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Vaccination at birth against hepatitis B virus greatly reduces the risk of liver cancer in young adulthood, new research suggests.

In a 20-year study that followed infants who were vaccinated against the liver disease in Taiwan beginning in 1984, when a universal vaccination program went into effect, Dr. Mei-Hwei Chang, of the Department of Pediatrics at the National Taiwan University Hospital in Taipei, and colleagues looked at young people who had developed liver cancer.

The researchers found that only a few people who had been vaccinated developed liver cancer, and there were possible explanations in most cases, such as insufficient doses of the vaccine.

The findings appear in the Sept. 16 online edition of the Journal of the National Cancer Institute.

“These data suggest that the effectiveness of the universal hepatitis B virus immunization program to prevent [liver cancer] has extended beyond childhood and into young adulthood over the past two decades,” the authors concluded.

In the United States, hepatitis B vaccination is recommended for all infants, older children and adolescents if they haven’t previously been vaccinated. Officials recommend that adults get the vaccination if they’re at risk for the disease.

Black patients who suffer cardiac arrest in the hospital are much less likely to survive than white patients, a new study finds.

Most of this disparity appears to result from the hospital in which black patients receive care, although other factors play a role as well, the researchers said.

“We know that survival after having a cardiac arrest in the hospital setting has always been historically low,” said lead researcher Dr. Paul S. Chan, a cardiologist at St. Luke’s Mid-America Heart Institute in Kansas City. “The rate of survival has been about 30 to 33 percent on average.”

But the survival rates for blacks were significantly lower, 25 percent vs. 37 percent for whites, Chan said.

“This 12 percent absolute difference in survival is larger than any survival I can think of in terms of a racial disparity, in any other medical condition,” he said.

The report is published in the Sept. 16 issue of the Journal of the American Medical Association.

For the study, Chan and colleagues used data from the National Registry of Cardiopulmonary Resuscitation to look at differences in survival among patients with in-hospital cardiac arrest.

They collected information on 10,011 patients, about 19 percent of whom were black, from 274 hospitals. These patients had all been defibrillated after a cardiac arrest.

The lower rates of survival to hospital discharge for blacks reflected lower rates of successful resuscitation (55.8 percent for blacks vs. 67.4 percent for whites) and survival after resuscitation (45.2 percent for blacks vs. 55.5 percent for whites), the researchers noted.

About a third of the difference can be explained by the patients themselves, Chan said, “Black patients were sicker when they had a cardiac arrest than white patients,” he said.

Another third of the difference was explained by the hospitals many black patients were in, Chan said.

“This suggests that black patients were having cardiac arrests in hospitals that, on average, did a lot worse, in terms of survival, for all their patients, compared with white patients who went to hospitals that performed better, and patients were more likely to live in those hospitals,” he said.

In addition, the quality of care after resuscitating a patient was worse in hospitals treating mostly black patients compared with care in hospitals treating white patients, Chan said.

“The hospital effect is huge and substantial, and is a contributor to the difference between black and white survival,” he said. “If we can improve survival in those lower-performing hospitals at which black patients are more likely to be having cardiac arrest, we can eventually narrow the difference between black and white survival.”

The remaining difference in survival between blacks and whites could not be explained, Chan said.

There did not seem to be a difference between the treatment blacks and whites received, so racism did not seem to play a role in care between blacks and whites, he said.

“We cannot exclude it fully,” Chan said. “But it’s really hard to imagine that a physician would treat a black patient differently than a white patient during a cardiac arrest.”

Dr. Kim A. Williams, director of nuclear cardiology at the University of Chicago, was surprised that the disparity between blacks and whites wasn’t greater.

“I am truly shocked at the results — only 11 percent less initial resuscitation success,” Williams said. “I thought the differential was far greater than this study demonstrates, but I am not surprised that the results are being attributed, at least in part, to the facilities involved rather than just the co-morbidities of the patients.

“Any attempts to improve this egregious disparity must start with the underlying risks and disease differences identified in this study, which would involve pre-morbid education, prevention and screening, and once risks are identified, better access to affordable chronic care and medications,” he said. “It’s clearly a system problem.”

People with milder symptoms of celiac disease face a slightly higher risk of dying than other people, a new study finds.

Cancer and heart disease were the main causes of death in the patients studied, and the risk was higher in people who had had small-intestinal biopsies in childhood, the researchers found.

Celiac disease affects about 1 percent of people in the Western world, the researchers said, and it is triggered by exposure to gluten, a protein found in barley, wheat and rye. It frequently causes diarrhea and weight loss.

According to the study, which appears in the Sept. 16 issue of the Journal of the American Medical Association, celiac disease is thought to be connected to higher risk of disease, but less is known about “nonspecific small-intestinal inflammation without villous atrophy,” a kind abnormality.

Swedish researchers found the risk of death increased by 39 percent in patients with celiac disease and 35 percent with latent celiac disease.

The research “reinforces the importance of celiac disease as a diagnosis that should be sought by physicians. It also suggests that more attention should be given to the lesser degrees of intestinal inflammation and gluten sensitivity,” wrote Dr. Peter H. R. Green, of Columbia University College of Physicians and Surgeons, in a commentary.

In people with newly diagnosed type 2 diabetes, the glucose-lowering medications metformin and insulin don’t appear to reduce the inflammation associated with heart disease, new research suggests.

Even though these medications helped reduce glucose levels, the researchers found they didn’t affect inflammatory markers any more than a placebo drug did, according to a study published in the Sept. 16 issue of the Journal of the American Medical Association.

“Heart disease is one of the many co-morbidities associated with diabetes,” explained study author Dr. Aruna Pradhan, an assistant professor at the Harvard Medical School and Brigham and Women’s Hospital in Boston, and a cardiologist at the VA Boston Medical Center. “We thought by lowering glucose levels that we would also address inflammation. But, we found that going lower in glucose levels doesn’t impact inflammation, which is a risk factor for heart disease.”

This study comes on the heels of other recent studies on diabetes and cardiovascular disease. Some suggested that intensive glucose control couldn’t affect heart disease risk, while a recent meta-analysis suggests that good blood sugar levels could reduce death from heart attack, according to background information in Pradhan’s study.

Almost 24 million Americans have diabetes, mostly type 2 diabetes, according to the American Diabetes Association. Risk factors for developing the disease include being overweight and being over 40, though younger and thinner people can also develop the disease. In type 2 diabetes, the body either doesn’t produce enough insulin or can’t use insulin effectively.

The current study included 500 men and women with type 2 diabetes diagnosed two years earlier on average. Slightly more women than men were included, and most of the study volunteers had a body-mass index above 30, which is considered obese. The majority of the study participants were white, and about one-quarter of the group were smokers.

The volunteers were randomized into one of four groups: placebo alone, placebo plus insulin glargine (Lantus), metformin (an oral anti-diabetes medication) alone or metformin plus insulin glargine. Study volunteers also received advice on diet and weight.

Overall, the volunteers lost an average of 3.2 pounds during the 14-week study, except for the insulin and placebo group.

As for markers of inflammation, the researchers found reductions in inflammation (as measured through levels of C-reactive protein, IL-6 and tumor necrosis factor receptor 2) for all of the groups. The insulin-plus-placebo group, however, had the smallest reduction in inflammatory markers. For example, C-reactive protein levels went down in the placebo group by 19 percent, in the metformin group by 16 percent and the metformin and insulin group by 20 percent. However, the insulin plus placebo group went down just 3 percent.

Pradhan said the researchers adjusted the data to account for the weight loss, and still found a similar effect. She said it may be that the weight changes affected the distribution of fat, and that abdominal fat tends to have more of an effect on inflammation.

“While these two agents didn’t lower inflammation [any more than the placebo], they did lower glucose levels and are excellent drugs for preventing microvascular outcomes, like eye and kidney diseases,” said Pradhan. The findings also confirm that diet and exercise can affect inflammation levels, she added.

“While this is a well-conducted study, there are no big surprises here,” said Dr. Vivian Fonseca, chief of endocrinology at Scott & White Clinic in Temple, Tex., and Texas A&M Health Sciences Center, College Station. “There are many drugs that benefit people and reduce cardiovascular risk without decreasing inflammation, and there are drugs that reduce inflammation that have sometimes killed people from cardiovascular disease.”

“We’re trying to look at this problem the other way,” said Fonseca. He and other researchers across the country will test an anti-inflammatory medication, salsalate, to see if lowering inflammation directly can have an impact on blood glucose levels.