Clarifying

Summertime is here

Cynthia Haggard — Tue, 19 Jul 2011 13:19:30 +0000

Everyone,

It is that time of year when people have travel plans. They leave the hot and humid discomfort of an east-coast city and head to cooler climes. This is what I’m about to do. As a consequence, I won’t be posting new blogs until September.

I hope that everyone has a wonderful summer, and expect to see something new in this space come the first week of September.

Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women

Cynthia Haggard — Tue, 12 Jul 2011 13:12:09 +0000

Sudden cardiac death (SCD) is responsible for over half of all deaths due to heart disease. Unfortunately, SCD is usually the first manifestation of heart disease, especially among women. At the moment, the most popular way of preventing SCD is to implant defibrillators into patients with severe left ventricular dysfunction. The problem with this approach is that only 25% to 30% of SCDs occur among this high-risk subgroup. Clearly, prevention strategies are needed to reach lower risk populations.

With this in mind, the authors analyzed data from the Nurses Health Study that was begun in 1976, when 12,700 female nurses aged 30 to 35 years provided information on lifestyle and medical history. The authors analyzed data from June 1976 to June 2010 to determine what role modifiable lifestyle factors, such as smoking, BMI, diet, and alcohol intake played in preventing SCD.

There was a clear association between healthy lifestyle – including no smoking, a BMI less than 25, a mediterranean diet, and moderate alcohol intake – and lower risk of SCD.

To read more, click here, or go to JAMA, July 6, 2011 – Vol. 306, No. 1, pp. 62-69.

-–Cynthia Haggard is a medical writer by day, and a novelist by night.. To see more about her medical writing business, go to clarifyingconcepts. To see more about her creative writing, go to spunstories.com (c) 2011 All rights reserved.

As much as one in ten infants are given herbal supplement teas by their mother

Cynthia Haggard — Tue, 05 Jul 2011 13:05:58 +0000

A recent study has raised the issue of herbal supplement teas being given to infants. The data are based on questionnaire responses from over 2000 healthy mothers who answered questions about their pregnancy and their child’s first year of life. The most commonly used supplements included gripe water, given for colic, chamomile teething tablets, an unspecified types of tea.

It all sounds so harmless, doesn’t it? Until you realize that the herbal supplements industry is not regulated in the same way as pharmaceuticals. This means that the ingredients listed on the label do not necessarily match what is actually in the product. Thus infants could be exposed to heavy metals or various other contaminants. Even if the product is just fine, it is possible that it could cause adverse effects if given while your infant is taking medication prescribed by the doctor.

As always, consult your doctor before taking anything yourself, or giving it to your child.

To read more, click here, or go to JAMA, June 1, 2011 – Vol. 305, No. 21, p. 2161.

Temporal Trends in the Prevalence of Diabetic Kidney Disease in the United States

Cynthia Haggard — Tue, 28 Jun 2011 13:28:05 +0000

Diabetic kidney disease (DKD) is an unfortunate complication of diabetes. Approximately 40% of patients with diabetes develop this condition. And DKD accounts for about 50% of cases of end-stage renal disease (ESRD) in the United States.

As the five-year survival rate for people with ESRD is less than 5 years, clinicians are naturally anxious to prevent it from occurring. This means also managing the occurrence of DKD, and so the authors of the study investigated trends in the prevalence of DKD in the United States of the past 2 decades to determine if diabetes therapies that are currently offered are helping to prevent DKD.

The main finding was that the incidence of DKD increased in direct proportion to the prevalence of diabetes itself in the United States over the past 2 decades. This means that as the incidence of diabetes increases among the US population, so also will the incidence of DKD.

To read more, click here, or go to JAMA, June 22/29, 2011 – Vol. 305, No. 24, pp. 2532-2539.

How to Prevent & Treat Hypertension in Elderly Patients

Cynthia Haggard — Tue, 21 Jun 2011 20:46:47 +0000

Clinicians now have guidelines on how to prevent and treat hypertension in people aged 65 or older. The guidance, released in April, comes from an expert panel convened by the American College of Cardiology and the American Heart Association.

To determine if hypertension exists, the patient’s blood pressure should be measured after the patient has been standing for 1 to 3 minutes. This allows the clinician to evaluate for both low and high blood pressure.
Next, the clinician needs to determine if the blood pressure reading represents hypertension, taking into account the fact that blood pressure increases naturally with age.
If hypertension is determined, physicians should identify the reversible and treatable causes, check for organ damage, assess other cardiovascular risk factors.

To read more, click here, or go to JAMA, June 15, 2011 – Vol. 305, No. 23, pp. 2394 and 2398.

How do I know if I have Melanoma?

Cynthia Haggard — Tue, 14 Jun 2011 13:14:17 +0000

Melanoma is the most dangerous form of skin cancer. It happens when the cells that produce melanin, the pigment responsible for the color of skin, are transformed into cancerous cells.

The main cause of this transformation is ultraviolet light from the sun or from a tanning bed. If you have fair skin, and blond or red hair, you have a greater tendency to be affected by UV rays.

This is not to say that other people are not at risk. So how do you know if you have melanoma?

First, examine yourself to see if you have any discolored patches of skin.

Second, Use this way of remembering:

A Does the discolored patch of skin have an Asymmetric Appearance?

B Does the discolored patch have irregular or Blurred Borders?

C Does the Color vary?

D Is the Diameter greater than 0.25 inch, the size of a pencil eraser?

E Is the patch Evolving, with a change in size, shape or color over time.

If this is true, see your doctor immediately. If this condition is discovered early, it can be cured with surgery.

How do you prevent this condition?

Take a few simple precautions:

1. Wear a hat, sunglasses, long sleeves and long pants when going outside.

2. Avoid direct exposure to sunlight between 9 am and 3pm. If you must go outside, pick the shady side of the street to walk on. It’s cooler anyway.

3. Always use sunscreen. Don’t leave home without some.

4. Keep away from those tanning beds.

To read more, click here, or go to JAMA, June 8, 2011 – Vol. 305, No. 22, pp. 2368.

Factors Associated with Closures of Emergency Departments in the United States

Cynthia Haggard — Tue, 07 Jun 2011 13:07:21 +0000

Federal law requires that ALL patients who show up in the emergency room MUST be treated REGARDLESS of their ability to pay. Yet in the 10-year period between 1998 and 2008, the number of hospital-based emergency rooms declined 3.3% while visits INCREASED by more than 30%.

The authors conducted a study to find out why emergency rooms were closing. They identified several risk factors:

Hospitals that are perceived as serving mainly as a safety net. These hospitals are usually located in poor communities, and serve patients who either have no health-care insurance, or don’t have enough to cover their medical costs. The reason why these hospitals are at risk of closing is because they can’t maintain an on-call staff of specialists, because physicians who have put in extra hours to train as specialists typically don’t want to cover emergency cases, especially if the patients are not able to pay their medical bills.
Hospitals that are located in counties where many residents live in poverty. The main reason for this is overcrowding of the emergency room, and the difficulties of providing high-quality medical care when faced with such a bottomless pit of need, and no funds to meet this challenge.
Competition from other, more financially secure emergency rooms that are located within a 15-mile radius pose another risk.
An emergency room that is located in a for-profit hospital. Because it is financially challenging to operate an emergency room that complies with Federal law that mandates that all patients must be treated no matter what the cost, for-profit hospitals are more likely than non-profits to close their emergency rooms.

To read more, click here, or go to JAMA, May 18, 2011 – Vol. 305, No. 19, pp. 1978-1985.

Image: en.wikipedia.org

Public Health Implications of Government Spending Reductions

Cynthia Haggard — Tue, 31 May 2011 13:31:18 +0000

As you are no doubt aware, the United States is in the midst of a fiscal crisis, causing many state, local and federal agencies to propose cutbacks in spending. While it is obvious that cutbacks in health care directly impact the wellbeing of millions of people, cutbacks that affect basic living conditions, such as employment, education, housing and diet, also have an effect.

The statistics bear this out. In 2007, adults with a bachelor’s degree were four times LESS likely to report poor health than those without a high school eduction. Adults with a bachelor’s degree have HALF the cases of diabetes, than those without a high school diploma. At age 25, life expectancy is five years LONGER for college graduates than for those who did not complete high school.

Families with financial insecurity face difficulties that often cause them to pay less attention to their health. They are more likely to eat poorly, skip exercise, and miss medications in order to stretch their budget. Low incomes force families to live in unhealthy housing, or in bad neighborhoods, which also tend to have limited access to medical care, nutritious food and safe places to exercise.

To read more, click here, or go to JAMA, May 11, 2011 – Vol. 305, No. 18, pp. 1902-1903.

Image: iron.icc.gatech.edu

Whole genome sequencing: A step closer to personalized medicine

Cynthia Haggard — Tue, 24 May 2011 13:24:11 +0000

New technologies can now read millions of short 50-200 nucleotide DNA sequences, and complete a task that not so long ago would have taken months, in a few days. This means that the possibility of sequencing a person’s entire genome in a cost-effective way, is becoming closer to reality because the time to do the task has diminished considerably over the past five years.

The clinical implications of this are especially relevant for cancer patients, because the genetics of cancer tumors are complex, requiring the clinician not just to examine a single gene, but rather a pattern of many genes in order to understand the genetic underpinnings of the disease, which vary from person to person. Although it is not yet possible to sequence an entire genome in a clinical setting, oncologists are hopeful that it will become soon in the not-too-distant future.

To read more, click here, or go to JAMA, April 20, 2011 – Vol. 305, No. 15, pp. 1596-1597.

Mineral metabolism disorders in chronic kidney disease

Cynthia Haggard — Tue, 17 May 2011 13:17:09 +0000

One of the most rapidly increasing chronic diseases in the United States is kidney disease. It is estimated that more than 20 million adults have lost more than half of the function of their kidneys.

Data from cell culture and animal studies suggest that the inability to metabolize minerals such as phosphorus, vitamin D and calcium, might play a role in the onset of chronic kidney disease.

To examine this issue, the authors performed a meta-analysis on many studies. Their findings suggest that high levels of phosphorus play a role in kidney disease. It was less clear if other minerals were similarly implicated.

To read more, click here, or go to JAMA, March 16, 2011 – Vol. 305, No. 11, pp. 1138-1139.

Image: ncbi.nlm.nih.gov