A new 18-year nationwide study of US cities found that long term exposure to high levels of ground ozone, a main component of smog, was linked to significantly higher risk of dying from respiratory diseases.

The study was the work of Dr George Thurston, a professor in the Department of Environmental Medicine at New York University School of Medicine (NYU) School of Medicine, a part of NYU Langone Medical Center, and colleagues, and is published online on 12 March in the New England Journal of Medicine, NEJM.

Many studies have linked atmospheric ozone to poor health, and others have shown that a high-ozone day, for example as a result of city smog, is linked to an increased risk of acute health problems the next day, such as more asthma and heart attacks. However, until this study, the effect of long term exposure to ozone in air pollution (the summertime haze) on health and deaths in particular was somewhat uncertain.

Thurston, who directed the air pollution exposure assessment part of the study, said in a separate press statement that:

"What this study says is that to protect the public's health, we can't just reduce the peaks, we must also reduce long-term, cumulative exposure."

For this study, Thurston and colleagues looked at the potential contribution of exposure to ozone to the risk of death from cardiopulmonary or heart and lung related causes and specifically to death from respiratory causes. It is the first study to separate the effect of ozone from that of fine particulate matter, the tiny particles of pollutant material that cars, factories and power plants release into the atmosphere.

They used data from the American Cancer Society Cancer Prevention Study II and correlated it with air pollution figures for 96 metropolitan areas of the US. They analyzed study records from 448,850 people, including 118,777 deaths over an 18 year period from 1982 to 2000.

The study records included cause of death (where relevant), and things like age, smoking status, body mass index, and diet, plus where the subjects lived, so these potential confounding factors could be taken into account in the statistical analysis.

They were able to find data on daily maximum ozone levels from April 1 to September 30 from 1977 to 2000, and data on fine particles in the air (2.5 microns or smaller in diameter, called PM2.5) for 1999 and 2000.

The researchers found that:

* When they used a single pollutant model, increased levels of either PM2.5 or ozone were significantly linked to increased risk of death from cardiopulmonary causes.

* When they used a two pollutant model, increased PM2.5 was linked to increased risk of death from cardiovascular disease, while ozone was linked to increased risk of death from respiratory causes.

* The risk of dying from respiratory disease was more than 30 per cent higher in metropolitan areas with the highest ozone levels than those with the lowest.

* The estimated risk of dying from respiratory disease went up by 4 per cent for each increase in 10 parts per billion (ppb) of ozone.

* The city with the highest mean daily maximum ozone concentration over the 18 years of the study was Riverside, California (104 ppb).

* This corresponded to about 50 per cent higher risk of dying from lung disease compared to no exposure to ozone.

* Los Angeles came a close second, with an estimated 43 per cent increased risk of dying from lung disease.

* Northeast cities were generally lower in ozone than California.

* For example, Washington DC and New York City, showed a 27 and 25 increased risk of death from respiratory causes linked to ozone exposures.

* The lowest ozone levels were in San Francisco with a 33 ppb long term average daily maximum that was linked to a 14 per cent estimated increase of death from respiratory causes.

* The link between ozone and risk of death from respiratory causes did not change when confounders were taken into account, and neither did it change when they used different statistical models.

The researchers concluded that:

"In this large study, we were not able to detect an effect of ozone on the risk of death from cardiovascular causes when the concentration of PM2.5 was taken into account. We did, however, demonstrate a significant increase in the risk of death from respiratory causes in association with an increase in ozone concentration."

When it is high in the atmosphere, ozone protects us against the harmful UV (ultraviolet) rays of the sun. But at ground level, inhaled ozone causes inflammation of respiratory tissue, according to the Canadian Center for Occupational Health and Safety (CCOHS). Here it is primarily a byproduct of pollution, a secondary pollutant created when nitrogen dioxide from cars, power plants and factories meets with oxygen in the presence of sunshine.

This type of ozone takes time to form and is more likely to found downwind of cities in suburbs and rural areas, unlike fine particulate matter, a primary pollutant which hangs around where it is produced, in the inner cities, near roads and industrial sites.

Lead author Dr Michael Jerrett, associate professor, Division of Environmental Health Sciences, at the University of California, Berkeley, said that in line with rising death rates from respiratory disease, "background levels of ozone have at least doubled since pre-industrial-revolution times".

Thurston said that even though New Yorkers were breathing air with ozone levels very nearly in compliance with the Environmental Protection Agency short term ozone limit of 75 ppb, their estimates showed they were at a significant 25 per cent higher risk of dying from respiratory causes compared to non exposure.

The researchers said that San Francisco has low levels of ozone pollution because the city is often covered with a blanket of fog that stops the sun coming through to catalyze the photochemical reaction between nitrogen dioxide and oxygen. And Los Angeles, which has high levels, sits in a basin which stops the air pollution from dispersing as rapidly as it does in other cities like San Francisco.

Thurston said the current EPA air quality standards only address the health effects of short-term daily peaks in ozone exposure and do not protect against the long-term cumulative effects. The current EPA level for short term (8-hour) ozone exposure is 75 ppb, which is higher than the 60 ppb recommended by the agency's own scientific advisors, the American Lung Assocation and several other public health bodies. The EPA is going to review the standard in the next 12 months.

Revered in India as "holy powder," the marigold-colored spice known as turmeric has been used for centuries to treat wounds, infections and other health problems. In recent years, research into the healing powers of turmeric's main ingredient, curcumin, has burgeoned, as its astonishing array of antioxidant, anti-cancer, antibiotic, antiviral and other properties has been revealed.

Yet little has been known about exactly how curcumin works inside the body.

Now, University of Michigan researchers led by Ayyalusamy Ramamoorthy have discovered that curcumin acts as a disciplinarian, inserting itself into cell membranes and making them more orderly, a move that improves cells' resistance to infection and malignancy.

"The membrane goes from being crazy and floppy to being more disciplined and ordered, so that information flow through it can be controlled," said Ramamoorthy, a professor of chemistry and biophysics. The findings were published online March 3 in the Journal of the American Chemical Society.

The research project melds Ramamoorthy's past with his current scientific interests. As a child in India, he was given turmeric-laced milk to drink when he had a cold, and he breathed steam infused with turmeric to relieve congestion. Now as researcher he is fascinated with proteins that are associated with biological membranes, and he uses a technique called solid-state NMR spectroscopy to reveal atom-level details of these important molecules and the membranous milieu in which they operate.

"Probing high-resolution intermolecular interactions in the messy membrane environment has been a major challenge to commonly-used biophysical techniques," Ramamoorthy said. His research group recently developed the two-dimensional solid-state NMR technique that they used to probe curcumin-membrane communication in this study.

Scientists have speculated that curcumin does its health-promoting work by interacting directly with membrane proteins, but the U-M findings challenge that notion. Instead, the researchers found that curcumin regulates the action of membrane proteins indirectly, by changing the physical properties of the membrane.

Ramamoorthy's group now is collaborating with chemistry professor Masato Koreeda and U-M Life Sciences Institute researcher Jason Gestwicki to study a variety of curcumin derivatives, some of which have enhanced potency. "We want to see how these various derivatives interact with the membrane, to see if the interactions are the same as what we have observed in the current study," Ramamoorthy said. "Such a comparative study could lead to the development of potent compounds to treat infection and other diseases."

Life is hard for the children of a parent suffering from depression. Children take on an enormous amount of responsibility for the ill parent and for other family members. It is therefore important for the health services to be aware of this and have support functions in place for the whole family, and not just for the person who is ill. This is the conclusion of a thesis from the Sahlgrenska Academy, University of Gothenburg, Sweden.

Registered Nurse Britt Hedman Ahlström has examined the way in which family life is affected when a parent is suffering from depression. Nine families, including ten children and young adults between the ages of 5 and 26, and eleven parents were included in the study.

The results show how the family's daily life changes and becomes more complicated when a parent is suffering from depression. Uncertainty about what is happening has an effect on the daily life of the entire family. Depression also means that the parent becomes tired and exhausted, which then affects and weighs heavily on the children's daily life. Depression changes the relationship between a parent and his/her children, since they no longer communicate with each other as they used to. Family interplay and reciprocity decrease. The depressed parent withdraws from the family, and the children feel that they have been left to themselves.

Daily family life becomes unfamiliar to the children

The family members try their utmost, both as individuals and together, to cope with the situation, so that daily life can be restored to a more manageable level. The children take responsibility for both the depressed parent, siblings and themselves, when they notice that the parent cannot cope.

"The toughest burden of responsibility that children take on is ensuring that the depressed parent doesn't commit suicide. So children take on an extremely heavy responsibility by monitoring and keeping an eye on the depressed parent," says Britt Hedman Ahlström.

For children, the parent's depression means both a sense of responsibility and a feeling of loneliness The feelings of responsibility and loneliness include a striving and yearning for reciprocity with the parent, and for things to return to a state of normality.

"Even if the depression goes away for a time, the family is never entirely free from anxiety over it coming back. This means that there is a prolonged period of suffering associated with depression," says Britt Hedman Ahlström.

Health services must help the whole family

Involving the entire family when a parent becomes ill is important, both for the children and the parents. It is essential to have a well-defined level of guaranteed care on how, when and from whom the families will get support. Psychiatric healthcare personnel meet people suffering from depression at an early stage, and therefore have the opportunity to focus the care on the family, in order to together identify ways of helping the family get through the depression.

"We need a new approach within the health services, in which the focus is on the family's own perspective when a parent is suffering from depression. It's vital to be aware of the whole family's needs in terms of help and support, and not just those of the person who is ill. It's particularly important to be aware of the children's situation. Research can therefore focus on how to develop various ways of providing families with care and support, and introduce them into the existing organisation, as well as evaluating the consequences for the whole family, the parents and the children," says Britt Hedman Ahlström

While surviving cancer should be an occasion for rejoicing, many people who have undergone the standard or high-dose chemotherapy to defeat the disease unfortunately suffer from a physical and mental ailment known as "chemobrain." This cognitively dysfunctional symptom ranges from fatigue and memory loss to serious learning impairment due to possible brain damage. In CHEMOBRAIN: HOW CANCER THERAPIES CAN AFFECT YOUR MIND (Prometheus Books, $18.98), a clear, concise guide for cancer patients, survivors, families, friends, and caregivers, noted science journalist Ellen Clegg provides the latest information on this much-discussed but poorly understood side effect of chemotherapy treatment, while also - in an objective journalistic fashion - giving voice to those medical professionals who remain skeptical of chemobrain.

Based on extensive and candid interviews with both those suffering from chemobrain and the physicians and scientists who have treated and studied this problem, Clegg cuts through the scientific jargon and explains in understandable terms how chemotherapy works at the most basic biological level. In doing so, she provides cancer survivors with the knowledge to understand what is happening to them and practical tips for coping with the aftermath of chemotherapy treatment.

Clegg's extensive cross-analysis of chemotherapy survivors' stories with the opinions of doctors who recognize the symptoms will provide the affirmation that so many who suffer from chemobrain so desperately need. She includes tactics for dealing with cognitive problems and other lingering side effects, strategies for multitasking at home and reentering the workforce, and even ways to deal with health insurance.

In addition to personal strategies and stories, Clegg also provides the history of the patient empowerment movement that brought chemobrain to the attention of the medical establishment in the first place. She also addresses the future of cancer research and the search for treatments that do less harm, and looks at chemobrain's implications for the mental health of developing children.

Stewart B. Fleishman, MD, Director, Supportive Services, Continuum Cancer Centers of New York: Beth Israel and St. Luke's-Roosevelt Hospitals, is a doctor at the forefront of a new movement to treat cognitive dysfunction as a real symptom with real potential solutions. "We will learn more about the causes of cognitive impairment soon, asking future patient generations to invest less of their quality of life to not only survive, but also thrive after diagnosis of cancer and its treatment," he writes in the book's foreword. "Many questions have yet to be answered. Further studies are now underway to do so."

While survivor circles have acknowledged and debated chemobrain for years, this is the first and only book to delve into the cognitive problems many patients endure when they undergo chemotherapy. CHEMOBRAIN brings together cutting-edge science, the compelling stories of adults and children who have struggled for years with cognitive dysfunction, and the coping strategies being developed on the front lines of patient care. Clegg's investigative study of chemobrain is both a required read for today's upcoming medical professionals and a gospel for those suffering with this widespread symptom as well as for caring family members.

When Joyce Moss recently arrived at Loyola University Hospital with a life-threatening heart attack, it took just 42 minutes to perform an emergency balloon angioplasty.

The procedure opened up an artery that was 100 percent blocked. "There was no damage to the heart because of how quick they were," said Moss, 56, of Berwyn. "I feel good."

To further improve its emergency angioplasty times, Loyola will become the first hospital in Illinois to staff a Heart Attack Rapid Response Team (HARRT) at the hospital 24 hours a day, seven days a week. The HARRT program includes board-certified and highly-experienced interventional cardiologists, nurses and technicians.

Most hospitals do not have such personnel on site during nights and weekends. Thus, precious time is lost when the team has to be called in from home. This is especially true when staffers are delayed by snow storms or other bad weather.

"The HARRT program will provide the next leap of care for patients," said Loyola interventional cardiologist Dr. Fred Leya. Leya is among a team of interventional cardiologists who will rotate night and weekend shifts at the hospital. Leya is medical director of Loyola's cardiac catheterization lab.

Reducing angioplasty times is a coordinated effort that begins with paramedics who take patients to the hospital. There are 51 west suburban fire departments and ambulance companies in the Loyola Emergency Medical Services System. A growing number of ambulances are being equipped so that paramedics can administer 12-ead EKG exams while en route to the hospital. An EKG can confirm a heart attack, and results are radioed ahead to the hospital, said Dr. Mark Cichon, Loyola's director of emergency medical services.

Once a heart attack is confirmed, it takes less than five minutes to prep the patient. The interventional cardiologist then threads a catheter (thin tube) from an artery in the groin to the heart. The cardiologist inflates a balloon at the tip of the catheter to open the artery. In many cases, the cardiologist places a stent (wire mesh tube) to keep the artery open.

The doctor must be fast and accurate. "You become very focused," said interventional cardiologist Dr. Bruce Lewis. "It's like shooting a three-pointer with two seconds to go, except that you can't afford to miss." Lewis is a professor in the division of cardiology at Stritch.

Experience helps improve outcomes. Interventional cardiologists on the HARRT team each perform approximately 300 angioplasties per year. "We have seen just about every permutation," Lewis said.

A task force of the American College of Cardiology and American Heart Association recommends that a patient undergoing a heart attack receive a balloon angioplasty as soon as possible or at least within 90 minutes of arriving at the hospital -- known as the door-to-balloon time. Speed "is of central importance because the benefits of therapy diminish rapidly with delays in treatment," the task force said in a November, 2008 statement published in the heart association journal Circulation.

During a heart attack, a blockage in an artery stops blood flow. Heart muscle begins to die due to lack of blood and oxygen. An emergency angioplasty can reopen a blocked artery and restore blood flow. The procedure does the most good if done within one hour of the patient's arrival, known as the Golden Hour. After three hours, there may not be enough benefits to justify the risks of the procedure.

"Time is heart muscle," said Dr. David Wilber, director of Loyola's Cardiovascular Institute. "The sooner we can open the artery, the better."

A balloon angioplasty is the most effective way to reopen an artery, according to a review of 23 studies published in the British medical journal Lancet. In the studies, heart attack patients were randomly assigned to receive a balloon angioplasty or an intravenous clot-busting drug such as streptokinase. Among patients receiving clot-busting drugs, 14 percent died or suffered a stroke or subsequent heart attack, compared with only 8 percent in the angioplasty group.

Loyola is among a small but growing number of hospitals that are establishing around-the-clock angioplasty teams. Other hospitals include Detroit Medical Center, Vanderbilt Medical Center in Nashville, Tn. and Aurora St. Luke's Medical Center in Milwaukee. Detroit Medical Center has cut its door-to-balloon time to 47 minutes.

"There is increasing evidence that timely angioplasty not only results in better patient outcomes, but may actually reduce overall health care costs in the long run by cutting down the need for later diagnostic procedures, interventions, and hospitalizations." Wilber said. "This is achieved despite the additional effort and expense on the front end. As physicians and hospitals strive to improve the quality of care while controlling long-term costs, it is likely that more centers will adopt these programs."

In Moss' case, there was a blockage in a branch to one of her major heart arteries. After reopening the blockage, Lewis placed a stent. An echocardiogram later found there was no significant damage to her heart muscle.

Moss' heart attack occurred while she was driving to her job as a school bus driver. She said it felt like there was a 50-pound weight on her chest. Her left arm went numb and fell off the steering wheel. She was sweating and nauseous. She pulled off the road and called 911. "I knew it was a heart attack," she said.

Moss, who has six children and 11 grandchildren, said "It's good to still be here."

Loyola University Health System board member James Dowdle and his wife, Sally, have pledged $500,000 to help offset the initial costs of opening the program. The Dowdles have donated more than $2 million to LUHS and to Loyola University Chicago. James Dowdle, a retired executive vice president of the Tribune Co., is the 2001 recipient of the Sword of Loyola, the highest honor of Loyola University Chicago. Sally Dowdle has served as co-chair of the hospitality committee of the Stritch School of Medicine's annual award dinner.

Loyola is a nationally recognized center of excellence for heart and vascular care. It is the only Illinois hospital to be named to the Thomson Reuters 2008 list of the nation's top 30 teaching hospitals with cardiovascular residency programs. And U.S. News and World Report consistently ranks Loyola's heart program as one of the best in the country.