Identifying the public health and safety needs of children from low-income communities may be best accomplished through art, report University of Pittsburgh researchers in the current online issue of Progress in Community Health Partnerships: Research, Education and Action. In their paper, researchers describe the success of Visual Voices, an arts-based program that engages community members as partners in research.

The study was based on Visual Voices programs conducted with 22 children ages 8 to 15 in two low-income and predominantly African-American communities in Baltimore and Pittsburgh. During the Visual Voices sessions, participants created paintings and drawings to share their perceptions, both positive and negative, of community safety and violence, as well as their hopes for the future. Afterward, they combined their individual art projects into two “visual voice” exhibits that were publicly displayed in each city.

Michael A. Yonas, Dr.P.H., Visual Voices creator and assistant professor, Department of Family Medicine, University of Pittsburgh School of Medicine, and colleagues at Pitt and the Johns Hopkins Center for Injury Research and Policy, used qualitative research methods to review and code the participants’ art projects for themes. Factors that participants identified as important to safety included school and social networks – family, friends and the local community. Places that they identified as unsafe were corner stores, streets and alleys with poor lighting, and abandoned houses. Other contextual factors identified as unsafe were drugs, smoking, drinking, gambling, guns and violence.

“Community members are experts in their own lives much more so than those who reside outside their communities,” said Dr. Yonas. “Visual Voices helps incorporate residents’ unique expertise into the research process in a non-intrusive and fun way, and creates valuable data about their life experiences.”

Visual Voices is different than surveys or focus groups because it uses tools – crayons, paint and markers – that are familiar to children, and it can lead to in-depth discussions, encourage self-efficacy and help build trusting relationships between academic researchers and the communities they serve, added Dr. Yonas. It also can help experts prioritize public health interventions.

In Pittsburgh, for example, findings were shared with the local police department to develop potential intervention opportunities and to increase law enforcement’s understanding of young peoples’ perceptions of safety.

“The heart of Visual Voices is to ask and listen,” said Jessica G. Burke, Ph.D., study co-author and assistant professor, Department of Behavioral and Community Health Sciences, Pitt’s Graduate School of Public Health. “You need to first ask what it is people care about in order to develop public health interventions that are appropriate for specific communities.”

The jumping gene or “Sleeping Beauty” transposon is “Molecule of the Year 2009″. This was announced by Professor Isidro T. Savillo, President of the International Society for Molecular and Cell Biology and Biotechnology Protocols and Researches (ISMCBBPR). The transposon was generated by Dr. Zsuzsanna Izsvák, Dr. Zoltán Ivics and Dr. Lajos Mátés of the Max Delbrück Center for Molecular Medicine in Berlin-Buch. According to the jury, it was selected out of 15 molecules nominated in the contest because “this molecule holds great promise for gene therapy”. The jury pointed out that it can stably transfer genes even to stem or progenitor cells and is safer than a viral vector. It is the first time that the Molecule of the Year has been awarded to major recipients outside the USA in Europe.

Transposable elements are molecular parasites that propagate themselves in genomes. But at the same time they provide plasticity to the genome that clearly contributed to the evolution of gene function across the tree of life. About half of the human genome is derived from ancient transposable element sequences.

However, due to mutations, the vast majority of the transposons became inactivated. Based on transposons in fish that are presumed to have been active approximately 20 million years ago, Dr. Ivics and Dr. Izsvák resurrected a jumping gene more than ten years ago. They named the transposon Sleeping Beauty, because they literally awakened it after a long evolutionary “sleep”.

The scientists modified the originally reconstructed transposon so that it acquired a highly elevated potency in gene transfer. In its award citation, the jury noted that this hyperactive transposon promises to be a revolutionary technology platform for genetic engineering in vertebrates.

Why does an apple a day keep the doctor away? New research published in the open access journal BMC Microbiology contributes to our understanding of why eating apples is good for you.

Microbiologists from the National Food Institute at the University of Denmark fed rats on a diet that was rich in whole apples, apple juice, purée or pomace, or put them on a control diet. They then analysed the microbial content of the rats’ digestive systems to see if eating apples had any impact on the numbers of presumed ‘friendly’ bacteria in the gut. “Certain bacteria are believed to be beneficial for digestive health and may influence the risk for cancer. We faced a well-known problem though – many types of bacteria cannot be easily cultured in the lab”, said research leader Professor Tine Rask Licht. The team therefore used genetics instead of culture techniques to examine the microbiology of the intestines. 16S rRNA is a molecule that is only found in bacteria and its make up is unique to each species or strain. “By working out the sequences of 16S rRNA molecules in the rats’ intestines and matching these to known bacterial profiles of 16S rRNA, we could determine which microorganisms were abundant in each group of rats”, explained Licht.

So what was the verdict? “In our study we found that rats eating a diet high in pectin, a component of dietary fiber in apples, had increased amounts of certain bacteria that may improve intestinal health”, said co-researcher Andrea Wilcks. “It seems that when apples are eaten regularly and over a prolonged period of time, these bacteria help produce short-chain fatty acids that provide ideal pH conditions for ensuring a beneficial balance of microorganisms. They also produce a chemical called butyrate, which is an important fuel for the cells of the intestinal wall”.

Of course, further research is needed to determine whether the digestive system of humans responds to apples in the same way as rats, but these findings certainly suggest that Europe’s favourite fruit has a well-deserved place in our 5-a-day.

New findings by researchers at UNC Lineberger Comprehensive Cancer Center suggest that the most common form of malignant brain cancer in adults, glioblastoma multiforme (GBM), is probably not a single disease but a set of diseases, each with a distinct underlying molecular disease process. The study, published by Cell Press in the January issue of the journal Cancer Cell, provides a solid framework for investigation of future targeted therapies that may improve the near uniformly fatal prognosis of this devastating cancer.

“Previous work has established that gene expression profiling can be used to identify distinct subgroups of GBM,” says senior study author, Dr. D. Neil Hayes from the Division of Hematology/Oncology at the University of North Carolina at Chapel Hill. “However, the exact number and clinical significance of these was unclear.” Dr. Hayes and colleagues at UNC Lineberger expanded on previous GBM classification studies and used expression profiling techniques to comprehensively analyze hundreds of GBM patient samples. The group was able to reliably identify four distinct molecular subtypes of GBM tumors.

The researchers then went on to perform a unique integrative analyses across multiple platforms to look for defining characteristics associated with each subtype. Their findings were quite striking, implying that there are distinct types of GBM and that each one is associated with a specific molecular process. “We discovered a bundle of events that unequivocally occur almost exclusively within a subtype,” explains Dr. Hayes.

The researchers also report that the nature of these events indicate that the underlying disease process for each subtype may involve distinct cells of origin at a specific stage of differentiation. This is finding has potential clinical significance as determining the cells of origin of GBM is critical for establishing effective treatment regimens. Clearly, given this new information, it makes sense that some drug classes would be expected to work for some tumor subtypes and not other. In support of this conclusion, Dr. Hayes’s group found that response to aggressive chemotherapy and radiation differed by subtype.

Taken together, the findings represent an important step towards more rational therapies for GBM. “It appears that the simple classification into these four subtypes carries a rich set of associations for which there is no existing diagnostic test,” says Dr. Hayes “This comprehensive genomic and genetic-based classification of GBM should lay the groundwork from an improved molecular understanding of GBM pathway signaling that could ultimately result in personalized therapies for groups of patients with GBM.”

Current evidence suggests that using Doppler ultrasound in high-risk pregnancies to monitor a fetus’ health may reduce caesarean sections and the number of babies who die, according to a new Cochrane Systematic Review.

Doppler ultrasound is a well established technique used to diagnose problems during pregnancy. In the same way that a speed radar measures how fast cars are travelling, Doppler ultrasound can monitor how fast blood is moving in the umbilical blood flow. Professionals can then look to see whether the blood flow is normal, indicating that the fetus is healthy, or abnormal, indicating that the fetus is under stress. The health professionals can then decide which high-risk pregnancies need assistance in delivering the baby, and which women can be left to deliver without assistance.

The aim of using Doppler is to reduce risk to the baby. However, some experts argue that it may prompt some unnecessary early interventions.

The review included 18 studies which together included 10,000 women in “high risk” groups. High risk women included those who had previously lost babies during pregnancy, those carrying growth restricted babies and women with hypertension or diabetes. Women who were examined with Doppler ultrasound were compared with those who had no Doppler or with those who had cardiotocography (CTG), which monitors the baby’s heartbeat. According to the results, Doppler reduced infant deaths, possibly through better timing of caesarean sections, as well as reducing the number of caesarean sections themselves, and inductions of labour. However, the researchers say the studies included were of questionable quality.

“A case could certainly be made for a higher quality, multi-centre trial of Doppler ultrasound than we have so far seen,” said lead researcher Zarko Alfirevic, who is based at the Division of Perinatal and Reproductive Medicine at the University of Liverpool. “It is quite possible that for some so-called high risk groups fetal Doppler offers little or no benefit. Women with diabetes are one such group where fetal Doppler may, in fact, give false reassurance.

“It is important to point out, of course, that it is the clinical decision that follows a Doppler ultrasound examination that changes the outcome for the baby, and currently there is little agreement on what intervention should follow an abnormal Doppler finding.”

Combining drugs and radiotherapy improves the survival chances of women receiving treatment for cervical cancer. These are the conclusions of Cochrane Researchers who carried out the most comprehensive study of the effects of combined drug and radiotherapy in cervical cancer treatment to date.

Cervical cancer is the second most common cancer in women worldwide. Treatments for the disease have changed markedly over the last decade as a result of guidelines issued by the National Cancer Institute (NCI) in 1999, which stated that chemoradiotherapy should be considered as an alternative to radiotherapy. Chemoradiotherapy combines chemotherapy (drug treatment) and x-ray treatment, whereas radiotherapy is just x-ray treatment.

“We saw clear evidence that adding chemotherapy to radiotherapy improves survival, as well as disease free survival,” said Claire Vale, of the Medical Research Council Clinical Trials Unit in London in the UK. “These are effective, affordable treatments that provide a benchmark for other potential treatment approaches.”

The researchers analysed data from 15 trials involving a total of 3,452 women. They found that compared to women who had radiotherapy alone, women receiving chemoradiotherapy were more likely to live for longer after treatment. Five years after receiving treatment, 66 out of every 100 women survived with chemoradiotherapy compared to 60 out of 100 with radiotherapy. In addition, treatment with chemoradiotherapy reduced the chance of the cancer coming back or spreading to other areas. Crucially, their analysis showed that the benefits of chemoradiotherapy were not just restricted to the platinum-based drugs recommended by the NCI.

Based on a small subset of the data, there was also an indication that continuing drug therapy after chemoradiotherapy could improve survival rates even further, although the researchers say more studies are required to confirm this. “We suggest that new trials are needed to find out whether giving extra chemotherapy is better for women with cervical cancer or not,” said Vale.

Using beta-blockers as a second-line therapy in combination with certain anti-hypertensive drugs significantly lowers blood pressure in patients with hypertension, according to a systematic review by Cochrane Researchers. This review also goes some way to explaining the differences in the way that patients respond to beta-blockers and other classes of blood pressure lowering drugs.

Beta-blockers are commonly used in the treatment of hypertension (high blood pressure) to help reduce the risk of stroke and cardiovascular disease. They can be used alone or as a second-line therapy in combination with a wide range of anti-hypertensive drugs. The idea behind combining two different drugs to treat hypertension is that each has a different mechanism of action and thus may help tackle different mechanisms involved in causing the condition. In this way, greater decreases in blood pressure may be achieved than with single drug therapy.

The review included 20 trials involving a total of 3,744 patients. Overall, the researchers found that adding beta-blockers as the second-line drug, in combination with thiazide diuretics or calcium channel blockers, caused an additional blood pressure reduction. The reduction was around 30% greater when the dose was doubled.

This data was compared with a Cochrane Review published in Issue 4, 2009 that examined the blood pressure lowering effect of second-line thiazide diuretics. They concluded that the two drugs produced different patterns of blood pressure lowering. Second-line beta-blockers were found to be more effective at reducing diastolic blood pressure (the minimum pressure in the arteries between beats when the heart relaxes to fill with blood) but had little or no effect on pulse pressure, while second-line thiazides significantly decreased pulse pressure in a dose-related manner.

“We feel that these findings are generalisable to most patients being treated for hypertension where a beta-blocker is added as a second-line drug to a first-line thiazide,” said lead researcher, Jenny Chen, who works in Pharmacology and Therapeutics at the University of British Columbia in Vancouver, Canada. “The finding that beta-blockers produce a different pattern of blood pressure lowering to thiazides when used as second-line drugs certainly deserves further attention as it might explain why beta-blockers appear to be less effective than thiazide diuretics at reducing adverse cardiovascular outcomes, particularly in older individuals.”

“The major limitation of this work is that we only know what happens when you add beta-blockers to thiazides and calcium channel blockers. It is possible that adding beta-blockers to other classes of drugs might produce a different result,” said Chen.

Treadmill training can be used to help people with Parkinson’s disease achieve better walking movements, say researchers. In a systematic review of the evidence, Cochrane Researchers concluded treadmill training could be used to improve specific gait parameters in Parkinson’s patients.

Gait hypokinesia, characterised by slowness of movement, is one of the main movement disorders that affects Parkinson’s patients and can have a major impact on quality of life. More recently, health professionals have started incorporating exercise into treatment regimes as a useful complement to traditional drug therapies. Training on treadmills is one option that may help to improve movement.

The researchers analysed data from eight trials including 203 patients for the review, published in The Cochrane Library. They compared treadmill training versus no treadmill training, using effects on walking speed, stride length, number of steps per minute (cadence) and walking distance to measure improvement in gait. Treadmill training had a positive impact on each of these measurements, apart from cadence.

“Treadmill training appears to be a safe and effective way of improving gait in patients with Parkinson’s disease,” said lead researcher Jan Mehrholz, of the Wissenschaftliches Institut in Kreischa, Germany. “Crucially, we saw very few adverse effects or drop outs in patients given this type of rehabilitation therapy.”

However, the researchers say the findings must be treated with care as they are based on a limited number of small trials. “There is still a need for larger trials to establish if treadmill training can be safely used as a routine therapy for Parkinson’s patients,” said Merhholz. “We also need to answer basic questions about how long the benefits last and what a good training programme should consist of. For instance, how often and how long should patients train for?”

Intensive home-based nursing in HIV/AIDS patients significantly improves self-reported knowledge of HIV, awareness of medications, and self-reported adherence to medication programmes, according to a new Cochrane Systematic Review. One home-based care trial included in the review also significantly impacted on HIV stigma, worry, and physical functioning. It did not, however, help improve depressive symptoms, mood, general health, and overall functioning.

These conclusions are interesting, but more research is needed to understand the impact of home-based care in developing countries and on important disease outcomes, say the researchers. The study represents the first systematic review of the impact of home care in HIV/AIDS.

As a disease that affects 33 million people, HIV/AIDS puts a huge strain on health systems, particularly in developing countries. Therefore, in countries where health services are overstretched, home-based care is offered to HIV patients as an alternative to hospital care. Home-based care can include counselling, medical management, exercise, and spiritual support to try to improve patients’ quality of life in familiar surroundings, while reducing costs and pressure on hospital beds.

Researchers examined data from 13 studies, two of which were ongoing. The researchers report that home-based care has positive impacts on some aspects of patient wellbeing but little effect on others. Patients said that home care improved their knowledge of the disease, and of HIV medications, and helped them adhere to medication programmes. It also reduced worry and improved physical functions of patients, but had little effect on depression, general health, or indicators of disease progression such as CD4 counts.

Importantly, few studies considered the effects of home-based care in developing countries or on important disease outcomes. “Further large studies are needed to evaluate the effects of home-based care in developing countries, where HIV and AIDS take the biggest toll,” said Young. “And there should be a greater focus on how home-based care impacts on progression to full blown AIDS and death from the disease.”

“This study is a useful addition to the literature because of the wide range of home care options considered. However, there is no doubt that the evidence base for home-based care in HIV needs further development.”

Two experts on bmj.com today say that further research is needed before consumers can be reassured that electronic cigarettes (also known as e-cigarettes) are safe.

“Our knowledge on the acute and long term effects of e-cigarette use is, at best, very limited”, say Andreas Flouris and Dimitris Oikonomou, from the Institute of Human Performance and Rehabilitation in Greece.

Interest in alternative smoking products is augmenting since anti-smoking policies are becoming more widespread. Electronic cigarettes or e-cigarettes are one of the most newly introduced products on the market. These are battery operated devices that allow users to inhale a nicotine vapor. They are meant to substitute normal cigarettes and help smokers quit.

There are a number of doubts regarding the safety of e-cigarettes. The US Food and Drug Administration (FDA) had expressed serious concerns. Three reports have been undertaken on the product: one by the FDA, one by a private body called Health New Zealand (HNZ) and another by Demokritos, a publicly-funded Greek research institute.

The authors remark that the interpretations of the three reports diverge significantly. The FDA detected a number of toxins in e-cigarettes and “carefully raises caution on potential harmful effects of e-cigarettes.”On the other hand, HNZ recommends e-cigarettes as they are safer than normal tobacco products. DRI takes a neutral position.

In conclusion, the authors note that while “alternative smoking strategies are always welcome in an effort to reduce the threat to public health caused by the tobacco epidemic”, further research is necessary in order to inform consumers about the safety of these e-cigarettes.