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Is there an infectious component behind headaches and SIDS?
SCIENCE AND MEDICINE
Young people ignore warning of increased heart disease and stroke risk physical activity, cholesterol, or blood pressure (Am J Prev Med 2002; 22: 38–46). One explanation for the absence of behaviour change could be lack of awareness of increased risk. “These young people had no signs or
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Education may help change behaviour
symptoms of heart disease, and so the susceptibility isn’t hammered home. They may perceive the higher risk to be years in the future, if at all”, speculates Kip. “Another possibility is that because heart attacks are so common, you tend to discount them. And since a lot of people survive them, there’s a feeling that it’s not something you need to worry about.” The same is true for stroke risk, notes Larry Goldstein (Duke
Science Photo Library
oung adults are not getting the message that a myocardial infarction or stroke in a close family member puts a person at increased risk and signals the need for riskreducing behaviours, US researchers report this week. “There wasn’t any evidence at all over a 5-year period that when a severe cardiovascular disease event occurred in the family, the young adult changed any health behaviours in a positive way”, says lead researcher Kevin Kip (University of Pittsburgh Graduate School of Public Health, PA, USA). “In fact, there was some evidence that they went in the wrong direction, suggesting that some may have felt ‘genetically doomed’.” Kip and co-workers in the Coronary Artery Risk Development in Young Adults (CARDIA) study investigated changes in health behaviour among 3950 people aged 18 to 30 who either did or did not have an immediate family member who had a myocardial infarction or stroke. Those who had a change in family history during the study were no more likely than those who did not to stop smoking or initiate changes in modifiable risks such as weight,
Y
University, Durham, NC, USA), chair of the American Heart Association committee that wrote the primary prevention guidelines for ischaemic stroke. “The amount of denial about disease risk for stroke is astounding. People think it’s something that will happen to someone else, and even when it does happen to them, they tend to deny the symptoms. If older people who are having strokes are in denial, it’s not surprising that young people feel the same way”, he says. To encourage behaviour change, “we should borrow techniques from the advertising industry—delivering a clear message in a multifaceted way over and over again”, suggests Goldstein. “Have nurses and office staff promote healthful behaviours, offer reading materials, videotapes, and links to authoritative websites. After the office visit, send a letter to the patient repeating what was discussed, and do the same thing again next time”, he urges. “That, combined with public service announcements in the media is probably the only way to change behaviour, and even then, it’s not so easy.” Marilynn Larkin
Is there an infectious component behind headaches and SIDS? n infectious component underlying diseases previously considered non-infectious in origin is becoming more commonly identified, delegates heard at the 12th European Congress of Clinical Microbiology and Infectious Diseases (Milan, Italy, April 24–27, 2002). Studies have previously shown that some migraine sufferers are Helicobacter pylori positive, as identified in stool samples by PCR. In an study led by Maria Rita Gismondo (L Sacco Teaching Hospital, Milan, Italy), 130 patients with migraine and infected with H pylori were split into two groups. One group was given a 3-week course of metronidazole and clarithromycin and the other group received a 3-week course of the antibiotics plus lactobacillus—a probiotic. The probiotic group took three lactobacillus doses a day for 3 months, then dropped their intake to one dose a day for the next 9 months. One month after starting treatment, both groups were similar in terms of headache symptoms and bacterial colonisation. However in a 1-year follow-up, 40% of the
A
1584
antibiotic group were H pylori free compared with 70% of the those in the antibiotic and lactobacillus group. Furthermore the severity and frequency of headaches was reduced in the combination group, suggesting the probiotic confers an additional benefit. But Francis Megraud an expert on H pylori (Laboratoire de Bacteriologie CHU Pellegrin, Bordeaux, France) said “at this stage of the study there is no evidence for a causal relationship. It may well be that such a link exists for some cases of migraine but a randomised placebo-controlled trial would be required for the theory to stick.” In another study, Paul Goldwater from The Women’s and Children’s Hospital, North Adelaide, Australia identified an Escherichia coli protein by-product—known as curlin—in the bloodstream of 68 babies who had died of sudden infant death syndrome (SIDS), but not in 60 otherwise healthy babies. Curlin is thought to be involved in helping the bacteria compete for a foot-hold in the competitive intestinal wall environment. The serum of
babies who have died of SIDS is toxic to chick embryos, HeLa cells, and mice—suggesting the presence of a toxin. Goldwater focused on E coli, since strains isolated from cases of SIDS are more toxic to cell cultures than strains from healthy babies. “Mainstream researchers have concentrated on respiratory obstruction as a possible mechanism without any evidence that would support such a mode of death”, remarked Goldwater. “Those researchers ignored autopsy findings that consistently show wet, heavy lungs in SIDS babies. This is never seen in cases with asphyxia”, he added. In addition, autopsy findings showing small haemorrhages on the surface of the heart, lung, and thymus gland are not consistent with suffocation. Ronald Harper (UCLA School of Medicine, CA, USA) believes that “bacterial infection is one path to SIDS, not by itself, but in combination with neural damage, the risk being especially high during rapid eye movement sleep”. Pam Das
THE LANCET • Vol 359 • May 4, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.
Young people ignore warning of increased heart disease and stroke risk physical activity, cholesterol, or blood pressure (Am J Prev Med 2002; 22: 38–46). One explanation for the absence of behaviour change could be lack of awareness of increased risk. “These young people had no signs or
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Education may help change behaviour
symptoms of heart disease, and so the susceptibility isn’t hammered home. They may perceive the higher risk to be years in the future, if at all”, speculates Kip. “Another possibility is that because heart attacks are so common, you tend to discount them. And since a lot of people survive them, there’s a feeling that it’s not something you need to worry about.” The same is true for stroke risk, notes Larry Goldstein (Duke
Science Photo Library
oung adults are not getting the message that a myocardial infarction or stroke in a close family member puts a person at increased risk and signals the need for riskreducing behaviours, US researchers report this week. “There wasn’t any evidence at all over a 5-year period that when a severe cardiovascular disease event occurred in the family, the young adult changed any health behaviours in a positive way”, says lead researcher Kevin Kip (University of Pittsburgh Graduate School of Public Health, PA, USA). “In fact, there was some evidence that they went in the wrong direction, suggesting that some may have felt ‘genetically doomed’.” Kip and co-workers in the Coronary Artery Risk Development in Young Adults (CARDIA) study investigated changes in health behaviour among 3950 people aged 18 to 30 who either did or did not have an immediate family member who had a myocardial infarction or stroke. Those who had a change in family history during the study were no more likely than those who did not to stop smoking or initiate changes in modifiable risks such as weight,
Y
University, Durham, NC, USA), chair of the American Heart Association committee that wrote the primary prevention guidelines for ischaemic stroke. “The amount of denial about disease risk for stroke is astounding. People think it’s something that will happen to someone else, and even when it does happen to them, they tend to deny the symptoms. If older people who are having strokes are in denial, it’s not surprising that young people feel the same way”, he says. To encourage behaviour change, “we should borrow techniques from the advertising industry—delivering a clear message in a multifaceted way over and over again”, suggests Goldstein. “Have nurses and office staff promote healthful behaviours, offer reading materials, videotapes, and links to authoritative websites. After the office visit, send a letter to the patient repeating what was discussed, and do the same thing again next time”, he urges. “That, combined with public service announcements in the media is probably the only way to change behaviour, and even then, it’s not so easy.” Marilynn Larkin
Is there an infectious component behind headaches and SIDS? n infectious component underlying diseases previously considered non-infectious in origin is becoming more commonly identified, delegates heard at the 12th European Congress of Clinical Microbiology and Infectious Diseases (Milan, Italy, April 24–27, 2002). Studies have previously shown that some migraine sufferers are Helicobacter pylori positive, as identified in stool samples by PCR. In an study led by Maria Rita Gismondo (L Sacco Teaching Hospital, Milan, Italy), 130 patients with migraine and infected with H pylori were split into two groups. One group was given a 3-week course of metronidazole and clarithromycin and the other group received a 3-week course of the antibiotics plus lactobacillus—a probiotic. The probiotic group took three lactobacillus doses a day for 3 months, then dropped their intake to one dose a day for the next 9 months. One month after starting treatment, both groups were similar in terms of headache symptoms and bacterial colonisation. However in a 1-year follow-up, 40% of the
A
1584
antibiotic group were H pylori free compared with 70% of the those in the antibiotic and lactobacillus group. Furthermore the severity and frequency of headaches was reduced in the combination group, suggesting the probiotic confers an additional benefit. But Francis Megraud an expert on H pylori (Laboratoire de Bacteriologie CHU Pellegrin, Bordeaux, France) said “at this stage of the study there is no evidence for a causal relationship. It may well be that such a link exists for some cases of migraine but a randomised placebo-controlled trial would be required for the theory to stick.” In another study, Paul Goldwater from The Women’s and Children’s Hospital, North Adelaide, Australia identified an Escherichia coli protein by-product—known as curlin—in the bloodstream of 68 babies who had died of sudden infant death syndrome (SIDS), but not in 60 otherwise healthy babies. Curlin is thought to be involved in helping the bacteria compete for a foot-hold in the competitive intestinal wall environment. The serum of
babies who have died of SIDS is toxic to chick embryos, HeLa cells, and mice—suggesting the presence of a toxin. Goldwater focused on E coli, since strains isolated from cases of SIDS are more toxic to cell cultures than strains from healthy babies. “Mainstream researchers have concentrated on respiratory obstruction as a possible mechanism without any evidence that would support such a mode of death”, remarked Goldwater. “Those researchers ignored autopsy findings that consistently show wet, heavy lungs in SIDS babies. This is never seen in cases with asphyxia”, he added. In addition, autopsy findings showing small haemorrhages on the surface of the heart, lung, and thymus gland are not consistent with suffocation. Ronald Harper (UCLA School of Medicine, CA, USA) believes that “bacterial infection is one path to SIDS, not by itself, but in combination with neural damage, the risk being especially high during rapid eye movement sleep”. Pam Das
THE LANCET • Vol 359 • May 4, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet publishing Group.