbers of obese mothers are on the rise and this group of women require specialist care since they are more susceptible to illnesses and complications. So far, there hasn’t been a UK-wide study on the extent of the problem but we now have very good data on how these women are cared for and the areas where improvements are urgently needed”.

Dr Imogen Stephens, CMACE Clinical Director said, “This CMACE report shows that much more needs to be done in the NHS to deal with the growing numbers of obese pregnant women. We have already shown in our previous survey how specialist equipment such as wheelchairs, trolleys and beds are needed to care for this unique group of women. The findings from this new study show that the risks of clinical intervention increase with increasing levels of obesity and that specialist obstetric care is needed. All this requires improved, and better integrated, care for these women”.

Dr Tony Falconer, President of the Royal College if Obstetricians and Gynaecologists (RCOG) said, “Pregnant women who are obese need to know about the associated risks for them and their baby and must be supported to lose weight before they embark on pregnancy. This will involve counselling and advice from a range of healthcare professionals including GPs, midwives, maternity support workers and nutritionists.

When a woman finds out she is pregnant, she tends to adopt positive behaviours to ensure that she is as healthy as she can possibly be and this includes sensible eating and lower alcohol consumption. However, we need to think about being more proactive by encouraging and enabling women to lead healthier lives before they fall pregnant and after giving birth so that they take a more long-term approach to being healthy”.

Professor Cathy Warwick, General Secretary of the Royal College of Midwives, said “Our own research backs up these recommendations. Women have told us that they are not getting the level of care that they should from maternity services.

“There is no doubt that being obese and pregnant can leave women open to more problems in pregnancy than non- obese women. However with high quality care these problems can be identified and treated and women can have a very positive experience of pregnancy and birth. It is therefore crucial that midwives and other health professionals work together to ensure that these women get the best possible care, support and advice. Many women have told the RCM that one of the big barriers to this is that there are simply not enough midwives to spend time with them especially in the antenatal period.

“There is also a much wider and long-term public health message here. There is a real need to reduce obesity in the population as a whole, tackling the issue before women become pregnant.”

Notes

The research lead for this project and author of the report is Dr Kate Fitzsimons (Senior Research Fellow, CMACE). The editor of the report is Professor Ian Greer (Executive Pro-Vice-Chancellor, Faculty of Health & Life Sciences, University of Liverpool; Chair of the National Advisory Committee for CMACE).

To view Maternal obesity in the UK: Findings from a national project, please click here. The launch of the report accompanies the CMACE conference ‘Obesity in Pregnancy: Improving care and effecting change’. To view the conference programme, click here.

This new report follows the publication of the CMACE survey on NHS maternity provision to obese women and the joint CMACE/RCOG clinical guideline ‘Management of Women with Obesity in Pregnancy’ in March this year.

Body mass index (BMI) offers a useful measure of obesity and is a simple index of weight-for-height used to classify underweight, overweight and obesity in adults. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in metres (kg/m2). The table below shows a widely accepted classification published by both the World Health Organization and the National Institute for Health and Clinical Excellence (NICE). This report focused on women with a BMI 35+ (severely obese) in pregnancy. A woman with a height of 5ft 5″ and a weight of 15 stone would have a BMI of 35.

BMI (kg/m2) Classification

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Australian and American scientists have identified the origins of the most malignant type of brain tumour in a discovery that could lead to better therapies and improve our understanding of how tumours initiate.

The team, led by Professor Brandon Wainwright from the Institute for Molecular Bioscience at the University of Queensland in Brisbane, Australia, and Dr Robert Wechsler-Reya from Duke University in Durham, USA, studied medulloblastomas, which occur most often in children.

“Almost half the people who develop these tumours die from them, and those who survive often suffer severe side effects from the treatment,” Professor Wainwright said. “Improved treatments are urgently required, but in order to develop these, we need a deeper understanding of the molecular and cellular origins of medulloblastomas.”

The team found that medulloblastomas can originate from two types of cell: multipotent neural stem cells (NSCs) and granule neuron precursors (GNPs). NSCs are stem cells that can become most types of cell within the nervous system, while GNPs are similar to stem cells but only give rise to one type of cells, known as granule neurons.

“There was good evidence that either cell type could be the origin of medulloblastomas, but no one considered that both sets of evidence could be correct, and that these tumours could actually begin in two different cell types,” Professor Wainwright said.

“Identifying the normal cell that gives rise to a tumour is important because it allows direct comparisons between tumour cells and their normal counterparts so that key differences and vulnerabilities in the tumour can be identified.

“Also, recent studies suggest that cells resembling the original cell may persist in mature tumours and can be critical in ensuring its survival. If so, these cells would be an excellent target for treatment.”

The team made their discovery by examining a gene called Patched, which is involved in the regulation of both neural stem cells and GNPs. When the gene is inactivated, medulloblastomas develop.

However, when inactivation occurs, it happens in all cells, so there was no way of knowing in which cell the tumour had begun. The team took advantage of an allele, or version, of Patched that allows inactivation of the gene in either GNPs or neural stem cells, and found that the tumours developed no matter in which cell Patched was inactivated.

The study could also have wider implications for treating other types of cancer, as the team also found that cancer doesn’t always originate in the same way.

“It has always been thought that cells had to mutate several times before becoming a tumour,” Professor Wainwright said. “In this study we found that some stem cells only needed to mutate once.

“They would not turn cancerous immediately, but once they had been given an instruction to turn into a more specialised cell, the mutation would take hold and they would instead turn into a tumour.”

The study has been published in current issue of leading scientific journal Cancer Cell
, and is funded by the National Health and Medical Research Council, the Australian Cancer Research Foundation, the Cancer Council QLD and the John Trivett Foundation.

The University of Queensland, Brisbane Australia Continue reading →