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Compared with the year prior to the smoking ban, 12 percent fewer women reported smoking during pregnancy in the year after the ban, Dr. Zubair Kabir, of the Tobacco Free Research Institute in Dublin, Ireland, and colleagues report.

Their study, in BJOG: An International Journal of Obstetrics and Gynecology, also revealed “a welcome sign,” Kabir’s team notes. They observed 25 percent lower risk for preterm births in the year after the smoking ban compared with the year prior to the ban.

Kabir and colleagues analyzed records at Coombe Women and Infants University Hospital to assess whether Ireland’s workplace smoking ban altered smoking during pregnancy, a known risk factor for preterm birth and having a low birth weight infant.

Their comparison included 7,593 births in 2003 and 7,648 births in 2005, and allowed for other maternal factors tied to birth risks such as the mother’s age, number of previous births, alcohol intake, blood pressure, and complications during pregnancy.

Overall, babies with the highest birth weights on average were born to former smokers. By contrast, babies with the lowest birth weights had mothers who smoked during pregnancy.

However, in addition to the noted declines in maternal smoking and preterm birth risk, the investigators also identified 43 percent greater risk for low birth weight in the year after the smoking ban compared with the year prior to the ban.

This finding “is intriguing and needs further exploration,” Kabir and colleagues say, particularly in light of evidence that exposures to secondhand smoke during pregnancy may play a role in having babies with low birth weight.

They also call for further exploration of their observed increase in Caesarean delivery rates - from 15.4 in 2003 to 19.5 percent in 2005.

Bypass surgery has been the standard treatment for diabetic patients with coronary artery disease. However, less invasive approaches such as angioplasty with stenting — where a thin mesh tube is inserted to open the artery — have emerged. Until now, there’s been little study to see whether the procedure is as effective as bypass in diabetic patients.

“Cardiovascular disease is the leading cause of death among patients with type 2 diabetes, and approximately 25 percent of the patients who undergo revascularization procedures in the United States have type 2 diabetes,” noted Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, who was not involved in the study.

Earlier studies have suggested that bypass surgery provides more effective revascularization (re-opening of blood flow) and better long-term clinical outcomes in patients with type 2 diabetes and multi-vessel coronary artery disease compared to angioplasty/stenting, Fonarow said.

But this new clinical trial in patients with type 2 diabetes and multi-vessel disease suggests that in the first year at least, bypass and angioplasty/stenting produce similar results, he said.

“However, as this study is small and the follow-up period confined only to the first year, additional studies with more patients and longer-term follow-up are required,” Fonarow said.

The report is published in the Nov. 25 online edition of the Journal of the American College of Cardiology. The study was funded by a number of drug companies, including Eli Lilly & Co. and Bristol-Myers Squibb, as well as stent manufacturers such as Boston Scientific and Medtronic.

For the study, a team led by Dr. Kevin J. Beatt from the Mayday University Hospital in London, randomly assigned 510 diabetic patients who participated in the Coronary Artery Revascularization in Diabetes Trial to undergo coronary bypass surgery or angioplasty with stenting.

During one year of follow-up, the rate of deaths, heart attack and stroke was 10.5 percent among patients who had bypass surgery, compared with 13 percent for patients who underwent angioplasty and stenting, the researchers found.

The type of stent used seemed important. The first group of patients in the trial received bare metal stents, but when drug-eluting (emitting) stents became available many of the patients received them instead. The introduction of these stents greatly improved the outcome for the patients who received them, the researchers found.

While rates for death, heart attack and stroke were 12.4 percent among patients who underwent bypass surgery, they were 11.6 percent among patients who received drug-eluting stents, the researchers report.

“When the new drug-eluting stents were used, stenting seemed as good and was possibly better than bypass surgery,” said Dr. Byron Lee, an associate professor of cardiology at the University of California San Francisco. “However, this finding was based only on a subgroup analysis, and definitive proof will have to await the results of other ongoing trials,” he said.

In cardiac bypass surgery, the patient’s chest is opened, exposing the heart. The patient is put on a heart-lung machine that continues to pump blood though the body as the operation is done. The operation itself involves taking vein segments from the patient’s leg and using them to replace blocked coronary arteries.

In contrast, angioplasty, a minimally invasive procedure, involves passing a catheter from the patient’s groin into the blocked heart artery. A balloon at the tip of the catheter opens to expand the blocked artery. To ensure the artery remains open, a stent is placed in the artery. Drug-eluting stents are coated with a drug that promotes healing and helps prevent the stent from becoming blocked again.

A review published in the Nov. 25 online edition of BMJ found that a difference of just 5 grams of regular daily salt intake spells a 23 percent difference in the rate of stroke and a 17 percent difference in the rate of cardiovascular disease.

According to the review, the World Health Organization recommends that people consume only 5 grams — about a teaspoon — of salt each day. But people in the West typically eat around 10 grams a day, and those in Eastern Europe consume even more.

The review authors analyzed 13 studies, involving more than 170,000 people, that assessed the link between salt and cardiovascular disease and stroke.

The researchers estimated that reducing daily salt intake by 5 grams around the world could prevent more than 1 million stroke deaths and nearly 3 million deaths from cardiovascular disease each year. And because it’s hard to measure salt intake, those numbers could actually be even higher, the authors noted.

The drug, rituximab (Rituxan), helped patients keep producing some of their own insulin, even though the disease had destroyed some of their pancreatic beta cells, which produce the critical hormone, reports a study in the Nov. 26 issue of the New England Journal of Medicine.

The results were on par with those seen in other studies trying experimental immune therapies for type 1 diabetes, said study lead author Dr. Mark D. Pescovitz, professor of surgery and of microbiology/immunology at Indiana University in Indianapolis.

But the findings have to be interpreted with a “little caution,” warned Dr. Vivian Fonseca, professor of internal medicine at Texas A&M Health Science Center College of Medicine and director of the Diabetes Institute at Scott & White in Temple.

“This paper doesn’t appear as if this is a cure for diabetes. Patients did manage to produce more insulin themselves, but it’s not a huge amount more. The insulin dose they used was a little bit less but not hugely less,” he continued. “Even with this data, we’re a long, long way from getting approval for using this kind of treatment. Also, the patients in the study were newly diagnosed so there is virtually no application for people who have had type 1 diabetes for some time.”

But needing less outside insulin does have advantages. “We know that people who produce some of their own insulin tend to have less complications in the long term,” Fonseca said. Those complications can include blindness and heart trouble, although in no way do researchers yet know if rituximab will reduce those problems in type 1 diabetics over the long-term.

Type 1 diabetes is an autoimmune disease in which the body’s own immune system destroys the critical insulin-producing beta cells of the pancreas.

“People have been trying to change the immune system to treat type 1 diabetes, the rationale being that it’s an autoimmune disease where you get antibodies that destroy the cells in the pancreas that produce insulin,” Fonseca explained.

Up to now, much research has focused on the immune cells known as T-lymphocytes, the immune cells that attack the pancreas, but there has been increasing speculation that another type of cell, called B-lymphocytes, may also play a role. B cells work a step back in the process, stimulating the T cells to do their damage, Pescovitz explained. Rituximab targets B-lymphocytes.

“This deals with a whole new clinical pathway to try to deal with type 1 diabetes,” he said.

In this phase 2 trial, 87 patients with newly diagnosed type 1 diabetes were randomly assigned to receive rituximab infusions or a placebo at one-week intervals for four weeks.

After one year, C-peptide levels — an indicator of how much insulin is being produced by the body — were higher in people taking rituximab versus those in the placebo group.

Those in the rituximab group also needed less external insulin and had fewer B cells.

Side effects faded with time, although Pescovitz pointed out that long-term adverse effects from rituximab are not yet known.

It’s also not clear if this treatment would be superior to other immunosuppressive strategies, but it is certainly easier to deliver, he said.

“This [B cell] approach is all done as an outpatient basis whereas the [other agents] are done as inpatients,” said Pescovitz.

And treatment over only three weeks gave a response that lasted a year, Fonseca noted.

Next, researchers need to determine if additional infusions over time will confer added benefits, and they also plan to look into ways to help the beta cells actually grow back or ways to transplant beta cells.

The study was funded by the U.S. National Institutes of Health, the Juvenile Diabetes Research Foundation International and the American Diabetes Association. Genentech and Biogen Idec, which make rituximab, provided the medication for the trial.

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.

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 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.”

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.

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.”