SCIENCE AND MEDICINE
New US tuberculosis guidelines suggest targeted screening regimens but that efficacy increases positive skin-test results. The apprwith the length of theroach, says David apy. Cohn, the Statement On the basis of such Committee Co-Chair, findings, the current is logical: “don’t choices for treatment screen where the disinclude 9 months of ease isn’t, but where it isoniazid; 6 months of is. Testing among lowisoniazid; rifampicin prevalence populations and pyrazinamide for doesn’t turn up many 2 months; or rifaminfected cases, so this picin for 4 months. would not be a costThe authors coneffective strategy”. clude that suitable The guidelines, Screening for high risk groups treatments are best which are Russian TB epidemic prompts legal reform determined by evidence-based ratbased on the analysis of 30 Medécins Sans Frontières (MSF) is calling for ings, and that directly observed theryears of data from clinical immediate legal reform in the former Soviet Union apy will be a key component in trials and related studies, to contain the tuberculosis epidemic raging in ensuring compliance. In addition, also suggest that patients’ Russian prisons. In the April 12 issue of the clinical monitoring is recommended adherence to, and the sucJournal of Women’s Health and Law, an MSF panel at least at monthly intervals, including cess rate of, LTBI treatof authors writes that overcrowded cells are a patient education on adverse drug ment relate to the length, major factor. Poor screening and tracking of effects, and questioning about drug complexity, and adverse infected prisoners, as they move repeatedly in and adherence. Routine laboratory monieffects of a recommended out of jail through an arduously long legal process, toring is not generally recommended, treatment. Recent CDC adds to the problem. The result is inappropriate but it should be a consideration for data show that only 60% of and inadequate treatment of the disease, those with abnormal liver function patients complete at least 6 resulting in resistant strains and posing a general tests and for those at risk of hepatic months of drug therapy. tuberculosis threat both to the population of the disease. Other studies have sugformer Soviet Union and internationally. gested that better adherence occurs with shorter Angela Pirisi
he American Thoracic Society (ATS) and the US Centers for Disease Control and Prevention (CDC) released new guidelines, on April 20, for the treatment of latent tuberculosis infection (LTBI) in the USA. The authors hope that given the relatively low incidence of active tuberculosis in the USA, it may now be possible to eliminate the disease. The updated guidelines mainly call for targeted testing of high-risk populations, which will make better use of resources while cutting down on false-
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Identification of hypertension genes comes closer he genes involved in bloodpressure regulation in genetically hypertensive rats have been difficult to identify because they are so numerous and each one has a small effect. Now, an international collaboration has combined data from seven studies which crossed hypertensive with normotensive rats; 15 regions of the rat genome were identified where blood-pressure-related traits were linked with genetic markers from the normotensive or hypertensive strains. The researchers matched these regions in the rat with the syntenic (corresponding) regions of the human genome, thereby focusing the search for the hypertension genes in both species (Genome Res 2000; 10: 473–82). The seven studies involved five strains of hypertensive rats. Altogether 1687 animals were tested for one or more of 39 blood-pressure-related traits and their genetic markers catalogued. Researchers found 67 quantitative trait loci associated with blood pressure, grouped in 15 regions of the rat genome, and were able to identify
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THE LANCET • Vol 355 • April 29, 2000
Violent video games increase aggression
the syntenic regions of the human genome for 12 of these. They found five of six human genome regions previously identified as blood-pressure related, and several regions identified in mouse hypertension studies. “These data suggest that the rat studies may help predict the genetic basis of hypertension in humans”, explains Howard Jacob (Medical College of Wisconsin, Milwaukee, WI, USA). “Synteny doesn’t necessarily mean that all the orthologous [exactly corresponding across species] genes are present in the same order, but if you have a region with hypertension genes in the rat, then the region of synteny in the human should be investigated. It’s too early to say, but I hope if we study these regions of the genome individually, they would be better models for human hypertension than what we are currently using. I’m excited, because we will be able to ask ‘what aspects of this rat model reflect human hypertension?’—not only by phenotype, but by genotype”.
laying violent video games can increase aggressive behaviour, says Craig Anderson (Iowa State University of Science & Technology, IA, USA). The effects may be even more harmful than exposure to violent television and films, he adds, “because video games are interactive, engrossing, and require the player to identify with the aggressor”. In the first of two studies, Anderson measured aggressive personality traits, recent delinquent behaviours, and video-game playing habits of 227 college students. Those who reported playing more violent video games in the past engaged in more aggressive behaviour and had lower academic grades in college. In the second study, 210 college students were asked to play either a violent or non-violent video game; 15 minutes after playing, those who had played the violent game “punished” their opponents with a noise blast for a longer period than did students who had played the non-violent game (J Pers Soc Psychol 2000; 78: 772–90).
Paul M Rowe
Marilynn Larkin
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