Fax communication may improve quality of referrals for children with short stature.

Requesting information such as growth charts or results of thyroid function tests through fax communication from a referring physician could reduce the number of unnecessary referrals of children with short stature to the pediatric endocrinologist, according to a study presented at the Canadian Pediatric Endocrine Group 2012 Scientific Meeting.

“[Children of short stature] should be investigated by their referring physician,” Lyne Chiniara, MD, a pediatric fellow at the Centre Hospitalier Universitaire Sainte-Justine, department of pediatrics, Université de Montreal, said in an interview with Endocrine Today. “[Referring physicians] need to do a minimum number of investigations.”

Chiniara and colleagues conducted an independent audit of referrals of children with short stature to the hospital’s endocrinology service in 2001 and found growth charts were provided in slightly more than half (53%) of 109 referrals, 67 of which were male patients and 42 of which were female patients. They also found that baseline tests, such as thyroid function tests or complete blood count, were conducted in the minority of referral cases: 39% and 30%, respectively.

Pediatricians fared better over general practitioners in the quality of referrals, referring fewer children with normal height velocity (P=.01). They also plotted more values on growth charts (P=.02) and performed more baseline tests (P=.002), Chiniara said.

In 2006, the hospital asked that referrals be received by fax, and they requested that missing information be sent via fax if it was not received before the patient consult. Previously, phone calls from physicians and parents were accepted as legitimate referrals.

“By implementing this system, we received more baseline data and we could assure the referring physician, based on the data, that we didn’t need to see the child in the pediatric endocrinology clinic,” Chiniara said, noting that referrals continued to be accepted without fax communication to allow referring physicians to make the transition.

The 2006 audit of 138 referrals found that 69 were received by fax. Of 138 referrals, 65% came from pediatricians, 31% from general practitioners and 4% from other health care professionals.

Growth curves were obtained in 95.6% of cases in which fax communication was involved vs. 40.5% of cases in which it was not (P<.001). Moreover, more baseline investigations were conducted when fax communication was used (P<.001). The implementation of fax communication avoided 31 consults with patients; information from growth curves, laboratory results and imaging did not warrant these consults.

“We have improved the quality of referrals,” Chiniara said.

Source: Endocrine Today



Dietary counseling significantly lowered cholesterol, lipoprotein levels in boys only

Repeated dietary counseling was linked to significantly lower LDL cholesterol concentrations in boys aged 7 months to 19 years, but not girls in that age group, according to study findings.

The effect of repeated low saturated fat dietary counseling on dietary intake and lipoprotein measures were evaluated in 540 children in an intervention group and 522 children in a control group.

The population was followed in an atherosclerosis prevention study — the Special Turku Coronary Risk Factor Intervention Project — from age 7 months to 19 years. The researchers analyzed dietary intakes and serum lipid profiles of the study population annually.

Measurements of serum total and HDL cholesterol and triglycerides were taken and used to estimate very low-density lipoprotein triglycerides, intermediate-density lipoprotein cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein two cholesterol, as well as apolipoproteins A-I and B.

Boys in the intervention group had a lower saturated fat intake than controls, with a mean daily difference between groups of –2.1 (95% CI, –2.3 to –1.9). For girls, the mean difference in saturated fat was –1.9 (95% CI, –2.1 to –1.7).

A similar pattern was observed for LDL cholesterol concentrations. The difference between boys in the intervention group and controls was –0.18 mmol/L (95% CI, –0.26 to –0.1) compared with controls, and the difference between girls in the intervention group and girls in the control group was –0.1 mmol/L (95% CI, –0.19 to –0.01).

No differences were observed between study groups regarding HDL cholesterol and ApoA-I. Boys in the intervention group experienced lower total cholesterol and intermediate-density lipoprotein cholesterol, very low-density lipoprotein triglycerides, ApoB and triglyceride concentrations than boys in the control group, but no differences were observed in these measurements in girls.

“Repeated dietary counseling is effective in decreasing saturated fat intake and serum LDL-C values from infancy until 19 years of age in both genders. In boys, significant intervention effects are evident in various lipoprotein measures, indicating a more favorable lipid profile in the counseling group,” the researchers concluded.

Source: Endocrine Today


Pregnancy-related complications increased CVD risk.

Women who experience pregnancy-related complications, particularly gestational diabetes and preeclampsia, are more likely to develop cardiovascular disease later in life, according to study results.

In the prospective Avon Longitudinal Study of Parents and Children (ALSPAC), researchers studied the associations of gestational diabetes, preeclampsia, preterm delivery and size for gestational age with calculated 10-year CVD risk and CV risk factors measured 18 years after pregnancy in 3,416 women in Avon, United Kingdom.

“We wanted to learn about possible explanations as to why women with pregnancy complications tend to have more heart disease later in life,” study researcher Abigail Fraser, PhD, MPH, of the School of Social and Community Medicine at the University of Bristol, United Kingdom, said in a press release.

Of the women included in the analyses, 29.8% experienced one pregnancy-related complication, 5.2% experienced two and 0.8% experienced three, including gestational diabetes, preeclampsia, preterm delivery and babies who were large or small for gestational age at birth.

According to study data, gestational diabetes and preeclampsia raised risk for CVD by 26% and 31%, respectively. Researchers found gestational diabetes had a positive association with fasting glucose and insulin, whereas preeclampsia was associated with higher BMI, waist circumference, blood pressure, lipids and insulin. The ORs for the calculated 10-year CVD risk based on the Framingham prediction score was 1.31 (95% CI, 1.11-1.53) for preeclampsia and 1.26 (95% CI, 0.95-1.68) for gestational diabetes.

Study results showed that women with large for gestational age babies had larger waist circumference and higher concentrations of blood glucose vs. women with appropriate for gestational age babies. Women with small for gestational age babies and preterm delivery had higher BP.

“Pregnancy may provide an opportunity to identify women at increased risk for heart disease while they are relatively young; thus, it would be useful for medical professionals to have information on pregnancy complications so they can recommend lifestyle changes and any necessary medical intervention sooner,” Fraser said. “A woman who experiences complications during pregnancy should be proactive and ask her doctor about future CVD risk and steps she should take to modify her risk.”

Source: Endocrine Today

Younger women more likely than men to experience MI without chest pain.

In a study involving more than 1 million patients, researchers found women with myocardial infarction were more likely to present without chest pain and had higher mortality compared with men. These differences, however, became less pronounced with increasing age.

Researchers collected and analyzed hospital data from the National Registry of Myocardial Infarction on 1,143,513 patients (42.1% women) admitted with confirmed MI from 1994 to 2006. The presence or absence of chest pain/discomfort was the only symptom recorded. Main outcome measures included predictors of MI without chest pain and the relationship between age, sex and hospital mortality.

Researchers found a significant interaction between sex and age with chest pain at presentation (P<.001). The proportion of women who presented without chest pain (42%; 95% CI, 41.8-42.1) was higher when compared with men (30.7%; 95% CI, 30.6-30.8). This difference was larger in younger patients; however, the difference decreased with advancing age. For lack of chest pain in women, multivariable adjusted age-specific ORs were: 1.30 (95% CI, 1.23-1.36) for age younger than 45 years; 1.26 (95% CI, 1.22-1.30), 45 to 54 years; 1.24 (95% CI, 1.21-1.27), 55 to 64 years; 1.13 (95% CI, 1.11-1.15), 65 to 74 years; and 1.03 (95% CI, 1.02-1.04), 75 years or older.

The interaction between sex, age and presentation without chest pain was also significant for mortality, with 14.6% of women and 10.3% of men experiencing in-hospital mortality. According to study results, among MI patients presenting without chest pain, younger women had greater hospital mortality vs. younger men. However, adjusted ORs showed these sex differences decreased or even reversed with advancing age: 1.18 (95% CI, 1.00-1.39) for age younger than 45 years; 1.13 (95% CI, 1.02-1.26), 45 to 54 years; 1.02 (95% CI, 0.96-1.09), 55 to 64 years; (95% CI, 0.88-0.95), 65 to 74 years; and 0.81 (95% CI, 0.79-0.83), 75 years or older.

The researchers said to enhance the current understanding of underlying pathophysiology and potentially sex-tailored health messages to the general public, further research is warranted.

“Our results of sex-based differences in MI symptom presentation in younger patients are provocative and should be confirmed by others with clinical databases of MI or acute coronary syndromes,” the researchers said. “From a public health perspective, it is appropriate to target high-risk groups for delay with information on the American Heart Association/NIH MI message, but until additional research is conducted, the current chest pain/discomfort MI symptom message, which targets women and men equally irrespective of age, should remain unchanged.”

Disclosure: Mr. Frederick reports being an employee of ICON Clinical Research. Dr. Peterson reported receiving research grants from Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, Sanofi-Aventis, Schering Plough/Merck and St Jude Inc., and consultant fees from Bayer and Pfizer. Dr. Wenger reported receiving research grants and/or trial committee or data and safety monitoring board compensation from Abbott, Eli Lilly, Gilead Sciences, Merck, NHLBT and Pfizer; she also reported receiving consultant fees from Abbott Women’s Advisory Board, AstraZeneca, Gilead Sciences, Merck and Pfizer.


Source: Endocrine Today

Implantable osteoporosis drug-delivery microchip showed promising results

A wirelessly controlled osteoporosis drug-delivery system was linked to encouraging pharmacokinetic outcomes in a cohort of postmenopausal women, according to study results.

The researchers said daily injections are a patient compliance obstacle to osteoporosis treatment with human parathyroid hormone fragment [hPTH(1-34)]. A net increase in bone mineral density requires intermittent or pulsatile delivery of the drug, which is an ongoing challenge for implantable drug-delivery devices.

The current paper describes the first clinical trial of an implantable microchip-based hPTH(1-34) delivery system in eight osteoporotic postmenopausal women. Discrete doses of lyophilized hPTH(1-34) were contained in the microchip-based devices and administered to participants for 4 months. They were wirelessly programmed to release doses from the device once a day for up to 20 days, according to the results.

The implant was controlled by a computer-based programmer, who established a bidirectional wireless communication link. The programmer also received status reports from the implant that confirmed proper operation and programmed the dosing schedule of the drug.

Study participants subsequently received injections of the drug in escalating doses.

Primary outcome measures included pharmacokinetics, safety, tolerability and bioequivalence of hPTH(1-34).

Similar pharmacokinetic outcomes were observed between device dosing and multiple injections. The device was also linked to lower coefficients of variation.

Daily release of the drug from the device yielded increases in bone formation, according to evaluation of bone markers.

Neither the device nor the drug was associated with toxic or adverse events. The implant also did not affect quality of life, according to patient reports.

John T. Watson, PhD, professor of bioengineering and a founder of the von Liebig Center for Entrepreneurism and Technology Advancement at the University of California, San Diego, wrote an editorial accompanying the paper by Farra and colleagues.

“Although the new work documents the first-in-human trial of this implantable microchip-based device, many translational questions and requirements remain,” he wrote. “The clinical therapeutic goal has not yet been fully defined, so the microchip requirements are incomplete.”

Watson also said the reliability and durability of the device have yet to be established, and the timeline for determining these factors may be long. The device failed in one patient, and the manufacturing process yielded only one device with all 20 reservoirs of drug.

“Nevertheless, all doses present were released from the seven devices,” Watson wrote.

He said there is still much to be investigated and proved before FDA approval can be granted to implantable microchips. “Experience suggests that this technology must still negotiate several years of translational hurdles if, in fact, it becomes part of our clinical armamentarium,” he wrote. However, “a versatile implantable device that exploits the microchip approach for controlled drug delivery will be well worth the wait for patients with chronic diseases.”

Endocrine Today Editorial Board member Donald A. Bergman, MD, raised other questions regarding the microchip. “The issue is demand for this device,” he said in an interview. “I have not noticed any patient compliance issues with the daily injection routine.”

According to Bergman, who is a clinical professor of medicine at the Mount Sinai School of Medicine in New York, microchips may not, in fact, be a new frontier in medicine. “The expense, the small risk of infection at the implant site and maintenance plus the availability of traditional intermittent injections make this type of device not a high priority for most injections,” he said. “Where short interval pulse dosing is needed — such as infusion of gonadotropin-releasing hormone — this device is more of a necessity.”

Bergman said the way intermittent dosing was achieved was “clever” and “striking,” but he still held reservations.

“The most worrisome aspect of this had less to do with the data than it did a general concern that implant administration devices are subject to problems with administration,” he said. He cited accelerated administration or failure of administration as the two most notable of these concerns.

Source: Endocrine Today


FDA panel recommends approval for obesity drug.


The FDA’s Endocrinologic and Metabolic Drugs Advisory Committee voted 20-2 to recommend approval of combination phentermine plus topiramate for the treatment of obesity, but also suggested that the FDA require a post-approval cardiovascular outcomes trial.

“Obesity exists in epidemic proportions in the United States, with serious morbidity and mortality consequences, and there is an urgent need for better pharmacological interventions,” committee member Elaine H. Morrato, DrPH, MPH, CPH, told the panel. “Qnexa demonstrated a meaningful efficacy benefit and that there are consequences to nontreatment of obesity. I believe that the FDA and the sponsor are starting to find the right balance between providing access to effective anti-obesity medications and associated risks.”

The same committee voted in July 2010 against recommending approval for phentermine plus topiramate (Qnexa, Vivus) because of safety concerns, including the drug’s teratogenicity and an elevation in heart rate and CV events associated with the drug.

“The sponsor has done a good job at demonstrating efficacy, and they need to step up to the plate and do the cardiovascular outcomes trial and do it fast,” committee member Sanjay Kaul, MD, said during the meeting. “There is opportunity for the sponsor to fully characterize the impact of the drug on heart rate and blood pressure.”

Two studies were conducted to determine efficacy of the combination drug, intended for use as an adjunct to lifestyle modifications for treatment of obesity. The first study, OB-302, was a 1-year, randomized, double blind, placebo-controlled study that included 1,267 obese adults. Participants on the drug lost 14.4% of their baseline body weight.

The second study, OB-303, was a 1-year, randomized, double blind study that included 2,487 overweight and obese adults. Participants who took the drug lost 12.4% of their baseline body weight.

To further evaluate the long-term safety and efficacy of the drug, a 1-year extension study to OB-303 was conducted. The study, OB-305, was also a double blind, placebo-controlled trial that included 676 of the participants on the OB-303 trial. In the study, there were small increases in heart rate among participants who took the drug, but the increase was only significant among those who took the top dose of the drug vs. the low dose or the middle dose. There was no connection between this increase in heart rate and major adverse coronary events in those participants who took the drug.

Regarding teratogenicity, the prevalence of major congenital malformations associated with topiramate exposure during pregnancy was analyzed in three studies. The studies found that although topiramate exposure during the first trimester of pregnancy had no effect on prevalence of major congenital malformations overall, there may be a twofold increase in the prevalence of oral clefts.

Vivus proposed a Risk Evaluation and Medication Strategy (REMS) consisting of a medication guide, a communication plan and Elements to Assure Safe Use (EASU) for health care provider training and pharmacy training.

Although the FDA is not required to follow the recommendations of the advisory committees, it usually does.

Source: Endocrine Today

Early ripening of grapes pinned to warming, soil moisture

Researchers in Australia say they have pinpointed key factors in the early ripening of grapes, providing potential answers for wine growers threatened by global warming.

In Australia and Western Europe, there is an abundance of anecdotal evidence linking higher temperatures with earlier grape maturation, a phenomenon that can affect the quality of table wine.

But wine growing and climate change are each highly complex questions.

Until now, no-one has sorted out how the variables — warming, sunlight, soil moisture and vineyard management — each play a role in grape maturation.

A team led by Leanne Webb at Australia’s national science agency, the Commonwealth Scientific and Industrial Research Organisation (CSIRO), looked at 10 sites in southern Australia where there were highly detailed records, stretching from 1985 to 2009, for all of these factors.

Only at one site — at Margaret River on Australia’s southwestern tip — did the grapes ripen later. For the others, maturation occurred between six to 34 days earlier.

A 2009 photo shows vineyards in the internationally renowned Margaret River wine region in Western Australia. Researchers in Australia say they have pinpointed key factors in the early ripening of grapes, providing potential answers for wine growers threatened by global warming.

The commonest driver of earlier ripening was higher temperature, deemed a significant factor at seven sites.

Lower soil moisture, particularly in the drought-stricken southeast, was a major factor for earlier harvests at five sites. Drier soils lead to higher levels of a stress hormone called abscisic acid in vine roots, which drives the plant’s fruit to earlier ripening.

But vineyard management was also important.

In four sites, pruning and fertilisation methods that lowered crop yields contributed strongly to earlier maturation.

And there may be other technological innovations in these and other sites, such as improved disease and pest control, that could have been a ripening factor, says the study.

Armed with this knowledge, wine growers fretting over global warming have some valuable options, say the authors.

By increasing irrigation or laying down mulch, growers can manage soil moisture — and by changing their pruning regime, they can alter crop yields.

By choosing root stocks that are less sensitive to plant stress hormones, or trimming leaves, growers can also alter the response of the vine to lower humidity, the paper suggests.

Other crops facing the uncertainties of climate change could be helped by this analytical approach, according to the study,

Source: Journal Nature Climate Change.



Researchers test sugary solution to Alzheimer’s.

Slowing or preventing the development of Alzheimer’s disease, a fatal brain condition expected to hit one in 85 people globally by 2050, may be as simple as ensuring a brain protein’s sugar levels are maintained.

That’s the conclusion seven researchers, including David Vocadlo, a Simon Fraser University chemistry professor and Canada Research Chair in Chemical Glycobiology, make in the latest issue of Nature Chemical Biology.

The journal has published the researchers’ latest paper Increasing O-GlcNAc slows neurodegeneration and stabilizes tau against aggregation.

Vocadlo and his colleagues describe how they’ve used an inhibitor they’ve chemically created — Thiamet-G — to stop O-GlcNAcase, a naturally occurring enzyme, from depleting the protein Tau of sugar molecules.

“The general thinking in science,” says Vocadlo, “is that Tau stabilizes structures in the brain called microtubules. They are kind of like highways inside cells that allow cells to move things around.”

Previous research has shown that the linkage of these sugar molecules to proteins, like Tau, in cells is essential. In fact, says Vocadlo, researchers have tried but failed to rear mice that don’t have these sugar molecules attached to proteins.

Vocadlo, an accomplished chess player in his spare time, is having great success checkmating troublesome enzymes with inhibitors he and his students are creating in the SFU chemistry department’s Laboratory of Chemical Glycobiology.

Research prior to Vocadlo’s has shown that clumps of Tau from an Alzheimer brain have almost none of this sugar attached to them, and O-GlcNAcase is the enzyme that is robbing them.

Such clumping is an early event in the development of Alzheimer’s and the number of clumps correlate with the disease’s severity.

Scott Yuzwa and Xiaoyang Shan, grad students in Vocadlo’s lab, found that Thiamet-G blocks O-GlcNAcase from removing sugars off Tau in mice that drank water with a daily dose of the inhibitor. Yuzwa and Shan are co-first authors on this paper.

The research team found that mice given the inhibitor had fewer clumps of Tau and maintained healthier brains.

“This work shows targeting the enzyme O-GlcNAcase with inhibitors is a new potential approach to treating Alzheimer’s,” says Vocadlo. “This is vital since to date there are no treatments to slow its progression.

“A lot of effort is needed to tackle this disease and different approaches should be pursued to maximize the chance of successfully fighting it. In the short term, we need to develop better inhibitors of the enzyme and test them in mice. Once we have better inhibitors, they can be clinically tested.

Source:Simon Fraser University.


The myth of the eight-hour sleep.

We often worry about lying awake in the middle of the night – but it could be good for you. A growing body of evidence from both science and history suggests that the eight-hour sleep may be unnatural.

In the early 1990s, psychiatrist Thomas Wehr conducted an experiment in which a group of people were plunged into darkness for 14 hours every day for a month.

It took some time for their sleep to regulate but by the fourth week the subjects had settled into a very distinct sleeping pattern. They slept first for four hours, then woke for one or two hours before falling into a second four-hour sleep.

Though sleep scientists were impressed by the study, among the general public the idea that we must sleep for eight consecutive hours persists.

In 2001, historian Roger Ekirch of Virginia Tech published a seminal paper, drawn from 16 years of research, revealing a wealth of historical evidence that humans used to sleep in two distinct chunks.

His book At Day’s Close: Night in Times Past, published four years later, unearths more than 500 references to a segmented sleeping pattern – in diaries, court records, medical books and literature, from Homer’s Odyssey to an anthropological account of modern tribes in Nigeria.

Much like the experience of Wehr’s subjects, these references describe a first sleep which began about two hours after dusk, followed by waking period of one or two hours and then a second sleep.

“It’s not just the number of references – it is the way they refer to it, as if it was common knowledge,” Ekirch says.

During this waking period people were quite active. They often got up, went to the toilet or smoked tobacco and some even visited neighbours. Most people stayed in bed, read, wrote and often prayed. Countless prayer manuals from the late 15th Century offered special prayers for the hours in between sleeps.

And these hours weren’t entirely solitary – people often chatted to bed-fellows or had sex.

A doctor’s manual from 16th Century France even advised couples that the best time to conceive was not at the end of a long day’s labour but “after the first sleep”, when “they have more enjoyment” and “do it better”.

Ekirch found that references to the first and second sleep started to disappear during the late 17th Century. This started among the urban upper classes in northern Europe and over the course of the next 200 years filtered down to the rest of Western society.

By the 1920s the idea of a first and second sleep had receded entirely from our social consciousness.

When segmented sleep was the norm

  • “He knew this, even in the horror with which he started from his first sleep, and threw up the window to dispel it by the presence of some object, beyond the room, which had not been, as it were, the witness of his dream.” Charles Dickens, Barnaby Rudge (1840)
  • “Don Quixote followed nature, and being satisfied with his first sleep, did not solicit more. As for Sancho, he never wanted a second, for the first lasted him from night to morning.” Miguel Cervantes, Don Quixote (1615)
  • “And at the wakening of your first sleepe You shall have a hott drinke made, And at the wakening of your next sleepe Your sorrowes will have a slake.” Early English ballad, Old Robin of Portingale
  • The Tiv tribe in Nigeria employ the terms “first sleep” and “second sleep” to refer to specific periods of the night

He attributes the initial shift to improvements in street lighting, domestic lighting and a surge in coffee houses – which were sometimes open all night. As the night became a place for legitimate activity and as that activity increased, the length of time people could dedicate to rest dwindled.

In his new book, Evening’s Empire, historian Craig Koslofsky puts forward an account of how this happened.

“Associations with night before the 17th Century were not good,” he says. The night was a place populated by people of disrepute – criminals, prostitutes and drunks.

“Even the wealthy, who could afford candlelight, had better things to spend their money on. There was no prestige or social value associated with staying up all night.”

That changed in the wake of the Reformation and the counter-Reformation. Protestants and Catholics became accustomed to holding secret services at night, during periods of persecution. If earlier the night had belonged to reprobates, now respectable people became accustomed to exploiting the hours of darkness.

This trend migrated to the social sphere too, but only for those who could afford to live by candlelight. With the advent of street lighting, however, socialising at night began to filter down through the classes.

In 1667, Paris became the first city in the world to light its streets, using wax candles in glass lamps. It was followed by Lille in the same year and Amsterdam two years later, where a much more efficient oil-powered lamp was developed.

London didn’t join their ranks until 1684 but by the end of the century, more than 50 of Europe’s major towns and cities were lit at night.

Night became fashionable and spending hours lying in bed was considered a waste of time.

A small city like Leipzig in central Germany employed 100 men to tend to 700 lamps

“People were becoming increasingly time-conscious and sensitive to efficiency, certainly before the 19th Century,” says Roger Ekirch. “But the industrial revolution intensified that attitude by leaps and bounds.”

Strong evidence of this shifting attitude is contained in a medical journal from 1829 which urged parents to force their children out of a pattern of first and second sleep.

“If no disease or accident there intervene, they will need no further repose than that obtained in their first sleep, which custom will have caused to terminate by itself just at the usual hour.

“And then, if they turn upon their ear to take a second nap, they will be taught to look upon it as an intemperance not at all redounding to their credit.”

Today, most people seem to have adapted quite well to the eight-hour sleep, but Ekirch believes many sleeping problems may have roots in the human body’s natural preference for segmented sleep as well as the ubiquity of artificial light.

This could be the root of a condition called sleep maintenance insomnia, where people wake during the night and have trouble getting back to sleep, he suggests.

The condition first appears in literature at the end of the 19th Century, at the same time as accounts of segmented sleep disappear.

“For most of evolution we slept a certain way,” says sleep psychologist Gregg Jacobs. “Waking up during the night is part of normal human physiology.”

The idea that we must sleep in a consolidated block could be damaging, he says, if it makes people who wake up at night anxious, as this anxiety can itself prohibit sleeps and is likely to seep into waking life too.

Stages of sleep

Every 60-100 minutes we go through a cycle of four stages of sleep

  • Stage 1 is a drowsy, relaxed state between being awake and sleeping – breathing slows, muscles relax, heart rate drops
  • Stage 2 is slightly deeper sleep – you may feel awake and this means that, on many nights, you may be asleep and not know it
  • Stage 3 and Stage 4, or Deep Sleep – it is very hard to wake up from Deep Sleep because this is when there is the lowest amount of activity in your body
  • After Deep Sleep, we go back to Stage 2 for a few minutes, and then enter Dream Sleep – also called REM (rapid eye movement) sleep – which, as its name suggests, is when you dream

In a full sleep cycle, a person goes through all the stages of sleep from one to four, then back down through stages three and two, before entering dream sleep

Russell Foster, a professor of circadian [body clock] neuroscience at Oxford, shares this point of view.

“Many people wake up at night and panic,” he says. “I tell them that what they are experiencing is a throwback to the bi-modal sleep pattern.”

But the majority of doctors still fail to acknowledge that a consolidated eight-hour sleep may be unnatural.

“Over 30% of the medical problems that doctors are faced with stem directly or indirectly from sleep. But sleep has been ignored in medical training and there are very few centres where sleep is studied,” he says.

Jacobs suggests that the waking period between sleeps, when people were forced into periods of rest and relaxation, could have played an important part in the human capacity to regulate stress naturally.

In many historic accounts, Ekirch found that people used the time to meditate on their dreams.

“Today we spend less time doing those things,” says Dr Jacobs. “It’s not a coincidence that, in modern life, the number of people who report anxiety, stress, depression, alcoholism and drug abuse has gone up.”

So the next time you wake up in the middle of the night, think of your pre-industrial ancestors and relax. Lying awake could be good for you.

Source:BBC medicine.


A New Meningococcal Serogroup B Vaccine: Baby Steps Toward Success

The 4CMenB vaccine showed promise in a European randomized trial.

We currently have vaccines that protect against meningococcal serotypes A, C, W-135, and Y. However, we lack a type B meningococcal vaccine that is sufficiently antigenic, especially in infants, for whom type B disease is particularly common. In a manufacturer-funded, phase 2b open-label trial, investigators in Europe tested a new, multicomponent serogroup B meningococcal vaccine (4CMenB). In a 2:2:1:1 ratio, 1885 infants were randomized to one of four groups:

  • 4CMenB plus routine vaccines at ages 2, 4, and 6 months
  • 4CMenB at ages 2, 4, and 6 months; plus routine vaccines at 3, 5, and 7 months
  • 4CMenB plus routine vaccines at ages 2, 3, and 4 months
  • Routine vaccines alone at ages 2, 3, and 4 months

The primary outcome was a titer of 1:5 serum bactericidal activity against each of three meningococcal B strains that are specific for vaccine antigens. For two strains, all four schedules achieved the titer threshold in 99% of infants. For the third strain, adequate titers were attained in 79% to 86% of vaccinated infants, depending on the schedule. Titers for routine vaccines given concomitantly with 4CMenB were noninferior to titers for routine vaccines alone, except in response to one nonessential pertussis antigen (pertactin) and to pneumococcal serotype 6B. Fever occurred more often after administration of 4CMenB than after administration of routine vaccines.

Comment: This is the first study to show excellent immunogenicity for a vaccine against serogroup B meningococcal disease in young infants. The vaccine needs to be tested in larger, non-European populations, and optimal scheduling must be assessed. For now, these findings represent a welcome first step in preventing this often life-threatening illness.

Source:  Journal Watch Pediatrics and Adolescent Medicine