Public Health
Older adults should be part of treatment decisions
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Older adults with multiple health problems have their own opinions when it comes to stopping or continuing a particular treatment, and doctors should encourage them to speak up, according to researchers.
In focus-group discussions with older adults on multiple medications, Yale University researchers found that most had experience with the concept of “competing outcomes”—the dilemma patients face when treating one health condition may worsen another.
For example, an older adult taking a cholesterol medication that causes leg cramps may have to decide whether the lower cholesterol number—and potentially reduced risk of heart attack—is worth the painful side effect. The decision is more complicated when that person also has arthritis and the leg cramps keep him from exercising to reduce his arthritis symptoms.
Families, friends, schools and neighborhoods contribute to adolescent alcohol misuse
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Characteristics present in the four social environments in which young people live—families, peers, schools, and neighborhoods—contribute both positively and negatively to whether teens misuse alcohol, with risk from one area possibly being magnified or decreased by attributes of another.
That’s the finding of a new longitudinal study conducted by researchers at the University of North Carolina at Chapel Hill, the University of California at Davis, and the University of California at Irvine. The study appears in the November/December 2008 issue of the journal Child Development.
Previous research on teen drinking has focused mostly on individuals’ ties to friends and family members. This study suggests the need for a more inclusive view of the social world of adolescents and highlights the importance of examining the connections between all of the social environments in which they live.
New European guidelines on heart attack management put emphasis on speed of action
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New European guidelines issued today on the management of heart attack emphasise speed of action and the importance of “reperfusion” therapy to restore blood flow to the heart and improve survival rates. “A well-functioning regional system of care… and fast transport to the most appropriate facility is key to the success of the treatment,” state the guidelines, which have been developed by a Task Force of the European Society of Cardiology (ESC).
Professor Frans Van de Werf (Leuven, Belgium), chairman of the Task Force, describes the guidelines as “important” and says their broad uptake and adoption would make a “huge difference” to heart attack survival rates.
The new guidelines cover management of a common type of classical heart attack known as STEMI (ST-segment elevation acute myocardial infarction), a reference to its appearance on an ECG. Around one-third of all acute coronary events are diagnosed as STEMI.
Staying active may lower health risks for large, retired athletes
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Study highlights:
• Retired NFL players have fewer heart disease risk factors overall, but higher cholesterol and glucose levels.
• Physical activity may have prevented the development of higher rates of diabetes or greater amounts of atherosclerosis.
• Since today’s players are 50 percent larger than 25 years ago, further study is needed on whether current players are at greater risk for cardiovascular events or death, researchers said.
NEW ORLEANS, La., Nov. 11, 2008 — The larger body size of professional football players doesn’t increase risk of cardiovascular disease or atherosclerosis after they retire, according to research presented at the American Heart Association’s Scientific Sessions 2008.
Experts Available to Comment on New Study about Risk of Sudden Cardiac Death
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A new study in the November 5th 2008 issue of JAMA finds that during the first month after a heart attack, patients may have an increased risk for sudden cardiac death.
“The study justifies why we are so aggressive in treating patients during and after myocardial infarction,” says Howard S Weintraub, MD, FACC, clinical director of Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. “If you survive the first thirty days, your risk is lowered over the next months to years.”
According to Dr. Weintraub, patients at risk for sudden cardiac death during the first month are those with recurrent chest pain (similar to the symptoms they had with their heart attack) and heart failure. “Identification of people at risk is very important,” says Dr. Weintraub. “Patients should be very vigilant reporting symptoms of shortness of breath, especially when lying down, ankle swelling, recurrent symptoms of chest pain, symptoms similar to initial heart attack experience, or problems during exertion or at rest.” They should also understand that using the medications that were prescribed on discharge may be influential in preventing recurrent ischemia and the risk of sudden cardiac death.
Healthy Bones Program Reduces Hip Fractures by 37 Percent, Study Finds
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Proactive measures can reduce hip fracture rates by an average of 37.2 percent—and as much as 50 percent—among those at risk, according to a study conducted by Kaiser Permanente Southern California. The study was published online on November 3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.
The largest study of its kind, the five-year study tracked more than 625,000 male and female patients over the age of 50 in Southern California who had specific risk factors for osteoporosis and/or hip fractures. The implementation of a number of initiatives in the Kaiser Permanente Southern California Healthy Bones Program reduced the hip fracture rates beyond the goal rate of 25 percent.
“One-half of all women and one-third of all men will sustain a fragility fracture in their lifetime. The mortality rate due to osteoporosis-related fractures is greater than the rates for breast cancer and cervical cancer combined,” said study lead author Richard M. Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center. “Yet it’s a misconception that nothing can be done to prevent or treat osteoporosis. It is possible to achieve at least a 25 percent reduction in the hip fracture rate in the United States if a more active role is taken by all orthopedic surgeons in osteoporosis disease management.”
Scientists Map Molecular Regulation of Fat-Cell Genetics
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A research team led by Mitchell Lazar, MD, PhD, Director of the Institute for Diabetes, Obesity, and Metabolism at the University of Pennsylvania School of Medicine, has used state-of-the-art genetic technology to map thousands of positions where a molecular “master regulator” of fat-cell biology is nestled in DNA to control genes in these cells. The findings appear online this week in Genes & Development.
The international obesity epidemic is leading to major health risks, including increased rates of diabetes, heart disease, and cancer. Obesity is caused by increased numbers of fat cells that store more fat than normal. “This research has the potential to lead to new ways to think about therapies aimed at reducing the number of fat cells or altering fat cell function in ways that reduce the complications of obesity,” says Lazar.
The master molecule is called PPAR gamma, a gene regulator that is also the target of a major class of antidiabetic drugs, which include Actos® and Avandia. PPAR gamma binds directly to DNA, regulating the production of proteins by turning genes on or off. Actos® and Avandia are effective in treating diabetes, but their side effects, which include weight gain, prevent them from being recommended as a first-line therapy. The drugs bind to PPAR gamma in the nucleus of fat cells, which affects the expression of many genes, about twenty of which were previously known.
Lung Airway Cells Activate Vitamin D, Help Immunity
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Vitamin D is essential to good health but needs to be activated to function properly in the human body. Until recently, this activation was thought to happen primarily in the kidneys, but a new University of Iowa study finds that the activation step can also occur in lung airway cells.
The study also links the vitamin D locally produced in the lung airway cells to activation of two genes that help fight infection. The study results appear in the Nov. 15 issue of the Journal of Immunology, now online.
In addition to contributing to calcium absorption and bone health, vitamin D is increasingly recognized for its beneficial effects on the immune system. Vitamin D deficiency has been recently linked to increased risk of some infections, autoimmune diseases such as multiple sclerosis and type 1 diabetes, and some cancers.
Are Pediatricians Getting the Training They Need to Meet Patient Needs?
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The face of pediatric medicine is changing. Beyond new technology, treatments and vaccines, more children than ever before are requiring care for chronic diseases and more families also are seeking pediatricians who have expertise in specialty areas such as sports medicine and mental health.
But are future pediatricians getting the training they need to meet the demands of the changing world of medicine, as well as the needs of their patients?
Although medical training has been adapted to educate trainees about new diseases and therapies, the fundamentals of the training process in pediatrics have remained relatively unchanged during the past decade.
Four studies led by the Child Health Evaluation and Research (CHEAR) Unit at the University of Michigan C.S. Mott Children’s Hospital finds recently trained pediatricians and pediatricians-in-training agreed that a one-size-fits-all approach to education in pediatrics may no longer be the right course of action. The studies are set to appear in November Pediatrics supplement
In game of tennis, seeing isn’t always believing
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A universal bias in the way people perceive moving objects means that tennis referees are more likely to make mistakes when they call balls “out” than when they call them “in,” according to a new report in the October 28th issue of Current Biology, a Cell Press publication. Because recent rule changes allow professional tennis players to challenge the refs’ calls, athletes could exploit the new findings to their advantage, according to researchers at the University of California, Davis.
Like all visual illusions, the new discovery provides visual neuroscientists with a window on how the brain processes information, explained David Whitney.
“The visual system faces a big challenge when trying to code the locations of objects so that we can perceive them,” Whitney said. “Consider one of the difficulties: every time we move our eyes, the image on our retina moves. Even if our coffee cup is actually stationary on our desk, we move our eyes and head while reaching to pick it up so the image of the cup will move on our retina. This is a problem because the visual system is sluggish—it takes a hundred or more milliseconds for us to become aware of an image that strikes our retina. So, by the time we perceive an object like the coffee cup in one location, it will have already changed location as we move toward it. Our perception lags behind reality. The visual system has mechanisms that help alleviate this problem of living in the past, but these mechanisms are not perfect and occasionally result in visual illusions—like the misperception of tennis ball location we discovered.”
5 Things You Should Know About Stem Cell Research
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In just a few weeks, Michigan voters will have an important decision to make when casting their ballots.
Not just who they want to be president, or to represent them in Congress, but what they want the state to do about stem cells. And the way they vote on a ballot measure called Proposal 2 will determine the fate of a Michigan law that currently restricts research using embryonic stem cells.
Meanwhile, in other states, stem cells are emerging as a key issue in many races.
To cast an educated vote on stem cells, voters in Michigan and beyond must understand a complex, fast-emerging new field of medicine – no easy task. Stem cell research is generating great interest and investment worldwide because it could lead to possible treatments for spinal cord injuries, Parkinson’s disease, juvenile diabetes and other diseases. But some aspects of embryonic stem cell research may pose an ethical or moral dilemma for some people.
Withdrawal of Life Support Often an Imperfect Compromise
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Intensive Care Unit (ICU) doctors seeking to balance the complex needs of their patients and the patients’ families may make an imperfect compromise, withdrawing life support systems over a prolonged period of time. This practice is much more common than previously believed, and is also surprisingly associated with higher satisfaction with care-at least among surviving family members.
“We found that sequential withdrawal of life support is not as rare a phenomenon as previously believed,” wrote J. Randall Curtis, M.D., M.P.H., section chief for pulmonary and critical care medicine at the Harborview Medical Center and the University of Washington, in Seattle. “It occurred in nearly half of the patients we studied.”
The findings will be published in the second issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society. The study was funded by the National Institute of Nursing Research.
Regular exercise may reduce delirium risk
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Participating in an activity, especially regular physical exercise, appears to protect hospitalized elderly patients from developing delirium, according to study findings published in the Journal of the American Geriatrics Society.
“Delirium is a common, life-threatening clinical syndrome that is preventable,” Dr. Frances M. Yang, of Harvard Medical School, Boston, and colleagues write. “Given its high prevalence and incidence and its association with poor outcomes, finding mechanisms to prevent delirium remains a high priority.”
The researchers looked for factors associated with delirium in 779 newly hospitalized patients. The patients were at least 70 years of age and were free of dementia at the beginning of the study.
Study Highlights Successful Physical Activity Programs for Older Adults
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Yes, America, you can take scientific research and make it work in real-world, physical activity programs for aging Baby Boomers and senior citizens who may have health and activity challenges.
Researchers at the University of South Carolina’s Arnold School of Public Health, in collaboration with researchers at the Texas A&M Health Science Center School of Rural Public Health (HSC), recently looked at data from the Active for Life® program and found that physical activity programs developed and tested in research settings can be successfully implemented and diffused through community organizations.
Active for Life was established in 2003 at the HSC-School of Rural Public Health, with funding from the Robert Wood Johnson Foundation. The program goals were to learn how research-based programs need to be adapted for large-scale dissemination, understand factors that affect program adoption by community organizations, broaden the reach of programs, and understand what is needed at the community level to sustain programs. Active for Life specifically addressed physical activity among mature adults. The program used two lifestyle interventions, Active Choices, a telephone coaching program, and Active Living Every Day, a group-based program.
Condom ring-tone a hit in India
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A ring-tone that sings “condom, condom, condom” has attracted over 270,000 downloads since its launch last month and has spread the message of safe sex to many more mobile phone users in India and abroad.
The innovative “Condom a Capella” ring-tone that has the word “condom” sung in many overlapping melodies is the work of an Indian duo, Rupert Fernandes and Vijay Prakash. The website http://www.condomcondom.org, where the ring-tone can be heard, has had over 2 million hits.
The campaign has been produced by the BBC World Service trust in India and aims to target the increasing number of India’s mobile phone users, presently estimated at over 250 million.
