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January 15, 2006, 2:46 PM CT

Physicians Who Treat World Travelers

Physicians Who Treat World Travelers
Diseases know no borders, and as international business and personal travel continues to become more common, the borderlines become even more blurred. Physicians who specialize in travel and tropical medicine, like Phyllis E. Kozarsky, MD, professor of medicine, Emory University School of Medicine, now have new data that will help guide their therapy of international travelers.

Data on more than 17,000 ill returning travelers collected through the GeoSentinel Surveillance Network, an established network of International Society of Travel Medicine clinics, show, for the first time, that travelers to different parts of the developing world face varying but significant risks. The study appears in the Jan. 12 issue of "The New England Journal of Medicine."

The Emory TravelWell Clinic, located at Emory Crawford Long Hospital, is part of the GeoSentinel Surveillance Network, and Dr. Kozarsky, the clinic director, is a co-author of the study and a founder of the network.

"This data will not only guide me and my colleagues in travel and tropical medicine, but it will help internal medicine specialists and emergency physicians who may be faced with treating patients who present with unusual or exotic diseases," says Dr. Kozarsky.

"This information gives us a blueprint of what to look for when it comes to diagnosing sick travelers, based on where they have been," says lead author David O. Freedman, MD, director of the University of Alabama at Birmingham Travel Medicine Clinic. "Doctors -- travel medicine specialists in particular -- can use the destination-specific differences we've found to guide the diagnosis and therapy of ill travelers, meaning they can order the correct tests and begin the correct treatment while waiting for confirmation."........

Posted by: Mark      Permalink

January 13, 2006, 0:16 AM CT

Alcohol Advertising May Lead To Increased Drinking

Alcohol Advertising May Lead To Increased Drinking
Young people who view more alcohol advertisements tend to drink more alcohol, according to a new study in the recent issue of the Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Young people are beginning to drink at an earlier age than ever before and their actions can have consequences ranging from poor grades to alcoholism and car accidents, according to background information in the article. Several studies have found an association between exposure to alcohol advertisements and youth drinking, but have not been able to establish causality, the authors write. The alcohol industry has no federal restrictions on its advertising but is subject to voluntary codes dictating that 70 percent of the audience for their advertisements be adults older than age 21. The authors report that these ads still appear frequently in media aimed at young people.

Leslie B. Snyder, Ph.D., of the University of Connecticut, Storrs, and his colleagues interviewed a random sample of young people aged 15 to 26 years in 24 U.S. media markets four times between 1999 and 2001. The scientists interviewed 1,872 young people in the first wave, 1,173 of the same respondents in the second, 787 in the third and 588 in the fourth.

Young adults who reported viewing more alcohol advertisements on average also reported drinking more alcohol on average-each additional advertisement viewed per month increased the number of drinks consumed by 1 percent. The same percentage increase, 1 percent per advertisement per month, applied to underage drinkers (those younger than age 21) as well.........

Posted by: Janet      Permalink

January 13, 2006, 0:07 AM CT

Children's Weight And Neighborhood Safety

Children's Weightand Neighborhood Safety
Children who live in neighborhoods that their parents believe are unsafe are more likely to be overweight than those in neighborhoods perceived as safe, as per a studyin the recent issue of the Archives of Pediatrics and Adolescent Medicine, one of the JAMA/Archives journals.

Almost 16 percent of 6- to 11-year-old children in the United States are overweight, defined as having a body mass index (BMI) of greater than or equal to the 95th percentile of national norms for age and sex, according to background information in the article. Children who are African-American or Hispanic, who watch large amounts of television or who have parents with high BMIs are more likely to be overweight, but little is known about how a child's neighborhood affects his or her risks. Few prior studies have looked specifically at the relationship between neighborhood safety and children's risk of being overweight.

Julie C. Lumeng, M.D., of the University of Michigan, Ann Arbor, and his colleagues collected data from 768 children and families participating in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a study of families in 10 diverse regions of the United States. The parents completed questionnaires that assessed how safe they thought their neighborhoods were at the time their children were in first grade. The ratings were divided into quartiles, with the first quartile perceived as the least safe and the fourth as safest. Their children's height and weight were measured in the laboratory when they were 4 ½ years old and again the spring of their first-grade year in school, when their mean (average) age was 7. BMI was calculated by dividing their weight in kilograms by the square of their height in meters.........

Posted by: JoAnn      Permalink

January 12, 2006, 11:59 PM CT

Brain Volume And Dementia

Brain Volume And Dementia
Reduced volume, or atrophy, in parts of the brain known as the amygdala and hippocampus may predict which cognitively healthy elderly people will develop dementia over a six-year period, as per a studyin the recent issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

New strategies may be able to prevent or delay the onset of Alzheimer's disease (AD), the most common cause of dementia among older adults, according to background information in the article. Accurate methods of identifying which people are at high risk for dementia in old age would help physicians determine who could benefit from these interventions. There is evidence that adults with AD and mild cognitive impairment, a less severe condition that is considered a risk factor for AD, have reduced hippocampal and amygdalar volumes. However, prior research has not addressed whether measuring atrophy using magnetic resonance imaging (MRI) can predict the onset of AD at an earlier stage, before cognitive symptoms appear.

Tom den Heijer, M.D., Ph.D., of the Erasmus Medical Center, Rotterdam, the Netherlands, and his colleagues used MRI to assess the brain volumes of 511 dementia-free elderly people who were part of the Rotterdam Study, a large population-based cohort study that began in 1990. They screened the participants for dementia at initial visits in 1995 and 1996 and then in follow-up visits between 1997 and 2003, during which they asked about memory problems and performed extensive neuropsychological testing. The authors also monitored the medical records of all participants. During the follow-up, 35 participants developed dementia and 26 were diagnosed with AD.........

Posted by: Daniel      Permalink

January 12, 2006, 11:22 PM CT

Your Purse And Depression Treatment

Your Purse And Depression Treatment
Low-income people with depression are less likely to respond to therapy and more likely to be suicidal than those who have higher incomes, as per a studyin the recent issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Socioeconomic factors, including income, education and occupation, have long been linked to health status, illness and death. Research has shown that people with lower socioeconomic status (SES) are more likely to develop a depressive illness and that their depression is more severe than that of people higher on the SES scale. Several studies have hypothesized that socioeconomic factors, including income and education, would also affect how people respond to medications and other therapies for depression, but have ultimately proved inconclusive, according to background information in the article.

Alex Cohen, Ph.D., of Harvard Medical School, Boston, and his colleagues reanalyzed two prior clinical trials funded by the National Institute of Mental Health and conducted at the University of Pittsburgh. The 248 participants were all 59 years or older and receiving antidepressant medications combined with psychotherapy. Their education levels were assessed at the beginning of the original studies. Median annual household income for their areas was obtained from the U.S. Census Bureau. Low-income was defined as less than $25,000, middle-income between $25,000 and $50,000 and high-income more than $50,000. The subjects' depressive symptoms and response to therapy were measured weekly.........

Posted by: JoAnn      Permalink

January 12, 2006, 11:16 PM CT

Eating Disorders May Cause Problems In Infants

Eating Disorders May Cause Problems In Infants
Certain complications during and immediately after birth are associated with the development of the eating disorders anorexia nervosa and bulimia nervosa, as per a studyin the recent issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Eating disorders are believed to be caused by a complex interaction of genetic and environmental factors, according to background information in the article. Observational reports suggest that problems during neurodevelopment in the fetus might lead to anorexia nervosa or bulimia nervosa later in life, and some studies have found a correlation between obstetric complications and anorexia nervosa. "Obstetric complications might have more than one role in the etiopathogenesis of eating disorders; first, they may cause hypoxic-induced damage to the brain that impairs the neurodevelopment of the fetus, and second, the adequacy of nutrition during pregnancy and in the immediate postnatal period seems to influence the nutritional status of the adult and appetite programming throughout life," the authors write.

Angela Favaro, M.D., Ph.D., and his colleagues at the University of Padua, Italy, completed an analysis of 114 females with anorexia nervosa, 73 with bulimia nervosa and a control group of 554 without either condition, all born at Padua Hospital between Jan. 17, 1971, and Dec. 30, 1979. Fifteen of the people with anorexia, 22 with bulimia and all of the control subjects had participated in a prior study of the prevalence of eating disorders in Padua. The authors added in a sample of 99 people with anorexia and 51 with bulimia who had been referred to an outpatient clinic for their conditions. They then merged the samples and analyzed data about obstetric complications obtained from hospital archives.........

Posted by: JoAnn      Permalink

January 11, 2006, 8:00 PM CT

Link Between High-Fat Diet and Type 2 Diabetes

Link Between High-Fat Diet and Type 2 Diabetes Jamey D. Marth, Ph.D.
Howard Hughes Medical Institute scientists have discovered a molecular link between a high-fat, Western-style diet, and the onset of type 2 diabetes. In studies in mice, the researchers showed that a high-fat diet interferes with a genetic mechanism they discovered that promotes insulin production, resulting in the classic signs of type 2 diabetes.

In an article published in the December 29, 2005, issue of the journal Cell , the scientists report that knocking out a single gene encoding the enzyme GnT-4a glycosyltransferase (GnT-4a ) disrupts insulin production. Importantly, the researchers showed that a high-fat diet suppresses the activity of GnT-4a and leads to type 2 diabetes due to failure of the pancreatic beta cells.

"We have discovered a mechanistic explanation for beta cell failure in response to a high-fat diet and obesity, a molecular trigger which begins the chain of events leading from hyperglycemia to insulin resistance and type 2 diabetes," said Jamey Marth, a Howard Hughes Medical Institute investigator at the University of California, San Diego (UCSD). Marth and first author Kazuaki Ohtsubo at UCSD collaborated on the studies with scientists from the Kirin Brewery Co. Ltd., and the University of Fukui, both in Japan.

The discovery of the link between diet and insulin production offers new information that may aid in the development of therapys that target the early stages of type 2 diabetes. In its earliest phases, the disease causes failure of insulin-secreting beta cells in the pancreas, which leads to elevated blood glucose levels. As the disease progresses, the insulin-secreting beta cells overcompensate for the elevated blood glucose, and eventually pump out too much insulin. This leads to insulin resistance and full-blown type 2 diabetes.........

Posted by: JoAnn      Permalink

January 11, 2006, 7:50 PM CT

How Seniors Sleep Without Drugs

How Seniors Sleep Without Drugs
A new study lays to rest the notion that sleepless seniors might respond poorly to therapys that emphasize behavioral treatment over drugs.

Behavioral interventions for insomnia offer "a very powerful strategy" in people over 55, said Michael Irwin, M.D., of UCLA, the lead author of a systematic evidence review. "Their benefits may be greater than pharmacologic therapys, because they can persist for a longer period of time."

Treating insomnia with drugs may impair functioning, create dependency and worsen sleep after they are discontinued, he says.

Poor sleep is one of the more common complaints among adults, and the prevalence rate among the elderly is almost double that of younger adults. Moreover, scientists are now recognizing the importance of sleep to overall health.

"Insomnia is increasingly implicated as a predictor of cardiovascular and noncardiovascular disease mortality," says the review.

This review is the first in a new series of would be published in Health Psychology. Each evidence-based review will center on a specific psychological assessment or therapy conducted in the context of a physical disease process or risk reduction effort.

The systematic review included 23 randomized controlled trials involving more than 500 participants. The various non-drug therapys - cognitive behavioral treatment, relaxation and changes in sleep behavior - yielded "robust improvements" in a variety of common problems such as poor sleep quality, difficulty falling asleep and awakening during the night.........

Posted by: Janet      Permalink

January 11, 2006, 7:42 PM CT

Reducing Secondhand Smoke in Homes

Reducing Secondhand Smoke in Homes
People who see news stories and advertisements about the dangers of secondhand smoke are more likely to feel that it is harmful, and may restrict smoking at home, according to new research published in the American Journal of Health Behavior.

The study by W. Douglas Evans, of the nonprofit research corporation RTI International, and his colleagues found that anti-secondhand smoke media messages have a strong indirect effect on smoking restrictions in the home.

Anti-secondhand smoke media account for 10 percent of people's negative attitudes about secondhand smoke, but these negative attitudes explain nearly 60 percent of home smoking restrictions, Evans said.

"Media work through changing people's attitudes to get them to change home smoking rules," he said.

People may "have to process the information" they get from the media through family discussions or through one person in a household taking a strong position on secondhand smoke before the change in attitude becomes a change in home restrictions, Evans suggested.

According to 2003 statistics compiled by the Centers for Disease Control and Prevention, secondhand smoke exposure is the third leading cause of preventable death in the United States. Secondhand smoke exposure has been linked to lung cancer and heart disease in adults and severe respiratory infections and asthma, especially in infants and young children.........

Posted by: Janet      Permalink

January 11, 2006, 7:37 PM CT

Elderly With Alcoholism And Heart Attack

Elderly With Alcoholism And Heart Attack
Older Americans with alcohol problems do not get worse therapy than their sober peers when they are hospitalized for a heart attack, according to new research on Medicare patients across the country.

Alcoholic patients were less likely than sober patients to receive beta-blocker drugs when they were discharged from the hospital, but there were no other significant therapy differences between the two groups. The study is published in the latest issue of the journal Alcoholism: Clinical and Experimental Research.

"Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized" for heart attack, David Fiellin, M.D., of Yale University School of Medicine and his colleagues conclude.

The encouraging finding "speaks to the fact that there have been significant efforts across the board, in medicine in general, to monitor the provision of quality care," Fiellin said.

However, the scientists also note that the "overall provision of quality of care indicators was low," when measured across all patients.

Fiellin and his colleagues analyzed data for 155,026 Medicare patients age 65 and older admitted to a hospital with a heart attack. Only 1,284 of these patients also had an alcohol-related diagnosis on their medical records.........

Posted by: Daniel      Permalink

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Did you know?
Adolescents who suffer physical injuries are vulnerable to emotional distress in the months following their hospitalization, yet almost 40 percent of hospitalized adolescents interviewed for a new study had no source for the follow-up medical care that could diagnose and treat symptoms of post-traumatic stress. These young trauma survivors are at risk for high levels of post-traumatic stress and depressive symptoms, as well as high levels of alcohol use, according to research by researchers at the Harborview Injury Prevention and Research Center. Archives of society medical news blog

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