Screen All Baby Boomers for Hepatitis C, Expert U.S. Panel Says

MONDAY, June 24 (HealthDay News) -- All adults born between 1945 and 1965 -- the baby boom generation -- should be screened for the hepatitis C virus along with injection-drug users and anyone transfused before 1992, according to new recommendations from the U.S. Preventive Services Task Force.

The guidelines, released Monday, mirror recommendations from the U.S. Centers for Disease Control and Prevention and provide a long-awaited policy from the task force, an independent panel of experts.

"For everyone born between 1945 and 1965 we recommend a one-time screening," said task force member Dr. Kirsten Bibbins-Domingo, an associate professor in residence at the University of California, San Francisco, School of Medicine.

People in this age group account for three-quarters of all hepatitis C cases in the United States, Bibbins-Domingo said. Many contracted the disease decades ago but don't know it.

Hepatitis C -- a leading cause of liver damage and liver disease in the United States -- is considered a silent killer because it progresses without any indications of illness. More than 30 percent of U.S. patients needing liver transplants have end-stage liver disease related to hepatitis C.

"The challenge is that many people have hepatitis C and don't have signs and symptoms of the disease," Bibbins-Domingo said. "Those people should be identified and consider treatment."

An estimated 3.9 million people are infected with hepatitis C in the United States, the task force said. Unlike other types of hepatitis, there is no vaccine for hepatitis C.

In its 2004 statement, the task force advised against routine screening of adults without symptoms and high risk of infection. It also said it had too little evidence to recommend for or against routine screening for adults with high risk of infection.

It became apparent, however, that two-thirds of infected people weren't getting screened, while treatment was becoming more successful.

"Many people appear to benefit from treatment," Bibbins-Domingo said. "That is what led the task force to conclude that it is beneficial for people to find out they have hepatitis C in order to seek treatment."

Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center in New York City, said he welcomes the new guidelines, which were published June 25 in the Annals of Internal Medicine.

"I am absolutely thrilled that the U.S. Preventive Services Task Force, which has had a head-in-the-sand approach toward screening, has come out for a one-time screening for hepatitis C," Siegel said.

Siegel encourages everyone at risk to get tested.

Screening for hepatitis C involves a simple, inexpensive blood test. Those who test positive usually receive a course of antiviral medication over several months. Most people have no detectable virus following treatment, Bibbins-Domingo said.

"Treatment is effective in preventing the complications of hepatitis C," Bibbins-Domingo said. "Treatments have gotten better, and I suspect treatments will continue to get better."

Many people who test positive for the virus have no signs of active infection. Whether they should be treated should be discussed with their doctor, she said.

Although baby boomers should have a one-time screening, those who continue to be at risk for the infection should be screened more often, Bibbins-Domingo said.

Past or current injection-drug use is the greatest risk for hepatitis C infection. Also at high risk are people with a history of blood transfusions before widespread adoption of screening and infection-control measures in 1992; people who have undergone long-term dialysis treatment; and those with exposure to hepatitis C in health care settings. People with HIV/AIDS, a history of intranasal drug use or tattoos from unregulated or unsafe parlors also are at greater risk than the general population.

This expanded screening may identify millions of Americans who were unaware of their infection, the task force said.

By Steven Reinberg - HealthDay Reporter

Discovery May Lead to New Treatments for Jaundice

GUELPH, Ontario - June 10, 2013 - University of Guelph News Release - Helping to protect newborns and older patients against more severe effects of jaundice is the hope of University of Guelph researchers, who have shown how a liver enzyme protects cells from damage caused by the condition.

Their discovery might ultimately lead to an alternative treatment for jaundice, such as a new drug or supplement, says Daniel Kim, a research technician in Guelph’s Department of Biomedical Sciences.

He is lead author of a paper published recently in the journal Toxicology and Applied Pharmacology. Co-authors are biomedical sciences professor Gordon Kirby, former research associate Monica Antenos, and Prof. Jim Squires of U of G’s Department of Animal and Poultry Science.

Almost two out of three newborns contract jaundice, with its telltale skin yellowing. Normal treatment involves use of ultraviolet light. UV treatment doesn’t always work.

Although the condition is usually benign, severe cases can cause permanent brain damage and lead to cerebral palsy and hearing loss.

Jaundice can also affect people with liver disease or increased breakdown of red blood cells, as in malaria.

In all cases, a substance called bilirubin collects in the blood. High amounts can be toxic and can cause permanent brain damage, said Kirby.

Other researchers had already found a naturally occurring enzyme that breaks down bilirubin. Called cytochrome P450 2A5, the enzyme is known to increase in people with liver ailments.

The Guelph team has shown that more bilirubin in the blood activates the gene to make this enzyme. The enzyme helps remove bilirubin and prevents liver cells from dying, said Kirby.

The U of G researchers used cultured liver cells from mice for their study.

"Scientists need to determine safe and effective levels of the enzyme before developing any treatment, We need to fine-tune our ability to manipulate this enzyme and fully understand its role in bilirubin removal,” he said. Kirby has long studied the enzyme’s role in nicotine addiction in smokers.

Heart and Stroke Foundation report emphasizes there is life after stroke

Recovery can continue for years,
with survivor family and friends playing essential role

OTTAWA, June 10, 2013 /Canada NewsWire/ - More Canadians are surviving strokes due to advances in awareness and medical services but a new report by the Heart and Stroke Foundation reveals that more than one-third of Canadians mistakenly believe that the recovery period is limited to a few months.

Stroke recovery is a journey that can continue for years or a lifetime, according to the Heart and Stroke Foundation 2013 Stroke Report, which outlines the importance of family caregivers in the process. A poll* carried out for the report reveals that half of Canadians are directly touched by stroke and even more striking, that one in five Canadians have been involved in the support and care of a stroke survivor.

"Our poll confirmed what we have long suspected - that stroke touches the lives of many Canadians, and family members and friends play an important role in the recovery journey," says Ian Joiner, Director, Stroke, Heart and Stroke Foundation. "Obviously the best story is when a stroke is prevented, but we need to pay more attention to every aspect of stroke - prevention, recognition, treatment, and rehabilitation and recovery."

315,000 Canadians are currently living with the effects of stroke and this will increase

Fifty thousand strokes occur in Canada each year and 315,000 Canadians are living with the effects of stroke. As the population continues to age this number will increase - as will the number of Canadians caring for loved ones post-stroke. Now, 60 per cent of people who have a stroke report that they need help afterwards and 80 per cent have restrictions to their daily activities.

The economic cost is also high; stroke costs the Canadian economy $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity.

"Combine these factors and a complete story of stroke emerges," says Joiner, adding that advances in awareness and treatment mean deaths from stroke are actually declining. "More Canadians will be living with the effects of stroke. Recovery can continue for years, and many Canadians find themselves supporting stroke survivors through that recovery journey. The urgency and need for action is clear."

Rehabilitation and caregiver support are essential in the stroke recovery journey

Rehabilitation is a key part of the stroke recovery journey and rehabilitation research and enhancements to services and access will be more important than ever.

"We need rehabilitation research to better understand the difficulties someone is having after a stroke and then develop the treatments to help them get better," says Dr. Sean Dukelow, a physiatrist at the Hotchkiss Brain Institute Faculty of Medicine, an assistant professor at the University of Calgary and a Heart and Stroke Foundation-funded researcher who uses robotics to help stroke survivors recover. "We use a robotic model - a large robotic chair - that helps measure a patient's improvement over time and helps deliver therapy. It can require tens of thousands of repetitions of a particular movement to relearn how to do it after stroke and the robot can help us determine the type and intensity of the rehabilitation needed for a patient to relearn how to use his arm. We can use this information and turn that into a plan to treat the patient more effectively."

The role that relatives or close friends of stroke survivors carry out is essential to the recovery journey. They help survivors relearn routine activities, regain abilities, cope with challenges and frustrations and do things the survivors cannot do for themselves. They also become navigators of the healthcare system and advocates for services and follow-up.

"After my stroke, my mom was my rock," says Janel Nadeau, a stroke survivor who suffered a hemorrhagic stroke at 19 and has gone on to become a doctor. "She was my advocate. She was my communicator. I knew that I did not have to worry about what was going on outside of my little bubble, because my mom would take care of it so I could focus simply on recovering."

Other results from the Heart and Stroke Foundation poll reveal that not all Canadians have a clear picture of how strokes can be prevented. According to the poll, less than two-thirds of Canadians are aware that most strokes can be prevented and nearly one in six believe that once a person has recovered from a stroke there is nothing they can do to prevent another one. And the fact is that up to 80 per cent of premature heart disease and stroke can be prevented.

Canadians are optimistic about the outlook for stroke survivors and the possibilities of life after stroke. In the Heart and Stroke Foundation poll, more than four in five respondents said they believe that people who survive a stroke can be treated, recover and live meaningful lives.

Advances mean hope

The story of stroke is not over. Stroke is preventable. Stroke is treatable. And recovery from stroke is possible. For stroke survivors and their loved ones, continued advances in rehabilitation and recovery mean real hope for a better future. There is life after stroke.

For the full report, videos of researchers and survivors, resources for stroke survivors and caregivers, and calls to action for Canadians, government and healthcare professionals visit heartandstroke.ca/strokereport2013.

Heart and Stroke Foundation poll

According to a new poll* by the Heart and Stroke Foundation:

...One in two Canadians report having a close friend or family member who is a stroke survivor.

...One in five Canadians report being directly involved in the support and care of a stroke survivor.

...Fewer than two in three Canadians believe that most strokes can be prevented.

...Nearly one in five believe that most strokes are fatal.

...More than four in five believe that people who survive a stroke can be treated, recover and live meaningful lives.

...Nearly one in six Canadians believe that once a person has recovered from a stroke there is nothing they can do to prevent another one.

...One in three Canadians believe that once a person survives a stroke there is an initial period of a few months of recovery. After than they are unlikely to recover any further.

Heart and Stroke Foundation public opinion polling conducted by Environics by telephone between April 4 and 14, 2013 with a total of 2,002 respondents. Results of a survey of this size can be considered accurate to within plus or minus 2.19 percent, 19 times out of 20.]

The vital stats on stroke

There are an estimated 50,000 strokes in Canada each year. That is one stroke every 10 minutes.

About 315,000 Canadians are living with the effects of stroke.

Every seven minutes in Canada, someone dies from heart disease or stroke.

Stroke is the third leading cause of death in Canada. Six per cent of all deaths in Canada are due to stroke.

Stroke is a leading cause of death and disability among adults.

About the Heart and Stroke Foundation

The Heart and Stroke Foundation, a volunteer-based health charity, leads in eliminating heart disease and stroke, reducing their impact through initiatives to prevent disease, save lives and promote recovery. Healthy lives free of heart disease and stroke. Together we will make it happen. Heartandstroke.ca

The Foundation is asking all Canadians to make health last by taking action today to give themselves, their friends and families longer, healthier, fuller lives. Take the Heart&Stroke Risk Assessment at makehealthlast.ca.