Promising drug for Parkinson’s disease: Study supports fast track to clinical trials
Share on Twitter Share on Facebook Pinterest Oliver Bandmann, Professor of Movement Disorders Neurology at the University of Sheffield and Honorary Consultant Neurologist at Sheffield Teaching Hospitals NHS Foundation Trust, added: “Whilst we have been looking at Parkinson’s patients who carry the LRRK2 mutation, mitochondrial defects are also present in other inherited and sporadic forms of Parkinson’s, where we do not know the causes yet. Our hope is therefore, that UDCA might be beneficial for other types of Parkinson’s disease and might also show benefits in other neurodegenerative diseases.”The research is also the first to demonstrate beneficial effects of UDCA on dopaminergic neurons, the nerve cells affected in Parkinson’s disease, in a fly model of Parkinson’s disease which carries the same genetic change as some patients with the condition.The study published in the journal Neurology is funded by Parkinson’s UK, the Wellcome Trust and the Norwegian Parkinson Foundation.A mutation in the LRRK2 gene is the single most common inherited cause of Parkinson’s disease. However, the precise mechanism that leads to Parkinson’s is still unclear.Defects in mitochondria, and as a consequence reduced energy levels, are a factor in a number of diseases that affect the nervous system including Parkinson’s and Motor Neuron Disease. Nerve cells have a particularly high energy demands, therefore defects in the cell’s energy generators will crucially affect their survival.Professor Bandmann added: “Following on from the promising results of our in vitro drug screen, we were keen to further investigate and confirm the potential of UDCA in vivo – in a living organism.“UDCA has been in clinical use for decades and thus could be advanced to the clinic rapidly if it proves beneficial in clinical trials.”Collaborators Rebecca Furmston, White Rose PhD student, and Dr Chris Elliott, from the University of York’s Department of Biology, demonstrated the beneficial effects of UDCA in vivo using the fruit fly (Drosophila melanogaster). In fruit flies, the mitochondrial defects caused by the LRRK2 mutation to dopaminergic neurons can be monitored through the progressive loss of visual function. Flies carrying the mutation maintained their visual response when fed with UDCA.Dr Elliott said: “The treatment of fruit flies carrying the faulty LRRK2 gene with UDCA showed a profound rescue of dopaminergic signalling. Feeding the flies with UDCA partway through their life slows the rate at which the fly brain then degenerates. Thus, mitochondrial rescue agents may be a promising novel strategy for disease-modifying therapy in LRRK2-related Parkinson’s.”Dr Arthur Roach, Director of Research and Development at Parkinson’s UK, which part-funded the study, said: “There is a tremendous need for new treatments that can slow or stop Parkinson’s.“Because of this urgency, the testing of drugs like UCDA, which are already approved for other uses, is extremely valuable. It can save years, and hundreds of millions of pounds.“It’s particularly encouraging in this study that even at relatively low concentrations the liver drug still had an effect on Parkinson’s cells grown in the lab.“This type of cutting-edge research is the best hope of finding better treatments for people with Parkinson’s in years, not decades.” Share
Email A drug which has already been in use for decades to treat liver disease could be an effective treatment to slow down progression of Parkinson’s disease, scientists from the University of Sheffield have discovered.The pioneering research led by academics from the Sheffield Institute of Translational Neuroscience (SITraN), in collaboration with scientists from the University of York, supports the fast-tracking of the drug ursodeoxycholic acid (UDCA) for a clinical trial in Parkinson’s patients.Dr Heather Mortiboys, Parkinson’s UK Senior Research Fellow from the University of Sheffield, explained: “We demonstrated the beneficial effects of UDCA in the tissue of LRRK2 carriers with Parkinson’s disease as well as currently asymptomatic LRRK2 carriers. In both cases, UDCA improved mitochondrial function as demonstrated by the increase in oxygen consumption and cellular energy levels.” LinkedIn
LinkedIn Email Share on Facebook Share on Twitter As women entered the workforce in increasing numbers in the 1980s, some child development researchers began reporting that daycare had harmful consequences for children’s social and emotional adjustment. These findings stoked uncertainty and fear among parents, and led to debate amongst researchers in the field.“Three decades of follow-up studies have only further fueled this debate,” Dearing explains. “While some studies indicate that beginning care early in life and attending for long hours leads to high levels of behavior problems, such as elevated aggression, other studies indicate no risk associated with child care.”Dearing and colleagues from the Norwegian Center for Child Behavioral Development, Henrik Daae Zachrisson and Ane Nærde, determined that Norway’s child care practices offered a unique opportunity for empirically addressing this controversy.In Norway, most parents have up to a year of parent leave, so children in Norway rarely start attending daycare before they are 9 months old. Because publicly funded child care centers begin enrollment in August, children typically enter child care at different ages depending on what time of year they were born. For example, a child born in August would enter daycare at 12 months old, while a child born in February would be 18 months old by the time August enrollment opened.The researchers were able to use this as a natural randomizer; a child’s birth month, rather than their parents’ preferences, determined what age they started going to daycare.Trained assistants interviewed parents of 939 children about time spent in daycare at ages 6 months and 1, 2, 3, and 4 years old. Each year, the child’s daycare teacher reported on aggressive behaviors like hitting, pushing, and biting.“One surprising finding was that the longer children were in non-parental care, the smaller the effects on aggression became,” Dearing explains.When the children were 2 years old, those who had entered at earlier ages displayed modestly higher levels of aggression than peers who entered later. Importantly, these differences in physical aggression diminished over time — regardless of how much time children spent in daycare.“At age 2, there was some evidence of small effects of early, extensive, and continuous care on aggression,” Dearing says. “Yet, by age 4 — when these children had been in child care for 2 additional years — there were no measurable effects of child care in any of our statistical models. This is the opposite of what one would expect if continuous care was risky for young children.”“If early, extensive, and continuous non-parental care does, in fact, cause high levels of aggression in children, this study suggests that 1 year of parental leave, and entry into high-quality center care thereafter, may help prevent such an outcome,” the researchers write.Given the evidence that early child care is not associated with problems with aggression, the researchers are turning their attention to the potential positive effects that daycare may have for children’s language development and learning.
Pinterest Working parents often worry about sending their toddlers to daycare. But the results of a new study that tracked almost 1,000 Norwegian children enrolled in daycare indicate that working parents can breathe a sigh of relief: The amount of time children spent in daycare had little impact on aggressive behavior.The study is published in Psychological Science, a journal of the Association for Psychological Science.“From a public perspective, our findings are important because they should help ease parents’ fears about the potential harms of early non-parental child care,” says Eric Dearing, lead author on the study and a psychological scientist at the Lynch School of Education, Boston College. Share
LinkedIn Share on Twitter The researchers studied likely predictors of sensation-seeking trajectories in nearly 3,000 children all of Puerto Rican background, approximately half of whom lived in Puerto Rico and half in the South Bronx. Children were asked to agree or disagree with statements like “Sometimes you like to do things that are a little scary,” and “Riding very fast and doing tricks on a skateboard are fun.” Results were measured on a ten-item sensation-seeking scale.In children living in both settings, the researchers observed a spike in sensation-seeking behavior was first seen at ages 10 and 11, with rates climbing to age 17. More than three-quarters of the children were in the “normative” and “low-sensation-seeking” classes, in which sensation-seeking scores increased as expected with age. However, 16 percent had sensation seeking scores that increased faster than expected with age, and 7 percent started with high sensation-seeking scores that decreased over time.Rates of sensation-seeking were consistently higher in the South Bronx than Puerto Rico, and youth in the South Bronx generally reported sensation-seeking at an earlier age. “Children born into families of migrants scored higher in sensation-seeking either because they inherited a ‘novelty-seeking’ trait from their parents,” explains Martins, “or because they were exposed to family environments and different parenting practices that promoted certain behaviors.” Martins also noted that besides poverty, children living in the South Bronx very frequently face exposure to violence, peer delinquency or stressful life events compared to their counterparts in Puerto Rico.The researchers also found that boys and young men had higher levels of sensation-seeking than girls and young women–a finding Martins says is likely linked to testosterone, which is associated with the behavior, as well as culturally-mediated gender differences.“There is growing understanding that sensation-seeking is not just a personality trait or a rite of passage,” says Martins. “There is growing evidence that this behavior is mediated by factors, including where a child grows up.” Teenagers are known for taking unnecessary risks, from reckless driving to smoking marijuana, but some seek out risky experiences more than others. A new study of sensation-seeking behavior led by a researcher at Columbia University’s Mailman School of Public Health with colleagues from Columbia University’s Department of Psychiatry and the University of Puerto Rico School of Medicine, shows that children growing up in the United States versus Puerto Rico were more likely to seek out new and risky behaviors.Results of the study, the first to look at sensation-seeking patterns in young children and teenagers, are published online in the Journal of the American Academy of Child and Adolescent Psychiatry.“Sensation-seeking behavior in adolescents has been shown to be a factor in health risks from suicide and frequent illegal drug use to problem gambling and unprotected sex,” noted first author Silvia Martins, MD, PhD, associate professor of Epidemiology. “Our study shows that sensation-seeking behaviors don’t follow the same trajectory from childhood to adolescence in all populations: context matters.” Pinterest
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Pinterest Email Share on Twitter Share on Facebook Could human suicide have evolutionary roots in self-sacrificial behaviors like those seen in species such as honeybees and ants?A Florida State University researcher who is one of the nation’s foremost experts in suicide is trying to find out.Thomas Joiner, the Robert O. Lawton Distinguished Professor of Psychology, led a team of researchers in examining scientific knowledge and drawing parallels between suicide in humans and the self-sacrificial behaviors of colony-like — or eusocial — species such as shrimp, mole rats and insects.
LinkedIn Share “The idea that something mysterious and scary like suicide in humans could have some sort of analog in animals is not only kind of fascinating, but also really promising in terms of trying to figure it all out,” Joiner said.In a paper recently published in the journal Psychological Review, the researchers theorize that humans exhibit the characteristics of eusocial species such as relying on multigenerational and cooperative care of young and utilizing division of labor for successful survival.“Humans are a species that is eusocial, and that’s an important starting point,” Joiner said. “That suggests a certain set of characteristics, including some really striking self-sacrifice behaviors.”Those eusocial behaviors, understood as part of what is called inclusive fitness in evolutionary biology, are adaptive.“The idea is if you give up yourself, which would include your genes, it can be evolutionarily speaking ‘worth it’ if you spare or save multiple copies of your genes in your relatives,” Joiner said. “It’s a net benefit on the gene level.”However, when the researchers look at human suicide in a modern context, they surmise that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality.“It seems highly maladaptive and very psychopathological,” Joiner said. “That’s the quandary we’re facing with this paper. Is it possible that modern human suicide is a maladaptive or deranged version of the adaptive, behavioral model for self sacrifice that all eusocial species have?”The hope is this theory will spur a search for exactly what that disorder is at the brain level in order to demystify the phenomenon of suicide and further suicide prevention efforts.“If you can identify animal models for this behavior and understand its circuitry at the neurochemical and neurophysiological levels, then it might lead to new insights about similar circuitry that fail in human suicide,” Joiner said.
Using techniques to uncover people’s implicit intuitions, the researchers explored the fundamental differences behind our attitudes towards unemployment benefits and healthcare. According to the researchers, the differences may be found in the evolutionary history of our species.“For millions of years, a need for health care reflected accidents such as broken legs or random infections. Evolution could therefore have built our psychology to think about illnesses in this way, as something we have no control over. People everywhere seem to have this deep-seated intuition that ill people are unfortunate and deserve to be helped,” Michael Bang Petersen explains.Agreement across countries and political ideologiesEven countries like the US, which you would normally not associate with the term welfare state, healthcare costs are enormous. The researchers did research in both Denmark, the US and Japan and found that everywhere people intuitively believed that people who fall ill are unlucky, while unemployed people have brought it on themselves.“Because we have this psychological tendency to regard people who are ill as unlucky, people’s attitude towards the sick are extremely difficult to change,” Carsten Jensen explains.In modern societies, more people die from lifestyle diseases than from broken legs and infections, and there are considerable socio-economic differences in who will suffer from these lifestyle diseases. But we continue to think of illness as random accidents. This even applies across the political spectrum, where conservatives who normally oppose government spending think of ill people has unfortunate and deserving of care.“The traditional attitudinal factors such as self-interest, access to information and political ideology do not really matter in the healthcare area,” says Michael Bang Petersen and continues:“When it comes to healthcare, everyone seem united in the belief that people who are ill are unlucky and need help. This means that the policies in the areas of health care and unemployment are very different, as we all more or less agree on the goal in healthcare, while we deeply disagree on whether or not unemployed people deserve help.”Pressure on the politiciansIncreased healthcare spending is often explained by the supply of health – i.e. the costs of new technology and medicine. But the researchers from Aarhus University argue that when it comes to the rising costs of healthcare, we are also dealing with demand. Politicians find it hard not to accommodate people’s demand for better healthcare, and no one wants to be seen as responsible for a health scandal.The study behind these results have just been published in the American Journal of Political Science. New research from Aarhus BSS at Aarhus University explains why healthcare costs are running out of control, while costs to unemployment protection are kept in line. The answer is found deep in our psychology, where powerful intuitions lead us to view illness as the result of bad luck and worthy of help.Illness and unemployment are two types of ordinary risks to which we are all exposed. But from a historical perspective, unemployment and illness represent two very different types of risks. Unemployment came about as a result of the industrialisation, while illness is something the human species has faced for millions of years. This difference is reflected in current-day political attitudes.“People across countries are very positive towards the healthcare sector, but are not necessarily that inclined to give money to the unemployed. Why do people generally prefer helping the ill and not the unemployed?” This is the question posed by two professors in political science, Carsten Jensen and Michael Bang Petersen, from Aarhus University. Share on Facebook Share on Twitter Share
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LinkedIn Treatment with the drug prazosin effectively reduces symptoms of posttraumatic stress disorder (PTSD) for many people, but about one third of patients don’t respond to the treatment at all. Attempts to understand why people respond differently, based on symptom type or severity, have fallen short. Now, a new study reports that soldiers with higher blood pressure before beginning prazosin treatment see better results from the medication. The study, published in Biological Psychiatry, is the first to look for a biological marker that could be used to predict individual response to a drug treatment for combat PTSD.“These findings suggest that higher standing blood pressure is a biomarker that can contribute to a personalized medicine approach to identifying soldiers and veterans with combat PTSD likely to benefit from prazosin,” said Murray Raskind of the VA Puget Sound Health Care System and the University of Washington in Seattle, who led the study.A biomarker such as blood pressure would have exceptional clinical utility because it would provide an easily measureable and immediate predictor of treatment response that could help doctors determine the role of prazosin or a similar medication in the treatment strategy for an individual. Prazosin blocks α1-adrenergic receptors (α1AR), and through this mechanism prevents some of the effects of adrenaline and noradrenaline, chemicals released by the body during stress. “It would make sense if prazosin was most effective in those patients with the greatest activation of noradrenaline systems,” said John Krystal, Editor of Biological Psychiatry.However, activity of α1AR cannot be measured directly in humans. So the researchers identified a peripheral biological marker that is regulated by α1AR activity; noradrenaline stimulation of α1AR increases blood pressure, suggesting that blood pressure may be a useful indicator of α1AR activity.The researchers analyzed the combat PTSD symptoms and blood pressure measures collected previously as part of a randomized controlled trial of 67 soldiers who had returned from Iraq and Afghanistan. Thirty-two participants had received prazosin, and 35 had received placebo for 15 weeks.“Pretreatment standing systolic blood pressure strongly predicted response to prazosin,” said Raskind. By the end of the 15 week treatment period, participants with a higher initial blood pressure saw a bigger improvement in their PTSD symptoms, with a better outcome for every 10 mmHg increment above 110 mmHg.In addition to suggesting that blood pressure may help predict which soldiers with PTSD will benefit the most from treatment, the findings also provide insight into the pathophysiology of the disorder.“The increase in blood pressure in these PTSD patients may be a biomarker for patients who are more likely to benefit from prazosin,” said Krystal. “If so, it may be a useful indicator of activation of noradrenergic activation associated with PTSD in these patients.”
Share Email LinkedIn New neuroimaging research indicates that information about political corruption has a greater impact that positive messages. The study has been published in the journal Political Psychology.“Two reasons brought us to this research: first, there were no neuroimaging studies that explored the neural processing of corruption and, second, corruption in Spain is not having the expected political consequences (voting behavior), even though everyday citizens watch news about corruption,” said study author Luis-Alberto Casado-Aranda, an associate professor at Madrid Open University.The researchers recruited 20 people who indicated they were supporters of either the left-wing Spanish Socialist Workers’ Party or the right-wing People’s Party. Share on Twitter
Pinterest “Only participants with high levels of sympathy (8-9, in a scale from 1 to 10) towards conservative and liberal parties were assessed. This aligns with our aim of evaluating what happens in their brain when exposed to news strongly harmful or beneficial for their parties,” Casado-Aranda explained.While the researchers monitored their brain activity, the participants were shown positive political messages or statements about political corruption that were randomly paired with the logo of either party. For example, some participants read the corruption statement “Fraud and documentary falsification” and were shown the logo of the Spanish Socialist Workers’ Party. The participants then indicated how much the information made them want to support or punish the party.The researchers found that participants displayed a higher level of punishment for corruption messages related to their rival party. This bias, however, was less noticeable among left-wing supporters.The brain scan results suggested that messages about corruption (as opposed to the more positive messages) exerted the greatest cerebral impact on all of the participants. Statements about political corruption were associated with stronger activation of the anterior insula, dorsomedial prefrontal cortex, amygdala, orbitofrontal cortex, thalamus, precuneus, middle frontal gyrus, and inferior parietal gyrus. These brain regions are associated with the processing of punishment, risk, disappointment, and rejection.Positive political messages, on the other hand, were associated with activation of the anterior cingulate cortex.Together, the findings indicate “that negative (vs. positive) political messages exert the greatest neural impact on the electorate, and it seems to suggest that conservative sympathizers can experience a more intense partisan bias when exposed to political messages than their opposing counterparts,” the researchers wrote in their study.“A drawback to this study is that it only measures self-reported punishment and support, and not real voting behavior. Future research should link neural responses during the processing of political messages to actual political affiliation change. Further studies in political psychology should also apply fMRI in different contexts (e.g., countries.),” Casado-Aranda said.The study, “Does Partisan Bias Modulate Neural Processing of Political Information? An Analysis of the Neural Correlates of Corruption and Positive Messages“, was authored by Luis‐Alberto Casado‐Aranda, Vinod Venkatraman, Juan Sánchez‐Fernández, and Teodoro Luque‐Martínez. Share on Facebook
Share on Twitter Share on Facebook The researchers were particularly interested in a pattern of brain activity known as the late positive potential (LPP), which is a neurophysiological marker of attention to emotional stimuli. In other words, LPP provides a measure of how much someone is paying attention to emotional information.The researchers found that LPP for negative pictures was lower when participants reappraised negative pictures compared with passively viewing them. Additionally, LPP appeared to be substantially reduced in the frequently active group at the final stage of the reappraisal process.The finding “supports the idea that the frequency of physical activity might be positively related to better ability of controlling negative emotions,” the researchers said.Likewise, participants reported less unpleasant feelings after reappraising the negative pictures compared with passively viewing them. However, the frequently active and the infrequently active group did not differ in their self-rated feelings.“This might raise some concerns about the validity of the results presented in the article,” the researchers said. But they believe there findings are still valid “because we found a significant between-group difference in the LPP component, which is commonly regarded as the objective measure of the reappraisal efficacy.”In conclusion, the authors of the study said that “being physically active might be associated with a greater ability to control negative emotions via reappraisal. However, the differences between frequently and infrequently active participants seem to be small and observable only when neural measures of reappraisal efficacy are employed.”The study, “Frequent physical exercise is associated with better ability to regulate negative emotions in adult women: The electrophysiological evidence“, was authored by Tomasz S. Ligeza, Patrycja Kałamała, Olga Tarnawczyk, Marcin Maciejczyk, and Miroslaw Wyczesany. New research provides some preliminary neurophysiological evidence that women who are physically active tend to be better at decreasing the intensity of negative feelings. The study was published in the journal Mental Health and Physical Activity.For their study, the researchers assessed the ability of 26 frequently active and 26 infrequently active women to control negative emotions. Participants were considered “frequently active” if they were involved in aerobic activities at least three times per week for at least one year, while the infrequently active group reported exercising less than one time per week.The participants viewed emotionally charged pictures — such as disgusting food, sad people, accidents, violent images, animal mutilations, surgical procedures — and were asked to reinterpret the negative pictures in a less negative manner or to passively watch the picture in order to experience it naturally. During this task, the researchers monitored their electrical brain activity. Pinterest
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UK ‘Flusurvey’ joins European networkThe UK’s Flusurvey, begun in 2009, will this year join a European network of online surveys to gather information on how influenza spreads across the continent and enable between-nation comparisons. “For the first time, we will be able to compare cases across the continent as flu spreads through Europe,” said Sebastian Funk of the London School of Hygiene & Tropical Medicine (LSHTM), one of the Flusurvey’s founders, in an LSHTM press release yesterday. “This provides a fascinating opportunity to understand the dynamics of seasonal flu on a large scale.” John Edmunds, another founder, said, “We set up the Flusurvey to allow the public to report their illness directly. Anyone can take part.” Up to 5,000 people have taken the survey in previous years.Nov 8 LSHTM news releaseFlusurvey home page New H1N1 group found circulating in SpainPandemic 2009 H1N1 influenza (pH1N1) viruses circulating in Spain last flu season included a new genetic group, but none of the viruses studied show any significant antigenic changes, according to a phylogenetic analysis in the Journal of Clinical Virology. Spanish researchers analyzed 220 circulating pH1N1 viruses from Spanish Influenza Surveillance System labs. They found six different genetic groups, five of which were previously noted. The new group they identified constituted 12.3% of the viruses and was characterized by E172K and K308E changes and a prolinea type of amino acidat position 83 of the hemagglutinin protein. The authors conclude, “None of the groups identified to date have resulted in significant antigenic changes.”Nov 8 J Clin Virol abstract Nov 9, 2011
Study: Modest antibody response with H1N1 vaccine in immunocompromisedBrazilian researchers found that seroconversion rates in immunocompromised patients, including the elderly, 3 weeks after pH1N1 immunization generally ranged under 56% and seroprotection rates generally under 62%, according to a study in PLoS One. They studied 319 patients with cancer, 260 with rheumatoid arthritis (RA), 256 with HIV, 149 elderly patients, 85 kidney transplant recipients, and 83 with juvenile idiopathic arthritis (JIA). Seroprotection, seroconversion, and geometric mean titer ratios postvaccination were, respectively: 37.6%, 31.8%, and 3.2 for kidney transplant patients; 61.5%, 53.1%, and 7.5 for RA patients; 63.1%, 55.7%, and 5.7 in the elderly; 59.0%, 54.7%, and 5.9 in HIV patients; and 52.4%, 49.2%, and 5.3 in cancer patients. Bucking the trend were the JIA patients, whose numbers were 85.5%, 78.3%, and 16.5. The authors defined seroprotection as postvaccination hemagglutination-inhibition (HI) antibody titers of 1:40 or greater and seroconversion as HI antibody titer prevaccination less than 1:10 and postvaccination 1:40 or greater, or prevaccination 1:10 or greater, along with a fourfold or greater antibody increase. Guidance from the US Centers for Disease Control and Prevention for health professionals states that serology may overestimate flu vaccine efficacy.Nov 8 PLoS One studyCDC flu vaccine guidance
In an accompanying NEJM editorial today, infectious disease experts Michael B. Edmond, MD, MPH, and Richard P. Wenzel, MD, of Virginia Commonwealth University said the strengths of the study “include its large size and rigorous design. Weaknesses include a lack of surveillance for infections other than bloodstream infections and a failure to assess for resistance to chlorhexidine or mupirocin.” The REDUCE MRSA trial was conducted in two stages from 2009 to 2011 by researchers from the University of California, Irvine (UCI), Harvard Pilgrim Health Care Institute, Hospital Corporation of America, and the US Centers for Disease Control and Prevention (CDC). CDC Director Thomas Frieden, MD, MPH, said in the release, “CDC is working to determine how the findings should inform CDC infection prevention recommendations.” May 29, 2013 (CIDRAP News) – Disinfecting all intensive care unit (ICU) patients was found to be more effective and easier to implement than specifically screening ICU patients for methicillin-resistant Staphylococcus aureus (MRSA) before disinfection in a study of more than 70,000 patients published today. The more sweeping germ-killing approach—a process called decolonization—reduced bloodstream infections by up to 44% and significantly reduced the incidence of MRSA, the study in The New England Journal Medicine (NEJM) found. Targeted decolonization, with active detection and isolation plus intranasal mupirocin and chlorhexidine bathing for 5 days—a combined intervention (group 2) Researchers evaluated three MRSA prevention practices: Edmond MB, Wenzel MP. Screening inpatients for MRSA—case closed. (Editorial) N Engl J Med 2013 (published online May 29) [Full text] No detection and isolation but universal decolonization with intranasal mupirocin for 5 days and chlorhexidine bathing for the entire ICU stay—a mostly horizontal approach (group 3) “This study helps answer a long-standing debate in the medical field about whether we should tailor our efforts to prevent infection to specific pathogens, such as MRSA, or whether we should identify a high-risk patient group and give them all special treatment to prevent infection,” lead author Susan Huang, MD, MPH, of UCI said in the CDC release. “The universal decolonization strategy was the most effective and the easiest to implement. It eliminates the need for screening ICU patients for MRSA.” The study was funded by the Department of Health and Human Services.
Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013 (published online May 29) [Full text] May 29 CDC press release See also: They added that the findings have ramifications beyond MRSA. “The recent dissemination of carbapenem-resistant Enterobacteriaceae has stimulated calls to implement active detection and isolation for these organisms,” they wrote. “We hope that the results of this study will redirect that discussion and reinforce the utility of horizontal interventions to control not only the pathogens of today but those of tomorrow as well.” Researchers found hazards ratios for MRSA clinical isolates of 0.92 for group 1, 0.75 for group 2, and 0.63 for group 3. For bloodstream infections of any type, hazards ratios were 0.99, 0.78, and 0.56, respectively. This translates to a reduction in bloodstream infections of up to 44%. Active detection and isolation of MRSA patients—a vertical intervention (group 1) At issue was whether so-called vertical intervention measures, which focus on reducing colonization and infection with a single pathogen and are typically more expensive, are superior to horizontal interventions, which address all potential pathogens. But Edmond and Wenzel called the implications of the study “highly important.” The study included 43 US hospitals, 74 adult ICUs, and 74,256 patients, making it the largest published study on this topic, the CDC said in a news release today.