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Nearly 80 percent of Americans live within two hours by ground or helicopter transport of a verified burn center, but there are significant regional variations in access to these centers, a new study finds.

A verified burn center is one in which the quality of care has been assessed and confirmed by the American Burn Association. More than a half-million burn injuries and about 4,000 burn-related deaths occur each year in the United States, according to the association.

The study found that there were 128 self-reported burn centers in the United States in 2008, including 51 verified burn centers. The centers were served by 782 helipads and 804 helicopters. About 25 percent of the U.S. population lived within one hour by ground transport of a verified burn center, the study found. It also reported that 46 percent lived within two hours by ground transport and 68 percent lived within four hours by ground transport.

If taken by helicopter, about 54 percent could get to a verified burn center in an hour, and 79 percent in two hours, the study found. By helicopter, 75 percent could get to any self-reported burn center in an hour, and 96 percent in two hours.

The researchers noted that one-third of the U.S. population must be transported by air to reach a verified burn center within two hours.

Access varied greatly by region, the study authors reported in the Oct. 28 issue of the Journal of the American Medical Association.

“The greatest proportion of the population with access was highest in the northeast region and lowest in the southern United States,” wrote Dr. Matthew B. Klein, of the University of Washington in Seattle, and his research colleagues.

The regional variations identified in the study “may be an influential predictor of optimal regionalization strategy,” they wrote. “For states and regions with a relatively high baseline rate of access, the best strategy for improving access and reducing time to definitive care may involve optimization of air and ground emergency medical service systems. For states and regions with a relatively low baseline rate of access, the best strategy may involve construction or verification of new regional burn care facilities.”

The study did not determine optimal distribution of burn centers throughout the country, but the data “provide important information about population access that may be used to guide resource allocation in burn care,” the researchers concluded.

For people in their 70’s, light to moderate alcohol intake may offer women, but not men, some protection against loss of mobility, a study hints.

But the investigators caution that most of this benefit is tied to the drinkers’ lifestyle.

The study looked at associations between alcohol intake and the mobility levels reported by 3,061 healthy men and women who were 70 to 79 years old and living in the Pittsburgh, Pennsylvania and Memphis, Tennessee areas.

At enrollment, none had difficulty walking a quarter mile, climbing 10 steps, or performing basic activities of daily living. Every 6 months over the next 6.5 years, the participants had either a clinical examination or completed a mobility survey.

From these evaluations, Dr. Cinzia Maraldi of the University of Ferrara in Italy and colleagues determined that 24 percent of the study subjects had become unable to walk a quarter mile, climb 10 steps without resting, or perform daily activities. Another 49 percent developed difficulty performing these tasks.

When Maraldi’s team looked at mobility according to weekly alcohol intake, as determined at study enrollment, moderate drinking in men and light to moderate drinking in women appeared to be associated with lower loss of mobility.

For men, moderate intake was defined as 8 to 14 drinks per week. For women, light drinking was 1 to 3 drinks per week and moderate drinking, 4 to 7 drinks a week.

However, most of the apparent protective effect on mobility of light and moderate alcohol intake was found to be due to lifestyle factors of the drinkers - particularly lower body weight, higher physical activity levels, higher income, and more education.

In the Journal of the American Geriatrics Society, Maraldi and colleagues suggest caution in “attributing a direct benefit of moderate alcohol intake on functional ability,” since these findings show that lifestyle plays a more important role in elder’s ability to maintain mobility.

A higher risk of cardiovascular-related death isn’t the reason why kidney failure patients starting dialysis are at increased risk of death, according to new research that challenges previous thinking.

A number of studies have found that cardiovascular disease accounts for 40 percent to 50 percent of deaths in patients with end-stage kidney disease, and “it is believed that the life span of patients receiving dialysis is reduced mainly as a consequence of premature cardiovascular death,” noted the authors of the new study.

Using data from between January 1994 and January 2007, the researchers compared the death rates in 123,407 dialysis patients in Europe and in the general European population.

Among dialysis patients, non-cardiovascular causes accounted for 50.8 percent of deaths while cardiovascular disease caused 39.1 percent of deaths. In the general population, 58.4 percent of deaths were from non-cardiovascular causes, 40.4 percent were from cardiovascular causes, and 1.2 percent were from unknown causes.

The overall all-cause death rate was higher among patients on dialysis, according to the report published in the Oct. 28 issue of the Journal of the American Medical Association.

“In particular, non-cardiovascular mortality rates were higher than cardiovascular mortality rates in patients starting dialysis,” wrote Dinanda J. de Jager, of the Leiden University Medical Center in the Netherlands, and colleagues. “These results suggest that excess mortality in patients receiving dialysis is not specifically the result of increased cardiovascular deaths.”

The researchers concluded that “cardiovascular and non-cardiovascular mortality are equally increased during the first three years of dialysis, compared with the general population. This implies that the importance of non-cardiovascular mortality in patients receiving dialysis has generally been underestimated. Therefore, research should focus more on methods to prevent non-cardiovascular mortality.”

Children and teens who take medicines for conditions such as schizophrenia, bipolar disorder and autism tend to put on a substantial amount of weight, a new study finds.

The worry is that excessive weight gain and other metabolic changes in childhood can place kids at risk for chronic health problems as adults. Some of these medicines, collectively known as “atypical antipsychotics,” have been linked to increased blood-fat levels.

“We are very much afraid that this will lead to diabetes and metabolic syndrome,” said study author Dr. Christoph Correll, medical director of the Recognition and Prevention program at the Zucker Hillside Hospital in Glen Oaks, N.Y.

The study, reported in the Oct. 28 issue of the Journal of the American Medical Association, is the largest analysis of its kind, Correll said.

Jeanette M. Jerrell, a professor of neuropsychiatry at the University of South Carolina School of Medicine in Columbia, is the co-author of a similar study published last year in the Archives of Pediatrics and Adolescent Medicine.

“We found that obesity/weight gain, type 2 diabetes mellitus and cardiovascular conditions were more prevalent in the treated cohort,” she noted.

Her study also found that kids taking multiple antipsychotics were at significantly higher risk for obesity/weight gain, type 2 diabetes, abnormal blood-fat levels and cardiovascular problems.

“This new study is important because it draws further attention to the safety profile of antipsychotics in young populations, and the critical need for expanding the evidence base to guide clinical decisions,” she said.

Concerns about the safety of atypical antipsychotics are not new. In 2003, the U.S. Food and Drug Administration ordered manufacturers of these drugs to add a warning about the risk for hyperglycemia and diabetes.

What’s more, a 2008 report in The Lancet suggested that some of these drugs — sometimes called “second-generation” antipsychotics — may be no better than older, “first-generation” medicines. The authors concluded that each drug must be weighed individually based on its efficacy and side effects.

Correll’s study was designed to assess the safety and effectiveness of the newer class of drugs in youth. His team followed 272 patients, aged 4 to 19, who were taking an antipsychotic for the first time. Patients were being treated for mood spectrum, schizophrenia spectrum or aggressive behavior spectrum disorders.

Fifteen pediatric patients who refused to participate or discontinued their antipsychotic medication within four weeks of starting served as a control group.

The study focused on four antipsychotics commonly prescribed to children: aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal).

After nearly 11 weeks, the treated kids gained an average of 18.7 pounds on Zyprexa, 13.4 pounds on Seroquel, 11.7 pounds on Risperdal and 9.7 pounds on Abilify, while the control group gained less than half a pound. Between 10 percent and 36 percent became overweight or obese during the treatment period, according to the study.

“In these kids that we studied, there was rapid and dramatic weight gain, more than has been described before,” said Correll, who is also a scientist in the Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research in Manhasset, N.Y.

Use of each drug was linked to wider bellies and increased “fat mass” — the proportion of the body comprised of fat.

The drugs had varying effects on metabolic levels. Zyprexa and Seroquel users experienced significant adverse changes in total cholesterol and trigylcerides. Risperdal use resulted in a significant increase in triglycerides. Abilify, however, appeared “metabolically neutral,” Correll said.

“Some of these kids are maintained on these medications for many years if not indefinitely, so it’s definitely a concern,” said Ronald T. Brown, dean and professor of public health at Temple University Health Sciences Center in Philadelphia. “For children who really don’t absolutely need these drugs, they need to be doing more behavioral approaches in psychotherapy.”

In an accompanying editorial, Drs. Christopher K. Varley and Jon McClellan of Seattle Children’s Hospital concluded that large, independently funded studies are needed to establish the long-term safety and benefit of these drugs in children.

“Until those data are available, consideration of less risky treatment interventions and scrupulous attention to metabolic parameters in children and adolescents who receive atypical antipsychotic medications are essential,” they wrote.

Correll, in fact, is currently involved in a longer-term follow-up study to assess the health effects of these drugs in children over an extended period of time.

For now, he advises clinicians and families to carefully weigh the risks and benefits of the medications against the risk of the illness, and to consider other pharmaceutical and non-pharmaceutical options. It’s also important to teach children about healthy lifestyles and to closely monitor kids’ weight, lipid levels and blood glucose, he said.

Researchers at the National Institutes of Health have identified a genetic mutation that accounts for a perplexing condition found in people with an inherited immunodeficiency. The disorder, called combined immunodeficiency, is characterized by a constellation of severe health problems, including persistent bacterial and viral skin infections, severe eczema, acute allergies and asthma, and cancer.

The team that made the discovery was led by Helen Su, M.D., Ph.D., at the National Institute of Allergy and Infectious Diseases (NIAID), and included collaborators from NIAID and the National Cancer Institute (NCI). The research is reported in this week’s New England Journal of Medicine.

“NIH clinicians have cared for people with unusual and difficult-to-treat immune disorders for decades,” says NIAID Director Anthony S. Fauci, M.D. “This study exemplifies their commitment to improving the lives of people with these diseases by trying to uncover the causes of these disorders and thereby better understanding how to treat them.”

Combined immunodeficiency is a type of primary immune deficiency disease (PIDD) in which several parts of the immune system are affected. This inherited disorder is characterized by increased susceptibility to bacterial, viral and fungal infections of various organs of the body. In some cases, susceptibility to cancers also may be seen.

There are 150 known PIDDs. Approximately 500,000 people in the United States have been diagnosed with a PIDD, while many more remain undiagnosed.

The NIAID and NCI investigators recognized that certain patients with an undefined form of combined immunodeficiency shared enough clinical features to make it likely that the cause might be a common genetic mutation. Originally, these individuals were thought to have a variant form of hyper-immunoglobulinema E syndrome (HIES), a disorder characterized by increased levels of a class of antibodies known as immunoglobulin E, superficial and systemic bacterial and fungal infections, and atopic dermatitis, also known as eczema.

This newly described group, however, had far more severe eczema than is typical in people with variant HIES. They also had extensive and difficult-to-manage viral infections of the skin, such as warts, molluscum contagiosum — a type of poxvirus that only infects the skin — and herpes simplex. Some in this group also developed skin cancers, as well as lymphoma of the skin.

“Even though these individuals were diagnosed with a more uncommon form of HIES, they were still considered to have a mystery disease, because they had severe allergies and had developed cancers,” says Dr. Su.

Using a technique called comparative genomic hybridization, a process by which large amounts of DNA are fixed to a computer chip and analyzed for changes in the genes, scientists examined the genes in the tissue samples from five different groups: the 11 individuals with the unknown immunodeficiencies, people with the variant form of HIES, people with classic HIES, those with other immunological diseases, and healthy individuals.

The researchers discovered that people with the unique form of HIES had mutations in a gene called DOCK8 that led to deletions in parts of the gene. The normal function of DOCK8 is currently unknown.

When compared with healthy individuals, the people with DOCK 8 mutations had fewer CD8 positive T cells, immune cells needed to fight viral infections; fewer antibody-producing B cells; and increased numbers of eosinophils — immune cells associated with allergy.

According to Dr. Su, these findings indicate that DOCK8 is essential for defense against viral infections and for preventing the development of cancer and allergies.

Although further study is required to determine if DOCK8 mutations occur in other people with similar disease symptoms, DOCK8 immunodeficiency syndrome may be a new PIDD. These findings mean that individuals with this rare disease will be able to receive a more accurate diagnosis. Identifying a genetic cause for the disease provided comfort to some of those diagnosed who had battled an unknown immune disease for years, according to Dr. Su.

“The study of inherited disorders and the genetic alterations that are responsible for their complex array of disease symptoms has often resulted in the discovery of causative genes that play a role in cancer initiation,” said NCI Director John E. Niederhuber, M.D. “The disease mutations found in this study in the DOCK8 gene exemplify that kind of important finding. As with any discovery of a genetic defect, the challenge going forward is to develop a complete knowledge of the cascading pathways of biological function for which DOCK8 is responsible.”

Chemotherapy can save the lives of people with cancer, but new research suggests it may have devastating effects on the brain.

Many cancer patients who receive chemotherapy report “chemobrain” — a range of symptoms including a loss of memory and the ability to concentrate, and other problems such as difficulty thinking.

The stories of women who survived breast cancer but suffered from weakened brain power are told in a study published online Sept. 16 in the Journal of Cancer Survivorship.

Saskia Subramanian, from the Center for Culture and Health at the University of California — Los Angeles, and colleagues interviewed 74 women who had completed cancer treatment at least a year earlier. The women described a variety of emotions, including fear, frustration and emotional exhaustion.

In some cases, women stated that they feared losing their independence because they wouldn’t be able to take care of themselves like before. They sometimes devoted less time to work and to social activities, and felt that the medical community didn’t pay enough attention to their symptoms of chemobrain, according to a news release about the study.

At the workplace, the side effects of chemotherapy robbed their ability to focus, potentially making it less likely that they’d be promoted, the study authors pointed out.

“These data underscore the very serious ways in which chemobrain can affect the life experiences of cancer survivors — emotionally, psychologically and economically,” the researchers concluded. “A clear understanding of the cognitive impairments experienced by survivors will aid researchers in developing targeted therapies and interventions aimed at improving or mitigating these post-treatment side effects.”

There’s no bad time of the day, week or year to have elective coronary artery bypass surgery, say researchers who analyzed how 18,597 people fared after having the procedure.

The Cleveland Clinic team conducted the study to determine whether working off-hours and long shifts might affect the performance of surgeons and other medical staff. Other studies have shown that lack of sleep, prolonged work hours and natural body-rhythm disturbances reduce the performance of drivers and pilots.

“We started the study believing that timing was likely to influence outcome,” senior investigator Dr. Allen Bashour said in a news release from the American Society of Anesthesiologists. “If so, hospitals could intervene with precautions to improve patient safety during high-risk periods.”

The researchers also looked at the phases of the moon because it’s widely believed that a full moon can increase the number of accidents and emergency room visits.

“However, our results showed that serious complications were rare and that the timing of elective surgery did not influence the outcome,” Bashour said.

Coronary artery bypass graft surgery was studied because it’s the most common heart surgery and because there are well-established protocols for the surgery, the researchers said.

Overall, people in the study had a 4.8 percent major complication rate and a 1.4 percent death rate. The rates were similar for each weekday and each month, and for each phase of the moon, according to the study.

“The study found that elective coronary artery bypass surgery can be scheduled anytime throughout the workday, any day of the week, and in any month of the year with equally good outcomes,” Dr. Daniel I. Sessler, chairman of the Department of Outcomes Research at the Cleveland Clinic and a researcher on the study, said in the news release.

“Our results also suggest that the supposed effect of moon phase on medical complications is merely an urban legend,” he said.

If you have the choice between a seasonal flu vaccine that comes in a nasal spray or an injection, go for the injection, new research shows.

In a study of adults tracked over one flu season, vaccines made from inactivated, or “killed,” flu virus — the injectable form — provided better protection against the seasonal flu than vaccines made from live attenuated virus, the type of vaccine available in a nasal spray.

“The nasal spray vaccine is effective but isn’t as effective as the injected vaccine,” said lead study author Arnold S. Monto, an epidemiology professor at the University of Michigan School of Public Health. “But it’s better to get some vaccine than no vaccine, so if you’re averse to getting an injection, get the nasal spray.”

The researchers stressed that their findings, published in the Sept. 24 issue of the New England Journal of Medicine, applied to seasonal flu vaccine efficacy in adults only. The same may not hold true for children, who may respond just as well to a nasal spray vaccine, or for the H1N1 swine flu vaccines that are on the way.

Researchers gave 1,952 adults aged 18 to 49 either an injected flu vaccine, a placebo injection, a flu vaccine nasal spray or a placebo nasal spray during the 2007-2008 flu season. That season, vaccines were well-matched to the predominant flu in circulation, according to the study.

Participants were reminded each week to come in for an exam and lab tests if they showed signs of respiratory illness. About 6.1 percent of participants, 119 in all, got the flu, mostly influenza A/H3N2.

Among those who got sick, participants who’d received the injected flu vaccine were 68 percent less likely to have the flu compared to those who’d received a placebo, according to the study. The flu virus was confirmed using lab tests.

Participants who’d received the nasal spray vaccine were 36 percent less likely to get the flu than those who’d received a placebo.

The injection was 50 percent better in preventing the flu than the nasal spray, according to the study.

Though researchers did not test vaccines in children, nasal sprays may work just as well in children as injections, Monto said.

There are two different types of vaccines, usually referred to as live attenuated, which contain very weakened or modified live virus, and inactivated, which contain bits of dead virus.

Live attenuated influenza vaccine, which comes in nasal sprays, must replicate in the body in order to provoke the immune system to produce antibodies against the virus. In adults who may already have some immunity against that or other flu strains, the live attenuated virus may not be strong enough to cause that response, Monto said.

Children are more likely to lack antibodies to the virus. Without any natural immunity, the nasal spray may be equally effective, Monto said.

Live attenuated vaccines “must infect in order to protect,” Monto said. “Adults, unlike children, have antibodies to the virus included in the vaccine. They are not infected by it and therefore are not protected. This would explain why the LAIV [live attenuated influenza vaccine] is highly effective in younger children.”

In some cases, the live attenuated influenza vaccine may even provide enhanced protection, said Dr. Kenneth Bromberg, director of the Vaccine Research Center at the Brooklyn Hospital Center in New York City.

In addition to immunity involving antibodies, live attenuated vaccines can also provide cell-mediated immunity, an added type of immune response that can boost effectiveness.

“They are different approaches, and in the case of a well-matched strain, the inactivated vaccine worked better than the live attenuated,” Bromberg said. “There could be situations, such as with a mismatched strain, in which the live attenuated could perform just as well, or perhaps even better, than the injected.”

And what about for H1N1 swine flu vaccines?

With the swine flu, vaccines made with live attenuated virus may work just as well as injected vaccines because children and most adults have no antibodies or natural immunity to the new strain, Monto noted.

“We are totally susceptible,” he said. “That’s why we are having these school outbreaks with high attack rates.”

People’s beliefs about the benefits and risks of their asthma medication may be key to their willingness to take it as directed, a new study finds.

The study, published in the Annals of Asthma, Allergy & Immunology, looked at adherence to inhaled corticosteroid medication among 261 low- income, minority asthma patients.

Inhaled corticosteroids reduce inflammation in the airways and are the cornerstone of managing chronic asthma. To be most effective, the drugs must be taken regularly, even when people are symptom-free.

But studies suggest that many adults do not take their inhaled corticosteroids regularly, and that the problem is more common among minority patients than their white counterparts.

In the current study, researchers found that 70 percent of patients said they used their inhaled corticosteroids all or most of the time.

Perhaps not surprisingly, those who believed it was “important” to take the drugs even when they were symptom-free were four times more likely to be compliant compared with patients who did not share that belief.

On the other hand, patients who worried about medication side effects were only half as likely to adhere to their treatment as those without those concerns.

Finally, patients who were confident in their ability to take their inhaled medication correctly were more than twice as likely to be compliant as those who lacked such self-confidence.

The findings point to several areas where healthcare providers could improve low-income, minority patients’ medication compliance, according to the researchers, led by Dr. Diego Ponieman of the Mount Sinai School of Medicine in New York City.

Doctors and nurses could, for example, help boost patients’ confidence by actively “coaching” them in how to take their medication properly, the researchers write.

In addition, they say, doctors should recognize that many patients worry about drug side effects and explicitly address those concerns.

The most common side effects of inhaled corticosteroids are considered relatively mild and include throat irritation and thrush, a yeast infection of the mouth.

The drugs are also much safer than the oral corticosteroids that may have to be given when a person has a serious asthma attack. So preventing attacks via inhaled corticosteroids is seen as a way of protecting patients from the risks of repeatedly using the oral versions — which include weight gain, elevated blood pressure and blood sugar, and decreased bone density.

By “bolstering positive beliefs and mitigating the negative ones,” Ponieman and his colleagues write, doctors may be able to convince more patients to stick with their inhaled-corticosteroid regimen.