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The children showed improvements on the days when their body temperature was raised to 102°F, compared with the days they were bathed at 98°F. Benefits were seen particularly in restricted and repetitive behavior as well as social behavior, said Hollander. The mechanism of action is under investigation, but researchers conjecture that raising the body’s temperature either through fever or a hot tub bath releases anti-inflammatory signals that can bring about the observed behavioral effects. Future studies need to be done to replicate many of these findings. But researchers suggest the data represent a step toward personalizing therapies for psychiatric and neurodevelopmental disorders and provide promise for the development of inflammatory biomarkers and treatment approaches for patients who are responsive to immune-targeted therapies.
Largest-Ever Ebola Outbreak Still Simmering in West Africa Joan Stephenson, PhD
N
ew cases of Ebola virus disease (EVD) continued to mount in West Africa in mid-July, adding to the toll of the largest outbreak of the infection to date. As of July 12, health officials said the outbreak in Guinea, Liberia, and Sierra Leone had resulted in 964 cases (including 603 deaths) attributed to EVD (http://bit.ly/1recLqf). The World Health Organization (WHO) said the agency and its partners were accelerating the emergency response to the outbreak, including contact tracing. Efforts to contain the outbreak have been complicated by “widespread misconception, resistance, denial, and occasional hostility in some communities,” said Manuel Fontaine, United Nations Children’s Fund regional director for West and Central Africa, in a statement (http://bit.ly /1nEGKoq). Between July 8 and 12, the WHO said the ministries of health in Guinea, Liberia, and Sierra Leone reported 85 laboratoryconfirmed, probable, and suspected cases and new cases of EVD, including 68 new deaths. These included 6 new cases (with 476
3 deaths) in Guinea, 30 new cases (with 13 deaths) in Liberia, and 49 new cases (with 52 deaths) in Sierra Leone. Guinea had the most cumulative cases as of July 12 (297 confirmed, 92 probable, and 17 suspected), with 304 deaths attributed to EVD (198 confirmed, 92 probable, and 14 suspected). In Sierra Leone, 386 cases (339 confirmed, 37 probable, and 10 suspected) and 194 deaths (151 confirmed, 38 probable, and 5 suspected) had been reported. Liberia had 172 cases (70 confirmed, 41 probable, and 61 suspected) and 105 deaths (48 confirmed, 33 probable, and 24 suspected). Cases from the outbreak, which is the first to occur in West Africa and the first Ebola outbreak to feature transmission in a capital city (Conakry, Guinea), were first reported in late March, the WHO said. The second-largest outbreak, in Uganda during 2000-2001, resulted in 425 cases and 224 deaths (a case-fatality rate of 53%). The WHO said that based on the information available, it does not recommend any travel or trade restrictions be applied to the 3 affected countries.
news@JAMA NEWS FROM JAMA’S DAILY NEWS SITE
Benefits of Liver Cancer Screening Still in Doubt Screening for liver cancer may not reduce the risk of liver cancer–related death, according to a systematic review assessing studies of screening tests for liver cancer in high-risk individuals (those with liver cirrhosis or chronic hepatitis B infection). Overall, the evidence is of low quality and offers no proof that screening these individuals provides any advantage in extending life or in decreasing mortality from the disease, the researchers said. None of the studies examined the harms of screening or overdiagnosis or finding very slow-growing tumors that never would have otherwise caused problems in a patient’s lifetime. http://bit.ly/1qcyz1j Walking to Curb Knee Arthritis Limitations Walking at least 6000 steps a day may be the ideal amount of physical activity to help ward off mobility problems for knee osteoarthritis, according to an analysis of 1788 older adults who had or were at risk of knee osteoarthritis. The researchers found that walking 5000 to 7499 steps daily halved the risk of developing functional limitations compared with walking fewer than 5000 steps. Walking 7500 or more steps a day reduced the risk by 60% to 70% compared with fewer than 5000 steps. The investigators found that 6000 steps per day was the best threshold to determine which participants did or did not develop functional problems. http://bit.ly/1ou7ZQb Report Highlights Teens’ Risky Health Behaviors Certain risky health behaviors of high school students such as marijuana use and distracted driving continue to pose a public health challenge, according to findings from the 2013 Youth Risk Behavior Survey by the US Centers for Disease Control and Prevention. Marijuana use remains high, with almost a quarter of students (23%) reporting using marijuana at least once in past 30 days. Texting or emailing while driving also remains common, with 41% of students claiming to have done so within the past 30 days. Wearing bicycle helmets remains uncommon, with about 88% of students reporting rarely or never using a helmet. http://bit.ly/1ou9Gx4
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA August 6, 2014 Volume 312, Number 5
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Nanyang Technological University User on 05/24/2015
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©iStock.com/choja
washout before beginning the second 12week phase. The researchers used several measurementstoassesssymptoms,includingstereotypy (self-stimulatory behavior), repetitive behavior, and rigidity or craving for sameness. In their interim analysis of this pilot study, they demonstrated the feasibility and safety of using TSO in an adult population with autism and have found a potential benefit from treatment in all these domains. Hollander’s team is in the process of launching a new study of this same approach in a pediatric population with ASD, based on the idea that early intervention in developmental disorders is optimal. In a different therapeutic approach, Hollander and his colleagues studied 10 children with ASD who had a history of symptom improvement when they had fevers. All the children spent alternate days soaking in a hot tub at 102°F (to mimic fever) or at 98°F (control condition).
The children showed improvements on the days when their body temperature was raised to 102°F, compared with the days they were bathed at 98°F. Benefits were seen particularly in restricted and repetitive behavior as well as social behavior, said Hollander. The mechanism of action is under investigation, but researchers conjecture that raising the body’s temperature either through fever or a hot tub bath releases anti-inflammatory signals that can bring about the observed behavioral effects. Future studies need to be done to replicate many of these findings. But researchers suggest the data represent a step toward personalizing therapies for psychiatric and neurodevelopmental disorders and provide promise for the development of inflammatory biomarkers and treatment approaches for patients who are responsive to immune-targeted therapies.
Largest-Ever Ebola Outbreak Still Simmering in West Africa Joan Stephenson, PhD
N
ew cases of Ebola virus disease (EVD) continued to mount in West Africa in mid-July, adding to the toll of the largest outbreak of the infection to date. As of July 12, health officials said the outbreak in Guinea, Liberia, and Sierra Leone had resulted in 964 cases (including 603 deaths) attributed to EVD (http://bit.ly/1recLqf). The World Health Organization (WHO) said the agency and its partners were accelerating the emergency response to the outbreak, including contact tracing. Efforts to contain the outbreak have been complicated by “widespread misconception, resistance, denial, and occasional hostility in some communities,” said Manuel Fontaine, United Nations Children’s Fund regional director for West and Central Africa, in a statement (http://bit.ly /1nEGKoq). Between July 8 and 12, the WHO said the ministries of health in Guinea, Liberia, and Sierra Leone reported 85 laboratoryconfirmed, probable, and suspected cases and new cases of EVD, including 68 new deaths. These included 6 new cases (with 476
3 deaths) in Guinea, 30 new cases (with 13 deaths) in Liberia, and 49 new cases (with 52 deaths) in Sierra Leone. Guinea had the most cumulative cases as of July 12 (297 confirmed, 92 probable, and 17 suspected), with 304 deaths attributed to EVD (198 confirmed, 92 probable, and 14 suspected). In Sierra Leone, 386 cases (339 confirmed, 37 probable, and 10 suspected) and 194 deaths (151 confirmed, 38 probable, and 5 suspected) had been reported. Liberia had 172 cases (70 confirmed, 41 probable, and 61 suspected) and 105 deaths (48 confirmed, 33 probable, and 24 suspected). Cases from the outbreak, which is the first to occur in West Africa and the first Ebola outbreak to feature transmission in a capital city (Conakry, Guinea), were first reported in late March, the WHO said. The second-largest outbreak, in Uganda during 2000-2001, resulted in 425 cases and 224 deaths (a case-fatality rate of 53%). The WHO said that based on the information available, it does not recommend any travel or trade restrictions be applied to the 3 affected countries.
news@JAMA NEWS FROM JAMA’S DAILY NEWS SITE
Benefits of Liver Cancer Screening Still in Doubt Screening for liver cancer may not reduce the risk of liver cancer–related death, according to a systematic review assessing studies of screening tests for liver cancer in high-risk individuals (those with liver cirrhosis or chronic hepatitis B infection). Overall, the evidence is of low quality and offers no proof that screening these individuals provides any advantage in extending life or in decreasing mortality from the disease, the researchers said. None of the studies examined the harms of screening or overdiagnosis or finding very slow-growing tumors that never would have otherwise caused problems in a patient’s lifetime. http://bit.ly/1qcyz1j Walking to Curb Knee Arthritis Limitations Walking at least 6000 steps a day may be the ideal amount of physical activity to help ward off mobility problems for knee osteoarthritis, according to an analysis of 1788 older adults who had or were at risk of knee osteoarthritis. The researchers found that walking 5000 to 7499 steps daily halved the risk of developing functional limitations compared with walking fewer than 5000 steps. Walking 7500 or more steps a day reduced the risk by 60% to 70% compared with fewer than 5000 steps. The investigators found that 6000 steps per day was the best threshold to determine which participants did or did not develop functional problems. http://bit.ly/1ou7ZQb Report Highlights Teens’ Risky Health Behaviors Certain risky health behaviors of high school students such as marijuana use and distracted driving continue to pose a public health challenge, according to findings from the 2013 Youth Risk Behavior Survey by the US Centers for Disease Control and Prevention. Marijuana use remains high, with almost a quarter of students (23%) reporting using marijuana at least once in past 30 days. Texting or emailing while driving also remains common, with 41% of students claiming to have done so within the past 30 days. Wearing bicycle helmets remains uncommon, with about 88% of students reporting rarely or never using a helmet. http://bit.ly/1ou9Gx4
For more on these stories and other medical news, visit http://newsatjama.jama.com.
JAMA August 6, 2014 Volume 312, Number 5
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Nanyang Technological University User on 05/24/2015
jama.com
©iStock.com/choja
washout before beginning the second 12week phase. The researchers used several measurementstoassesssymptoms,includingstereotypy (self-stimulatory behavior), repetitive behavior, and rigidity or craving for sameness. In their interim analysis of this pilot study, they demonstrated the feasibility and safety of using TSO in an adult population with autism and have found a potential benefit from treatment in all these domains. Hollander’s team is in the process of launching a new study of this same approach in a pediatric population with ASD, based on the idea that early intervention in developmental disorders is optimal. In a different therapeutic approach, Hollander and his colleagues studied 10 children with ASD who had a history of symptom improvement when they had fevers. All the children spent alternate days soaking in a hot tub at 102°F (to mimic fever) or at 98°F (control condition).
