Friday, 24 June 2011

“High doses of statins could increase risk of diabetes

“High doses of statins

could increase risk of diabetes,” theDaily Mail reported. The newspaper said that people taking intensive courses ofstatins, the cholesterol-lowering medicines, are 12% more likely to get the disease.

These findings come from a review that combined the results of previous trials to compare the effects of intensive-dose stains with moderate-dose statins. It found that the risk of diabetes was higher in people given the intensive dose, with one extra case of diabetes expected for each 498 people treated in this way for one year. However, the intensive regime would also be expected to prevent an additional three people from having a cardiovascular event, such as a heart attack or stroke.

This research provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up the circumstances of each patient, assessing whether the reduced risk of cardiovascular events with intensive statin therapy is worth the additional risk of diabetes. Overall, the results of this research suggest that the benefits are likely to outweigh the risk in people with a greater chance of cardiovascular events.

As the Mail importantly noted, people should not stop taking their statins because of this research.

Where did the story come from?

The study was carried out by researchers from the University of Glasgow and other research centres in the UK, US and Australia. No sources of funding were reported for the current study. The study was published in the peer-reviewed Journal of the American Medical Association.

Both The Daily Telegraph and Daily Mail covered this story well, noting that the cardiovascular benefits of intensive-dose statins in high-risk individuals are likely to outweigh the risks, and that people should not stop taking their statins as a result of this research. The Telegraph also helpfully provided absolute figures that allow readers to gauge the effects of these treatments, rather than just percentage increases or reductions in risk, which can be difficult to interpret.

The Daily Express took another angle, suggesting that “cheaper statins on NHS can put patients in danger”. The newspaper said the study found that the drug simvastatin “recommended by the National Institute for Health and Clinical Excellence does not protect against coronary events as effectively as the alternative drug atorvastatin among patients taking high doses” and that the researchers call for NICE “to recommend the more expensive pill instead”. This does not represent the aims or conclusions of this research paper, and the researchers did not make such as recommendation.

The study did not aim to compare atorvastatin and simvastatin. Instead, it was concerned with comparing the effects of different doses of statin. While one analysis carried out in the study did find that intensive dose simvastatin did not reduce risk of cardiovascular events compared with moderate dose statins, this was not the main aim of the paper, and therefore these results need to be treated with caution until this observation can be investigated further.

What kind of research was this?

This systematic review and meta-analysis compared the risk of developing diabetes associated with intensive-dose statin therapy and moderate-dose statin therapy.

Statins are drugs used to reduce the levels of cholesterol in the blood, with the aim of reducing the risk of cardiovascular events such as heart attacks. In 2010, the authors of this study published a similar study which found that statin therapy was associated with an increased risk of developing type 2 diabetes. In the current study, they looked at whether the risk varied depending on the dose of statin used. As statins aim to reduce the risk of cardiovascular events, the researchers also wanted to see how the dose of statin affected the risk of cardiovascular events, such as heart attacks, strokes or death from these events.

A systematic review is the best way to summarise the evidence currently available on a particular question. Pooling the results from the available studies can lead to a more robust estimate of the effects of a treatment. However, the studies included need to have sufficiently similar methods in order for the pooled results to be meaningful and valid.

What did the research involve?

The researchers searched various research databases to identify randomised controlled trials published between 1996 and 2011 that met their inclusion criteria. They also asked other researchers in the field to provide details of any additional relevant unpublished studies. To be included, the trials had to have compared intensive-dose statin therapy and moderate-dose statin therapy in over 1,000 participants, and followed them up for at least a year.

The researchers used the search terms “intensive” or “aggressive” to identify relevant trials, but did not provide a specific definition of what they considered constituted moderate- or intensive-dose therapy. All trials used statin doses that were within the licensed dosing range for the drug, with intensive doses tending to be at the maximum recommended dose (such as 80mg of simvastatin or atorvastatin daily), while moderate doses tended to be the lower starting doses (for example, 10mg or 20mg daily).

The researchers asked the people who conducted the eligible trials to provide data that could be used in their analyses. These included the number of participants in their trials who had diabetes at the start of the study, and the number of people who developed diabetes or had cardiovascular events. They also collected data on the participants’ characteristics such as body mass index (BMI) and levels of cholesterol, other blood fats and glucose.

They then used accepted statistical methods to pool these results to see if the risk of diabetes or cardiovascular events differed between intensive-dose and moderate-dose statins. They also used statistical methods to assess how similar the trial results were. If the results were very different, this would suggest that the studies might be too different to be pooled in this way.

What were the basic results?

The researchers identified five trials that included 32,752 participants without diabetes. Three of these trials compared different doses of the same statin (simvastatin or atorvastatin), while two compared an intensive dose of one statin against a moderate dose of another statin (atorvastatin versus either pravastatin or simvastatin).

During an average of 4.9 years’ follow-up, 2,749 participants (8.4%) developed diabetes. This included 1,449 (8.8%) of those receiving intensive-dose statin therapy and 1,300 (8.0%) of those receiving moderate-dose statin therapy. This represented two more cases of diabetes per 1,000 patient years in the intensive-dose statin group than in the moderate-dose group (rising from about 17 cases per 1,000 patient years to about 19 cases per 1,000 patient years). This means that 498 people would need to be treated with intensive-dose therapy for a year to lead to one additional case of diabetes over and above what would be seen with moderate-dose statins.

During follow-up, 6,684 participants had a cardiovascular event. This included 3,134 (19.1%) of those receiving intensive-dose statin therapy and 3,550 (21.7%) of those receiving moderate-dose statin therapy. This represented 6.5 fewer cases of cardiovascular events per 1,000 patient years in the intensive-dose statin group than the moderate-dose group (reduced from 51 cases per 1,000 patient years to 44.5 cases per 1,000 patient years). This means that 155 people would need to be treated with intensive-dose therapy for one year to prevent one additional person having a cardiovascular event compared to what would be seen with moderate-dose statins.

How did the researchers interpret the results?

The researchers concluded that “intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy”. However, they note that intensive-dose statin therapy does reduce the risk of cardiovascular events compared with moderate-dose statins. They say that their findings “suggest that clinicians should be vigilant for the development of diabetes in patients receiving intensive statin therapy”.

Conclusion

This systematic review and meta-analysis suggest that intensive-dose statin therapy is associated with an increased risk of diabetes compared to moderate-dose statins. However, intensive use also reduces the risk of cardiovascular events, such as heart attacks or strokes. The study used appropriate methods to investigate this question and, importantly, gives us an idea of the trade-off between benefits and harms of intensive-dose statin therapy.

There are some points to note:

The trials that were included varied in their methods of diagnosing diabetes, which could affect the reliability of the pooled results. However, the researchers performed statistical tests and applied different types of analyses to the data. This suggests that, despite these differences in method, the trials all had similar findings. This increases our confidence in the findings of this review.

The pooled trials all included people who had established coronary disease and were at high risk of having future cardiovascular events. This means that the results may not represent what might happen in groups of people with different characteristics and who might be prescribed statins. For example, this could include people with a higher risk of developing diabetes or people with certain risk factors that had not yet developed heart disease or had cardiovascular disease events (such as people with raised cholesterol due to the hereditary condition of familial hypercholesterolemia, who are often treated with high-dose statins as “primary prevention” against them developing cardiovascular disease).

Most of the trials (four out of five) did not regularly test for diabetes so some cases may have been missed. The researchers say that it is possible that people given intensive statin therapy may have had more side effects than those on moderate-dose statins, and may therefore have seen their doctors more regularly, and received medical checkups more regularly. This could have led to diabetes being picked up more often in people receiving intensive statin therapy, with those receiving moderate-dose statin therapy remaining undiagnosed.

This research provides more information about the potential link between statin treatment and the risk of developing diabetes. It provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up for each patient whether the reduction in risk of cardiovascular events seen with intensive statin therapy is worth the additional risk of diabetes.

As echoed by most newspapers, the absolute increase in the risk of diabetes was relatively low compared to the absolute reduction in risk of cardiovascular events. Therefore, overall the benefits of statins outweigh the side effects. However, it is also worth remembering that statins are used in different ways and that this balance of benefit and risk may vary in the different groups who are prescribed the drugs. These include, people at high risk of diabetes or who take the statin as “primary prevention” to stop them developing cardiovascular disease and people who are prescribed them after an event such as a heart attack.

Links to the headlines

High-dose statins 'increase Type 2 diabetes risk'. The Daily Telegraph, June 22 2011

High doses of statins could increase risk of diabetes. Daily Mail, June 22 2011

Cheaper statins on NHS can put patients in danger. Daily Express, June 22 2011

Links to the science

Preiss D, Kondapally Seshasai SR, Welsh P et al. Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy. A Meta-analysis. Journal of the American Medical Association. 2011;305(24):2556-2564

Some of the drugs examined

Category one, mild

Codeine (painkiller)
Warfarin (blood thinner)
Timolol maleate (eye drops)

Category three, severe

Piriton (antihistamine)
Ditropan (incontinence drug)
Seroxat (antidepressant)

Full list of drugs investigated

A combined score was calculated in 13,000 patients aged 65 or over, by adding together the scores for all the medicines they were taking.

A patient taking one severe drug and two mild ones would have an overall score of five.
Deadly consequences
Between 1991 and 1993, 20% of patients with a score of four or more died. Of those taking no anticholinergic drugs only 7% died.
Patients with a score of five or more showed a 4% drop in ratings of brain function.
Other factors, such as increased mortality from underlying diseases, were removed from the analysis.

“Start Quote

Do not stop your medicines without taking advice first”

End Quote Dr Clare Gerada Royal College of GPs

However, this study cannot say that the drugs caused death or reduced brain function, merely that there was an association.

Dr Chris Fox, who led the research at the University of East Anglia, said: "Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects.
Dr Clare Gerada, chairman of the Royal College of GPs, said the findings of the study were important.
She told patients: "The first thing is not to worry too much, the second thing is to discuss it with your doctor or the pharmacist, and the third thing is do not stop your medicines without taking advice first."
She said doctors reviewed medication every 15 months and were aware of the risks of combining different drugs.
Dr Fox said he wanted to conduct further research to investigate how anticholinergic drugs might increase mortality.

Electrical signals cannot cross the gap between brain cells; neurotransmitters pass the message on

A more modern study is also thought to be desirable. Practices and drugs have changed since the data was collected two decades ago.
Ian Maidment, an NHS pharmacist in Kent and Medway, believes the situation may now be even worse.
He said the use of anticholinergic drugs had "probably increased as more things are being treated and more drugs are being used."
Brain decline
Reduction of the neurotransmitter acetylcholine has already been implicated in dementia.
The drug Aricept is given to some patients with Alzheimer's disease to boost acetylcholine levels.
Dr Susanne Sorensen, head of research at the Alzheimer's Society, said a 4% drop in brain function for a healthy person would feel like a slow, sluggish day.
"If you are at a level where one little thing pushes you over into confusion, then that is much more serious," she added.
"However, it is vital that people do not panic or stop taking their medication without consulting their GP."
Rebecca Wood, chief executive of Alzheimer's Research UK, said: "This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription."

Have you been affected by the issues raised in this story? Send us your comments using the form below:

Type 2 diabetes in newly diagnosed 'can be reversed'

Newcastle University researchers found the low-calorie diet reduced fat levels in the pancreas and liver, which helped insulin production return to normal.
Seven out of 11 people studied were free of diabetes three months later, say findings published in the journal.
More research is needed to see whether the reversal is permanent, say experts.
Type 2 diabetes affects 2.5m people in the UK. It develops when not enough insulin is produced in the body or the insulin that is made by the body doesn't work properly.
When this happens, glucose - a type of sugar - builds up in the blood instead of being broken down into energy or fuel which the body needs.
The 11 participants in the study were all diagnosed with Type 2 diabetes within the previous four years.
They cut their food intake drastically for two months, eating only liquid diet drinks and non-starchy vegetables.
Fat loss
After one week of the diet, researchers found that the pre-breakfast blood sugar levels of all participants had returned to normal.
MRI scans of their pancreases also revealed that the fat levels in the organ had decreased from around 8% - an elevated level - to a more normal 6%.
Three months after the end of the diet, when participants had returned to eating normally and received advice on healthy eating and portion size, most no longer suffered from the condition.

“Start Quote

It offers great hope for many people with diabetes.”

End Quote Prof Keith Frayn University of Oxford

Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University and lead study author, said he was not suggesting that people should follow the diet.

"This diet was only used to test the hypothesis that if people lose substantial weight they will lose their diabetes.
"Although this study involved people diagnosed with diabetes within the last four years, there is potential for people with longer-standing diabetes to turn things around too."
Susceptibility question
Dr Ee Lin Lim, also from Newcastle University's research team, said that although dietary factors were already known to have an impact on Type 2 diabetes, the research showed that the disease did not have to be a life sentence.
"It's easy to take a pill, but harder to change lifestyle for good. Asking people to shift weight does actually work," she said.
However, not everyone in the study managed to stay free of diabetes.
"It all depends on how much individuals are susceptible to diabetes. We need to find out why some people are more susceptible than others, then target these obese people. We can't know the reasons for that in this study," Dr Lim said.
Professor Edwin Gale, a diabetes expert from the University of Bristol, said the study did not reveal anything new.
"We have known that starvation is a good cure for diabetes. If we introduced rationing tomorrow, then we could get rid of diabetes in this country.
"If you can catch people with diabetes in the early stages while beta cells are still functioning, then you can delay its onset for years, but you will get it sooner or later because it's in the system."
But Keith Frayn, professor of human metabolism at the University of Oxford, said the Newcastle study was important.
"People who lose large amounts of weight following surgery to alter their stomach size or the plumbing of their intestines often lose their diabetes and no longer need treatment.
"This study shows that a period of marked weight loss can produce the same reversal of Type 2 diabetes.
"It offers great hope for many people with diabetes, although it must be said that not everyone will find it possible to stick to the extremely low-calorie diet used in this study."
Dr Iain Frame, director of research at Diabetes UK, which funded the study, said the diet was not an easy fix.
"Such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term."

Wednesday, 22 June 2011

westof: pasty faced wimp Dr Mark Salter of the Health Protection Agency.

pasty faced wimp Dr Mark Salter of the Health Protection Agency.

Health warning to festival goers

Crowds create infection risks

Too much alcohol, drugs, and sex, coupled with poor hygiene, can be a health risk at festivals, an expert is warning.

Sunburn, heat stroke, sprains and other minor ailments make up most casualties at music events, says Dr Mark Salter of the Health Protection Agency.

But there are occasional reports of sexual health problems, heart attacks and chest complaints.

Avoiding doing anything to excess is the best way to stay healthy, he adds.

Dr Salter, a consultant in communicable disease control at the HPA's Health Protection Unit in the South West has been attending festivals, including Glastonbury, for 20 years, to offer health protection advice.

More top tips for festival health

Anyone who is unwell before a festival, particularly with diarrhoea and sickness, should not go to prevent spreading infection
Take a good supply of existing medicines and pack them in luggage
Find out where health services are at the festival, and seek help if you fall ill
Drinking water should be taken from potable water taps which are signposted
Source: Dr Mark Salter, HPA

His "top tips" for surviving festivals include using condoms, drinking plenty of water from a safe source, wearing a hat and sunscreen, and washing hands thoroughly after using the toilet.

Dr Salter said: "Avoid doing anything to excess is the best way to protect your health if you are visiting a festival this year.

"My experience of providing health advice and assistance at festivals for over 20 years tells me that people generally end up being unwell due to the combination of too much alcohol, drugs, sex and less than ideal hygiene.

"It is inevitable when suddenly thousands of people crowd together at a rural site with no fixed toilet system or bathing facilities and lots of alcoholic drinks that some people will become unwell as the risk of infection increases.

"It is therefore essential to follow good hygiene practices and wash your hands thoroughly after using the toilets."

Tuesday, 14 June 2011

Deaths from E. coli still rising in Germany

Test samples of bean sprouts in a German lab, 10 Jun 11

Investigators still want to know how bean sprouts became contaminated

Europe's E. coli outbreak

The death toll has risen to 35 in Germany's E. coli epidemic and health officials say about 100 patients have severe kidney damage.

The source of infection has been identified as bean sprouts from an organic farm in northern Germany.

At least 3,255 people have fallen ill, mostly in Germany, of whom at least 812 have a complication that can be fatal.

About 100 patients with damaged kidneys will need transplants or life-long dialysis, one health expert said.

Karl Lauterbach, an epidemiologist who is also an opposition Social Democrat (SPD) politician, warned that E. coli infections were growing worldwide.

Since the start of the outbreak in May, all but one of the deaths have been in Germany.

Investigators say they believe organic bean sprouts from a farm in Bienenbuettel, Lower Saxony, were responsible. The farm's produce has been withdrawn from sale.

Several workers from the farm have fallen ill with the virulent new E. coli strain.

Biological challenge

Germany's national disease agency, the Robert Koch Institute (RKI), said the death toll rose to 35 at the weekend, but the rate of new infections was declining.

Yet it is still not clear how the bean sprouts became contaminated with the bug, which normally lives in the guts of cattle and sheep.

Health advice

Wash fruit and vegetables before eating them
Peel or cook fruit and vegetables
Wash hands regularly to prevent person-to-person spread of E. coli strain

Source: UK Health Protection Agency

Health experts quoted by the Associated Press news agency said the toxin produced by the new E. coli bug in Germany was especially potent.

The German strain causes not only bloody diarrhoea but also neurological disorders, including paralysis in some cases. The potentially fatal complication is called haemolytic uraemic syndrome (HUS).

Tests show that the strain has genes that make it resistant to many antibiotics.

Germany plans to tighten its checks on fresh vegetables and there are calls to speed up lab reporting procedures.

Consumer Affairs Minister Ilse Aigner said she had asked regional authorities across Germany to prioritise checks on growers and importers of bean sprouts, including handlers of imported seeds.

Germany has lifted its warning against eating raw cucumbers, tomatoes and lettuce, but kept it in place for the sprouts.

The European Commission has offered 210m euros (£186m; $303m) to European farmers who have seen a dramatic loss of income since the outbreak started in early May.

Initially Germany mistakenly blamed Spanish cucumbers - a move which brought some Spanish vegetable exporters to a standstill.

Southern Cross uncertainty surrounding the future of the UK's biggest care home provider.

Thousands of people are facing an anxious time due to the uncertainty surrounding the future of the UK's biggest care home provider.

Southern Cross has announced a plan to pay less to landlords of the properties in a bid to ease its financial plight.

The government says it will ensure there is protection for anyone affected by changes to the business - saying the welfare of residents is its "number one concern".

The company says it is confident a solution to its current problems can be found and industry experts consider mass closures to be unlikely. But there is speculation that the number of homes could be cut.

Some smaller care home operators do close the doors of their properties occasionally. So what are residents' rights if this happens?

Who is entitled to care assistance?

Many thousands of elderly people have places in care homes because they need more support than they can get in their own home.

Councils will usually do a needs assessment to work out what type of care is required.

This is then typically followed by a financial assessment to work out how much you will have to contribute to the cost of your care.

In England, if your savings and property are worth less than £14,250, your local council will pay all of the cost. However, you may have to contribute if the care home you choose is more expensive than what the council usually pays for.

If your savings and property are between £14,250 and £23,250, the council will make a contribution.

But if you are deemed to be worth more than £23,250, you will have to pay the full cost of your residential care.

However, if a medical assessment finds that you need continuing, medical care, the NHS in England will pay £108.70 per week towards just the nursing costs.

The NHS will pay the full cost of care for those with the greatest needs.

In Scotland, all of your personal care and nursing care will be paid for, subject to the necessary assessments.

But the cost of accommodation in a home is means-tested as in England. The figures differ slightly:

Savings and property up to £14,000 - full costs paid
Between £14,500 and £22,750 - some help
Over £22,750 - resident has to pay full cost of care home accommodation.

Wales and Northern Ireland both have means-tested systems which are similar to England, but both are looking to change.

In Wales, you will need to pay the full amount if you have more than £22,000 in savings and property.

Also, the NHS in Wales will contribute £120.55 per week towards nursing care.

In Northern Ireland, the threshold is £23,250. Above that amount you will have to pay for your care home.

What happens if a care home closes?

The local authority is obliged to find another place for residents who are forced to move, and whose place is publicly funded.

It is understood that there are enough places in total to cover the mass movement required if a company the size of Southern Cross was forced to fold.

However, the council must consider people's emotional needs, as well as their physical needs, according to advice charity FirstStop. This could include being put in a home that is close to where their relatives live.

Can the residents choose where to go?

Yes, there is an element of choice.

The local authority must find somewhere that provides a service that matches people's care needs.

Each local authority sets an amount which they would normally pay which relates to the level of need they have.

If other care homes charge more, and the resident chooses to live there, then relatives can top up the cost.

Alternatively, families can challenge the maximum cost rate set by the council if there are no homes in the area that are cheap enough and provide the care required.

What about those older people who fund their care home place themselves?

If people are self-funding their care home place, then they are still entitled to the needs assessment from the local authority.

This will help them judge which care home they can move into. They are entitled to information and support to find an alternative.

If they have no relatives to help, and are too unwell to make the decision themselves, then the local authority is obliged to help them.

Charities believe that the trauma of moving people around when they are very old can affect their health.

Saturday, 11 June 2011

German tests link bean sprouts to deadly E. coli

Bean sprouts and salad sprouts (file picture)

It is believed the bean sprouts were produced in Germany

Europe's E. coli outbreak

New data released in Germany strongly suggests that locally produced bean sprouts were, as suspected, the source of the deadly E. coli outbreak.

"It's the bean sprouts," said Reinhard Burger, head of Germany's centre for disease control.

Officials initially blamed the E. coli, which has killed 29 people, on imported cucumbers, then bean sprouts.

In another development, Russia agreed to lift its ban on imports of EU fresh vegetables in return for guarantees.

The Russian ban had compounded a crisis for EU vegetable-growers, with Spanish cucumber producers wrongly blamed for the contamination.

Mr Burger, who heads the Robert Koch Institute, told reporters on Friday that even though no tests of the sprouts from a farm in Lower Saxony had come back positive, the epidemiological investigation of the pattern of the outbreak had produced enough evidence to draw the conclusion.

The institute, he added, was lifting its warning against eating cucumbers, tomatoes and lettuce, but keeping it in place for the sprouts.

Some 3,000 people have been taken ill with the German outbreak of E. coli, which involves a previously unknown strain of the bacterium.

Sufferers may develop haemolytic uraemic syndrome (HUS) where bacteria attack the kidneys and nervous system, giving them fits and often forcing them on to dialysis.

'Hot lead'

A Robert Koch Institute team in protective gear inspect the organic farm in Bienenbuettel, 6 June

Robert Koch Institute researchers have been examining the farm in Bienenbuettel

"People who ate sprouts were nine times more likely to have bloody diarrhoea than those who did not," Mr Burger said.

Germany's top disease control official said the origin of the contamination was still believed to be the small organic farm in Lower Saxony which first came under suspicion at the weekend.

"The links are ever clearer - it's a hot lead," he told reporters in Berlin, at a joint news conference with the heads of Germany's federal institute for risk assessment and federal office for consumer protection.

He said it was possible that all tainted sprouts had now either been consumed or thrown away, but he warned the crisis was not yet over.

"There will be new cases coming up," he said.

"Thousands of tests carried out on tomatoes, cucumbers and lettuce have proved negative," he added.

Lower Saxony agriculture minister Gert Lindemann said earlier this week that experts had found no traces of the E. coli bacterium strain at the Bienenbuettel farm but he did not rule it out as the source of the contamination.

In an interview to be published in next week's edition of Focus magazine, Mr Lindemann said some 60 of the people taken ill had eaten sprouts from the farm, which employs about 15 people.

Contamination might have been caused by contaminated seeds or "poor hygiene", he added.

Ban to be lifted

The agreement to lift the Russian ban was announced after talks between top EU officials including the Commission chief, Jose Manuel Barroso, and Russian counterparts in the central Russian city of Nizhny Novgorod.

Health advice

Wash fruit and vegetables before eating them
Peel or cook fruit and vegetables
Wash hands regularly to prevent person-to-person spread of E. coli strain

Source: UK Health Protection Agency

"We are ready to resume the shipments under guarantees of the EU authorities," President Dmitry Medvedev told reporters.

Russia's top food safety officer, Gennady Onishchenko, said Russia would lift its prohibition after receiving food safety guarantees from the European Commission.

Mr Barroso said the EU would send a form for issuing food safety certificates to Russia in the next few days.

According to the Commission, the total value of EU exports of fresh vegetables to Russia is 600m euros (£530m; $870m) a year, a quarter of the total exported.

Spain, France, Germany and Poland are the biggest exporters.

Climate sceptics rally to expose 'myth'

10 June 2011 Last updated at 13:59

Global warming since 1995 'now significant'

Phil Jones's comments last year have become a touchstone for climate "sceptics"

Climate warming since 1995 is now statistically significant, according to Phil Jones, the UK scientist targeted in the "ClimateGate" affair.

Last year, he told BBC News that post-1995 warming was not significant - a statement still seen on blogs critical of the idea of man-made climate change.
But another year of data has pushed the trend past the threshold usually used to assess whether trends are "real".
Dr Jones says this shows the importance of using longer records for analysis.

“Start Quote

It just shows the difficulty of achieving significance with a short time series”

End Quote Phil Jones

By widespread convention, scientists use a minimum threshold of 95% to assess whether a trend is likely to be down to an underlying cause, rather than emerging by chance.

If a trend meets the 95% threshold, it basically means that the odds of it being down to chance are less than one in 20.
Last year's analysis, which went to 2009, did not reach this threshold; but adding data for 2010 takes it over the line.
"The trend over the period 1995-2009 was significant at the 90% level, but wasn't significant at the standard 95% level that people use," Professor Jones told BBC News.
"Basically what's changed is one more year [of data]. That period 1995-2009 was just 15 years - and because of the uncertainty in estimating trends over short periods, an extra year has made that trend significant at the 95% level which is the traditional threshold that statisticians have used for many years.
"It just shows the difficulty of achieving significance with a short time series, and that's why longer series - 20 or 30 years - would be a much better way of estimating trends and getting significance on a consistent basis."
Professor Jones' previous comment, from a BBC interview in Febuary 2010, is routinely quoted - erroneously - as demonstration that the Earth's surface temperature is not rising.
Globally consistent
The dataset that Professor Jones helps to compile - HadCRUT3 - is a joint project between the Climatic Research Unit (CRU) at the University of East Anglia (UEA), where he is based, and the UK Met Office.

Phil Jones is back at the scientific helm of CRU, though relieved of administrative leadership

It is one of the main global temperature records used by bodies such as the Intergovernmental Panel on Climate Change (IPCC).
HadCRUT shows a warming 1995-2010 of 0.19C - consistent with the other major records, which all use slightly different ways of analysing the data in order to compensate for issues such as the dearth of measuring stations in polar regions.
Shortly before the UN climate summit in Copenhagen, Phil Jones found himself at the centre of the affair that came to be known as "ClimateGate", which saw the release of more than 1,000 emails taken from a CRU server.
Critics alleged the emails showed CRU scientists and others attempting to subvert the usual processes of science, and of manipulating data in order to paint an unfounded picture of globally rising temperatures.
Subsequent enquiries found the scientists and their institutions did fall short of best practice in areas such as routine use of professional statisticians and response to Freedom of Information requests, but found no case to answer on the charges of manipulation.
Since then, nothing has emerged through mainstream science to challenge the IPCC's basic picture of a world warming through greenhouse gas emissions.
And a new initiative to construct a global temperature record, based at Stanford University in California whose funders include "climate sceptical" organisations, has reached early conclusions that match established records closely.

Thursday, 9 June 2011

strain of MRSA that appears to spread to humans from cattle

“Scientists in the UK have discovered a new strain of MRSA that appears to spread to humans from cattle and can cause life-threatening illness,” reported The Guardian. It said that a study of dairy herds had found the drug-resistant strain in cows' milk.

MRSA (meticillin-resistant Staphylococcus aureus) is usually detected using a technique called antibiotic-susceptibility testing. Borderline cases of MRSA are confirmed with molecular testing, which detects the presence of a gene that is common to these “superbugs”.

This study looked at strains of MRSA from cattle and humans to see whether they possessed any new genetic features that affect the reliability of these tests.

The study found a new type of gene in many of the cattle samples. This gene makes the bacteria resistant to a range of antibiotics. While the bacteria with this gene showed up in antibiotic-susceptibility testing, molecular testing could not recognise the gene and failed to identify the bacteria as MRSA.

Therefore, if molecular testing is used to detect MRSA or to confirm borderline cases, it will not identify bacteria with the new gene.

The researchers say that only a small proportion of MRSA bacteria possess this gene. However, as it has been detected in MRSA samples from dairy cows, these animals might form a “reservoir of infection”. They warn that close links with farms or contact with dairy cattle could increase the risk of MRSA being transmitted to humans. Further studies are needed to inform tests for diagnosing MRSA.

Experts highlight that the main worry is that bacteria may colonise people who work on farms, and not that people may be at risk from drinking milk. As almost all milk sold in the UK is pasteurised, drinking or eating dairy products is reportedly “not a health concern”.

Where did the story come from?

The study was carried out by researchers from the Department of Veterinary Medicine at the University of Cambridge and other health and academic institutions in Cambridge and the UK.

Funding was provided by the Department for Environment, Food and Rural Affairs, the Higher Education Funding Council for England, the Isaac Newton Trust (University of Cambridge) and the Wellcome Trust.

The study was published in the peer-reviewed medical journalThe Lancet.

The news headlines have oversimplified this complex research and may imply that people are at risk from drinking milk, which is not the case. The main implications of these findings are in the field of laboratory and diagnostic testing.

What kind of research was this?

This laboratory study looked at strains of MRSA from samples taken from cattle and humans. The researchers wanted to see if they possessed any new genetic features that meant that they could not be detected by standard tests for diagnosing MRSA.

The researchers explained that animals are known to act as a “reservoir” for new strains of bacteria, so could be a source of new strains of the superbug MRSA (meticillin-resistant Staphylococcus aureus) in humans. Staphylococcus aureus causes a wide variety of infections in humans, from skin infections to pneumonia and blood poisoning. However, many people carry the bacteria harmlessly on their skin.

MRSA has developed resistance to meticillin and other penicillin antibiotics that would normally kill Staphylococcus aureus. This means that MRSA can cause disease that is harder to treat. It is believed that the Staphylococcus aureus bacteria evolved to develop this resistance by acquiring a certain chromosome element (called SCCmec) which contain a gene called mecA. This gene encodes a protein that binds to penicillin.

The researchers describe how MRSA is usually identified in the laboratory using “antimicrobial susceptibility testing”. In this test, the bacteria are incubated with discs that are impregnated with antibiotics. The zone around the disc where bacterial growth has been prevented is measured. There are standard zones around the disc that confirm the presence of MRSA. If the results are borderline, molecular testing (called PCR testing) is used to detect the mecA gene or penicillin-binding protein in the bacteria.

Before 2003, most cases of MRSA were associated with human transmission and infection, but after this time it was found in livestock. Evidence was also found that some strains may not be restricted to a single species but can cross between humans and farm animals. There is concern that farm animals could act as a reservoir for MRSA and that close human-animal contact could increase the risk of transmission.

What did the research involve?

The researchers took isolates (a pure strain that has been separated from a mixed bacterial culture) of MRSA bacteria from both humans and cows and determined whether antimicrobial susceptibility testing could detect the bacteria.

In 2007, the researchers obtained 24 isolates of bovine MRSA from the Veterinary Laboratories Agency in the UK. These came from a collection of 940 Staphylococcus aureus isolates obtained from the milk of 465 different herds of cows with mastitis, which had been submitted to the agency for testing.

Isolates of human MRSA were obtained from the Health Protection Agency and the Scottish MRSA Reference Laboratory in the UK, and the National MRSA Reference Laboratory in Denmark. The human bacteria had been cultured from blood samples or infected wound swabs.

The researchers carried out antimicrobial susceptibility testing on these bovine and human isolates, and used PCR testing to see whether the mecA gene could be detected.

What were the basic results?

A new mecA gene (called mecALGA251) was discovered in 15 of 24 Staphylococcus aureus isolates from dairy cattle in England. These isolates were from three different strains of MRSA. The new mecALGA251 gene was also identified in 12 of 16 isolates from human samples from Scotland, 15 of 26 isolates from England, and 24 of 32 isolates from Denmark.

Antibiotic-susceptibility testing identified that these isolates were resistant to a wide range of antibiotics. However, PCR testing showed negative results for the mecA gene and penicillin-binding protein. This suggests that if PCR testing is used on its own or to confirm the results of antibiotic-susceptibility testing, it may fail to identify the infection as being due to MRSA.

How did the researchers interpret the results?

The researchers concluded that routine culture and antimicrobial susceptibility testing will identify Staphylococcus aureus bacteria with the new mecA gene as being resistant to meticillin and related antibiotics. However, PCR testing to confirm the results will not detect this gene and will fail to identify the bacteria as MRSA. The researchers concluded that new guidelines for the detection of MRSA should consider including tests for mecALGA251.

Conclusion

MRSA is usually detected by using antibiotic-susceptibility testing. Results are confirmed using molecular testing (PCR), which detects the presence of the mecA gene that is common to these bacteria. This laboratory research tested MRSA obtained from cattle and milk samples, which were stored at veterinary agencies in the UK, and MRSA samples from humans, which were stored at reference laboratories in the UK. In many of the cattle samples tested, the researchers detected a new type of mecA gene. Antibiotic-susceptibility testing showed that MRSA bacteria carrying this gene were resistant to a range of penicillin-related antibiotics, but further PCR testing could not identify these bacteria as MRSA.

The most important finding from this research is that if molecular testing techniques are used to detect or confirm the presence of MRSA, they will not correctly identify the new type of MRSA bacteria.

The researchers noted that only tentative interpretations can be made from these results, and more samples need to be studied. Some points of note include:

The strains containing this new gene were only obtained from existing MRSA collections. Researchers will need to carry out the same tests in samples obtained from other populations.
It is not known whether disease caused by MRSA with the new mecA gene is any different to that caused by conventional MRSA.
According to the researchers, their data suggest that the MRSA infections with the new gene are likely to account for 1 in 100 to 1 in 500 of total MRSA in the UK and Denmark. This is a small proportion of MRSA infections.
As this gene has been detected in MRSA samples from dairy cows, it suggests that these animals might form a reservoir of infection. Close links with farms or contact with dairy cattle could increase the risk of this type of MRSA being transmitted to humans. As the study did not look at the spread of resistance from cattle to humans, this will need to be investigated in further research.

The discovery of this previously undetected MRSA, which carries the new mecA gene, is potentially important to public health. Further quality evidence is required from observational and experimental studies to inform tests for diagnosing MRSA.

Links to the headlines

MRSA 'superbug' is found in British milk. The Independent, June 3 2011

New MRSA strain found in British cows' milk. The Daily Telegraph, June 3 2011

New strain of MRSA superbug may have spread from cattle to humans. The Guardian, June 3 2011

New form of MRSA found in cows' milk and human flesh wounds. Daily Mail, June 3 2011

Links to the science

García-Álvarez L, Holden MTG, Lindsay H et al. Meticillin-resistant Staphylococcus aureus with a novel mecA homologue in human and bovine populations in the UK and Denmark: a descriptive study. The Lancet Infectious Diseases, 2011 (published online first)

Friday, 24 June 2011

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