Moral of the story: The evidence continues to evolve as we learn more about Alzheimer's.  Mentally stimulating activity can delay onset, but once onset does occur, patients deteriorate most rapidly.

Source: AMA Morning Rounds 9/2/2010

Mentally stimulating activities may delay, not prevent, signs of Alzheimer's.

ABC World News (9/1, story 8, 0:30, Sawyer) reported, "There is a new study that found mentally stimulating activities," such as "reading and solving puzzles...can indeed delay the outset of Alzheimer's disease, but not prevent it for good."

        "Poring over crossword puzzles, reading, and listening to tunes may slow or delay brain decline at first, but being mentally active might speed up dementia once it hits," USA Today (9/2, Marcus) reports. According to Robert Wilson, PhD, of the Rush University Medical Center and the lead author of the study published online Sept. 1 in the journal Neurology, "The person who has had a more mentally stimulating lifestyle may have more signs of disease in his brain, but the brain has been able to compensate for it better." While "researchers don't fully understand why active-minded people suffer such a rapid decline once they develop Alzheimer's...the study shows the advantages of using your brain because of the early benefits."

        The Los Angeles Times (9/1, Healy) reported that in the "study of 1,157 Chicago-based seniors who were followed for an average of just over 11 years," investigators found that "the steepest downward trajectories belonged to those who had been diagnosed with Alzheimer's disease, but who had reported high levels of mental engagement at the outset of the study." Meanwhile, "fellow Alzheimer's sufferers who had not sought out much intellectual stimulation at the study's outset showed a more gradual decline in their function."

        The Washington Post (9/1, Stein) "The Checkup" blog reported that, according to Wilson, "those who have been mentally active are able to maintain their thinking abilities despite whatever damage is occurring in their brains for much longer than those who are not," probably because they have achieved some cognitive reserve. Therefore, "when the damage finally does get so bad that it starts to show itself, these people are actually much farther along and so go downhill much more quickly."

        The CNN (9/1, Landau) "The Chart" blog reported, "That's not necessarily a bad thing, if you consider quality of life issues, researchers say." The blog entry quoted Wilson as saying, "At the end of the day, you spend less of your lifespan in that demented state."

        HealthDay (9/1, Phillips) noted, "According to the authors, the results suggest that mental exercises help prevent the onset of dementia, but only if they're started before signs of cognitive impairment appear -- after that point, the brain is probably too damaged for such interventions to make a difference."

        New discovery reveals potential Alzheimer's medication target. The New York Times (9/2, A25, Kolata) reports that a discovery made by scientist Paul Greengard, PhD, appears to reveal "a new potential drug target that...could slow or halt the devastating effects" of Alzheimer's disease, according to research published in the journal Nature. Greengard has discovered what he calls the gamma secretase activating protein (GSAP), which tells gamma secretase to make produce beta amyloid. Working with genetically engineered mice, Greengard "blocked the gene for" GSAP. Notably, those mice stayed healthy and did not go on to develop beta-amyloid brain plaques that are characteristic in Alzheimer's disease.

        The CNN (9/1, Willingham) "The Chart" blog reported that modified forms of the medication Gleevec (imatinib mesylate), used to treat certain forms of leukemia and gastrointestinal cancers, have "the ability to bind" to GASP and even reduce "beta-amyloid production." Unfortunately, Gleevec "does not cross the blood-brain barrier," but researchers believe that it will someday be possible to create medications that "target GSAP, but do not have that limitation."

Want to get pregnant? relax

Moral of the story: Relaxing increases your chances of conception.  However, don't smoke or drink alcohol to relax, these decrease the chance of conceiving and will damage fetuses.

Moral of the story: A new 5 day emergency contraceptive drug is now on the market.  Previously the only option was a 2 day EC.

Source: AMA Morning Rounds 8/16/10

FDA approves new five-day emergency contraceptive.

NBC Nightly News (8/13, story 8, 0:15, Curry) reported, "Today, federal health officials approved a new type of morning after contraceptive that reduces the chance of pregnancy for five days. That's two days longer than the emergency contraception known as Plan B. The new pill is called Ella and it will be available by prescription only."

        The AP (8/14, Perrone) reported that the FDA on Friday approved a new type of morning-after contraceptive, Ella from HRA Pharma, a prescription-only birth control option that reduces the chance of pregnancy up to five days after sex. Ella "uses the hormone progesterone to delay ovulation, a key step in the fertilization process. Despite this, the drug has drawn criticism from anti-abortion groups who say it is closer to an abortion pill than an emergency contraception pill. Groups including the Family Research Council argue the drug is chemically similar to the abortion drug mifeprestone, which can be taken to end a pregnancy up to 50 days into the gestation period."

        The Los Angeles Times (8/14, Maugh II) "Booster Shots" blog said that the drug, "known generically as ulipristal acetate, is thought to inhibit or delay ovulation by interfering with the effects of the female hormone progesterone, which stimulates ovulation. ... Women with a known or suspected pregnancy or who are breastfeeding should not use the drug."

        The Washington Post (8/14, Stein) said that Ella "can cut the chances of becoming pregnant by about two-thirds for at least 120 hours after a contraceptive failure or unprotected sex, studies have shown." Supporters and opponents both said the FDA's decision "marked the clearest evidence of a shift in the influence of political ideology at the FDA. ... If the history of Plan B is any indication, Ella's approval is likely to mark the beginning of many years of political and regulatory battles over the drug."

        The New York Times (8/14, A1, Harris) reported on its front page that "some advocates said Friday that the agency's relatively rapid adoption of its scientists' advice meant that its traditional separation from political considerations had returned. 'It's really important the FDA made a decision that's based on the scientific evidence and not on the political controversy,' said Diana Zuckerman, president of the National Research Center for Women and Families. But Wendy Wright, president of Concerned Women for America, which opposes abortion, said that political considerations were still at work inside the agency."

        The Wall Street Journal (8/14, Mathews, Dooren) noted that the label says ulipristal likely works by inhibiting or delaying ovulation, but its efficacy also may be partly due to an effect of altering the lining of the uterus in a way that affects implantation.

        Bloomberg News (8/14, Waters, Peterson) noted, "Side effects among the 2,600 women who took part in studies included nausea, headache, abdominal pain and dizziness. Ella shouldn't be used when a woman is pregnant or suspects she may be, Watson said in the statement." In addition, "women who become pregnant or complain of lower abdominal pain after taking the drug should be examined for the possibility that an egg has become fertilized and lodged outside the uterus, the company said."MedPage Today (8/13, Gever) and WebMD (8/13, DeNoon) also covered the story.

Placebo effect, not acupuncture itself, helpful for OA

Moral of the story: Acupuncture does not help decrease pain from knee osteoarthritis.  It is the belief that it will help (placebo effect) that creates the relief.  Sham acupuncture and acupuncture had equivalent treatment effects.

Source: AMA Morning Rounds 8/19/10

Traditional Chinese acupuncture no more effective than sham acupuncture in relieving pain in patients with OA of the knee.

The Time (8/17, Blue) "Wellness" blog reported that, according to a study published Aug. 17 in the journal Arthritis Care & Research, "acupuncture probably only works because patients believe that it will -- and it's the belief, not the procedure, that makes the difference." For the study, researchers randomized "455 patients with osteoarthritis of the knee...either to receive traditional Chinese acupuncture or to receive a sham treatment -- a kind of mock acupuncture with needles inserted away from traditional acupuncture meridians, and with shallow needles designed to give very little of the stimulation that acupuncture provides."

        The study authors found that "traditional Chinese acupuncture was no more effective than sham acupuncture in relieving pain in patients with osteoarthritis of the knee," MedPage Today (8/17, Smith) reported. However, "both procedures were better at pain relief than no therapy, according to Maria Suarez-Almazor, MD, PhD, of MD Anderson Cancer Center in Houston, and colleagues." Interestingly, "treatment style -- neutral or positive -- also affected outcomes, with patients reporting better results if the acupuncturist was highly positive, regardless of whether what was actually delivered was traditional or sham acupuncture," the investigators found.

Alternative treatment for fibromyalgia

Moral of the story: an alternative to drugs for fibromyalgia

Source: AMA Morning Rounds 8/22/10

Tai chi may be effective therapy against fibromyalgia.

The New York Times (8/19, A16, Belluck) reports, "The ancient Chinese practice of tai chi may be effective as a therapy for fibromyalgia, according to a study published on Thursday in the New England Journal of Medicine."

        For the study, "doctors randomly assigned 66 fibromyalgia patients to take either a 12-week tai chi class or attend a 'wellness education' class that included stretching exercises," USA Today (8/19, Szabo) reports. "After finishing the course, 79% of tai chi participants said their symptoms had improved, compared with 39% of those in the educational class, the study shows. It was financed by the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health."

        The AP (8/19, Marchione) reports that an editorial accompanying the study "called the results 'provocative' and 'striking,' but said that it's unclear how much of the benefit is due to a placebo effect. The results need to be repeated in a larger study," the editorialists concluded.

        According to the Los Angeles Times (8/18, Roan) "Booster Shots" blog, "how tai chi works to reduce fibromyalgia symptoms is unknown, but it is likely a multi-factorial impact that includes improved muscle strength, psychosocial well-being, relaxation and rest that 'may raise pain thresholds and help break the 'pain cycle,' the authors wrote."

        CNN /Health.com (8/19, Storrs) reports, "Previous research has shown that tai chi can help relieve the symptoms of arthritis and other pain conditions, but this study is the first controlled trial to examine its effectiveness as a treatment for fibromyalgia, which affects an estimated 10 million Americans."

        The Boston Globe (8/18, Lee) "White Coat Notes" blog, WebMD (8/18, DeNoon), HealthDay (8/18, Goodwin), and MedPage Today (8/18, Neale) also covered the story.

Banning trans fats would save lives, say doctors

Moral of the story: In the end banning artificial trans fat would be a good public health measure.  Until that point you can try to avoid them on your own.

Source: BMJ Press Release


(3) Banning trans fats would save lives, say doctors
(Editorial: Removing industrial trans fat from foods)
http://www.bmj.com/cgi/content/full/340/apr15_1/c1826
Banning trans fats from all foods in the UK would prevent thousands of heart attacks and deaths every year, and would be a simple way to protect the public and save lives, say two senior doctors on bmj.comtoday.
Their views follow calls by public health specialists to eliminate the consumption of industrially-produced trans fats in the UK by next year.
Trans fats (also known as trans fatty acids) are solid fats found in margarines, biscuits, cakes, and fast food. Many studies demonstrate harmful effects of trans fats on cardiovascular risk factors.
For example, trans fats increase the amount of low density lipoprotein (LDL) or 'bad cholesterol' in the blood and reduce the amount of high density lipoprotein (HDL) or 'good cholesterol.' People with high levels of LDL cholesterol tend to have a higher risk of getting heart disease, while people with high levels of HDL cholesterol tend to have a lower risk.
A recent analysis of all the evidence recommended that people should reduce or stop their dietary intake of trans fatty acids to minimise the related risk of coronary heart disease.
The authors, from Harvard School of Public Health in the US, report that bans in Denmark and New York City effectively eliminated trans fats, without reducing food availability, taste, or affordability.
There is also no evidence that such legislation leads to harm from increased use of saturated fats.
Removing industrial trans fats is one of the most straightforward public health strategies for rapid improvements in health, they write. Based on current disease rates, a strategy to reduce consumption of trans fats by even 1% of total energy intake would be expected to prevent 11,000 heart attacks and 7,000 deaths annually in England alone.
Action by the UK might also produce larger benefits by inspiring other developed and developing countries to take similar measures to protect their citizens' health, they conclude.
Contact: Dariush Mozaffarian, Assistant Professor of Medicine and Epidemiology, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
Email: dmozaffa@hsph.harvard.edu

Parents' skewed weight perception of their children contributing to rising obesity rates

Moral of the story: Every parents believes their kids are perfect. Get real.  1/3 are too fat.

Source: AMA Morning Rounds 7/2/2010

Parents' skewed weight perception of their children contributing to rising obesity rates.

Claudia Kalb wrote in Newsweek (7/1) that a report by the Trust for America's Health and the Robert Wood Johnson Foundation "finds that the majority of Americans believe that childhood obesity is a 'significant and growing challenge for the country,' and yet 84 percent say their children are at a healthy weight -- despite national stats showing that nearly one third of children and teens are overweight...or obese." Although "Americans understand there's a problem," they "don't think their kids are a part of it" -- a "well-known phenomenon in the research world." But, research has also shown that "only seven percent of parents recalled ever being told that their child was gaining weight too fast or was overweight." Kalb concluded that "patients are listening. It's never too soon to start educating them."

Moral of the story: Ever wonder how your roommate can sleep through fire alarms, car horns, and other crazy loud things?  Surprise surprise (not really) you brain hears everything but some block those stimuli.

Source: AMA Morning Rounds 8/10/2010

Some brains may be specifically wired to block out noise during the night.

USA Today (8/10, Steinberg) asks, "Why can some people sleep through car alarms and thunderstorms when others wake up at the sound of footsteps?" Harvard researchers now "believe they've found the answer tucked in sleep spindles, or bursts of brain activity that occur only during sleep."

        Before reaching that conclusion, investigators conducted a "three-night study," inviting "12 volunteers who reported being deep and healthy sleepers into a sleep lab with a comfy queen-size bed outfitted with enormous speakers at the headboard," Time(8/10, Park) reports. The "researchers recorded the participants' brain waves as they slept normally the first night, and then on subsequent nights as they were bombarded with 14 different noises...which were played at progressively louder volumes." The team "paid particular attention to the patterns generated by the thalamus, a region deep in the brain that processes incoming visual and auditory stimuli."

        The team had surmised that "the thalamus might generate" the "sleep spindles as a way to prevent sensory input (such as loud noise) from reaching the sleeping brain," HealthDay (8/9, Phillips) reported. According to the paper in Current Biology, "people with higher rates of spindle rhythms were consistently less likely to awake in response to these noises." But, it's still not "completely clear if sleep spindles are directly interfering with sound transmission to the brain, although that's the current hypothesis."

New DNA test could allow earlier detection of colon cancer

Moral of the story: This is apparently a perfect test- catches all cancer and is never wrong (super rare) and this just increases the motivation you should have for getting your colonoscopy.  prevention prevention prevention

Source: AMA Morning Rounds 8/10/2010

The New York Times (8/10, D1, Wade) reports on the front of its Science Times section, "A new generation of DNA tests for colon cancer seems likely to improve the detection both of cancers and of the precancerous polyps that precede them." The Times adds that "Exact Sciences, a company based in Madison, Wis., is developing a colon cancer test based on highly methylated DNA," and "its researchers reported last month that by testing for methylated DNA at four markers, pieces of DNA drawn from specific genes, they could detect colon tumors and polyps, distinguishing them from normal tissue with 100 percent sensitivity and with no false positives."

Prolonged sitting may increase mortality risk, regardless of daily exercise.

Moral of the story: take breaks if you sit at a desk all day, watch less TV, be more active

Source: AMA Morning Rounds 6/23/2010

Prolonged sitting may increase mortality risk, regardless of daily exercise.

The CNN (7/22) "The Chart" blog reported that a paper appearing in the American Journal of Epidemiology reveals that "people who spend more time sitting during their leisure time have an increased risk of death, regardless of daily exercise." In fact, after following some 123,000 healthy adults, American Cancer Society researchers "found women who spend over six hours a day sitting during leisure time (watching TV, playing games, surfing the web, reading) were 40 percent more likely to die sooner than women who spend less than three hours sitting," while "men...have a 20 percent increased risk of death." Investigators say that "prolonged time sitting suppresses" the immune system and may increase "resting blood pressure and cholesterol levels."

Women should try to conceive as early as possible after miscarriage

Moral of the story: As the title says, try immediately after

Source: AMA Morning Rounds 8/6/2010

Women should try to conceive as early as possible after miscarriage.

CNN (8/6, Harding) reports, "When women have a miscarriage, one of the first questions they often ask is how long they should wait before getting pregnant again." Now, research from Scotland indicates that "the sooner they start trying, the better." In fact, those "who conceive within six months of a miscarriage instead of waiting up to a year reduce their risk of another miscarriage by one-third, and they also increase their chances of a healthy and successful pregnancy."

        At present, "guidelines from the World Health Organization...recommend women delay getting pregnant for at least six months after a miscarriage," the AP (8/6, Cheng) reports. Lead investigator Sophinee Bhattacharya, of the University of Aberdeen, "said WHO guidelines are based on a study from Latin America, where women usually have children at an earlier age than in the West." Yet, "because women in developed countries often wait until they are older to have children, Bhattacharya said any delays to conception could reduce the chances of a healthy baby."

        Before reaching those conclusions, investigators "collected data on 30,937 women who had had miscarriages in their first pregnancy and then became pregnant again," HealthDay (8/5, Reinberg) reported. The team eventually discovered that "women who got pregnant again within six months were less likely...to have to terminate the pregnancy or to have an ectopic pregnancy compared with women who got pregnant six to 12 months after their miscarriage." They were also "less likely to have a cesarean delivery, have a premature delivery or have a low birth weight baby," according to the paper in the BMJ.

        The team did find, however, that "getting pregnant less than six months after a miscarriage was associated with higher risk of induced labor than an interval of six to 12 months," MedPage Today (8/5, Phend) reported. And, "mental recovery may take some time...Bhattacharya's group acknowledged. But a delay poses problems for women in the Western world, where for social and economic reasons women tend to delay childbearing, they noted." Medscape (8/5, Beals) also covered the story.

Pertussis outbreak shows importance of vaccines

Moral of the story: Get vaccinated, stay up to date!

Source: AMA Morning Rounds 8/4/2010

Health officials recommending booster shots for nearly every Californian in light of pertussis outbreak.

USA Today (7/27, Szabo) reports, "In the midst of what could be the largest whooping cough outbreak in more than 50 years...California health officials are recommending booster shots for nearly everyone in the state, especially healthcare workers, parents, and anyone who may come in contact with babies." Infants "are the most likely to die from it," and the "only way to protect" them is "to vaccinate everyone around them...says Stacey Martin of the CDC." Thus, the "state health department is providing whooping cough boosters to new mothers and other close contacts of infants at all birthing hospitals, community health centers and local health departments." Notably, "nearly 1,500 Californians this year have been diagnosed with whooping cough -- five times the normal level for this time of year," and "doctors are investigating another 700 possible cases."

Vitamin D Deficiency

Moral of the story: There is rising awareness that tons of people are vitamin D deficient.  This is BAD.  Get some sun (just a bit every day) and drink your milk (skim to keep your arteries healthy).  If you are very deficient your doctor can give your prescription supplements.

Source: AMA Morning Rounds 8/4/2010

Large part of US population may be deficient in vitamin D.

Writing in the New York Times (7/27, D7) "Personal Health" column, Jane E. Brody reports that "a huge part of the population" may be deficient in vitamin D. Notably, "every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well." Current research suggests that "the effects of a vitamin D deficiency include an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, type 1 diabetes, and rheumatoid arthritis."

Moral of the story: STAY AWAY!!

Source: AMA Morning Rounds 8/4/2010

Consumer Reports finds 12 supplements with unsafe ingredients.

ABC World News (8/3, story 8, 1:50, Sawyer) reported, "Dietary supplements are a $27 billion a year business in this country, but Consumer Reports has an alert" on "supplements the magazine says can be dangerous to your health." Consumer Reports' Nancy Metcalf said, "With the dozen supplements that we've identified, we think it's all risk and no benefit."

        The CBS Evening News (8/3, story 6, 1:55, Couric) also reported, "Consumer Reports analyzed data from 1,100 supplements and identified 12 that are linked to serious health problems. These include ingredients in weight loss products...which can cause heart problems and liver damage." Certain other supplements "used for cough...are associated with liver cancer and even death." CBS noted that the "FDA cannot regulate" the supplements, which are labeled as foods, "until after a product is already on the market."

        The Los Angeles Times (8/4, Stein) points out that the list of those that are unsafe include "aconite, bitter orange, chaparral, colloidal silver, coltsfoot, comfrey, country mallow, germanium, greater celandine, kava, lobelia, and yohimbe." The report also "argues that the FDA has not fully used its limited authority granted by the Dietary Supplement Health and Education Act to ban supplement ingredients that may be dangerous." In addition, the FDA was criticized "for not inspecting Chinese factories where many of the raw materials for supplements originate."

        The Washington Post (8/4) adds that supplement manufacturers "routinely, and legally, sell their products without first having to demonstrate that they are safe and effective." WebMD (8/3, Doheny) also covered the story.

Foreign trained docs are just as good as US docs

Moral of the story: No need to worry if your doctor went to medical school in a different country.  If they did their residency here in the US, they are just as good as us folks who probably paid a heck of a lot more to go to school here in the good old US of A.

Source: AMA Morning Rounds 8/4/2010

Foreign-trained physicians as good as those in the US.

The Los Angeles Times (8/3, Dennis) "Booster Shots" blog reported, "Some US patients -- or even fellow doctors -- might be less than comfortable with a foreign-born physician who didn't graduate from a US medical school." But according to a newly publishedstudy in Health Affairs, "they shouldn't be."

        That assertion is based on an analysis of "244,153 hospitalizations of patients with congestive heart failure or acute heart attack," the Baltimore Sun (8/3, Walker) "Picture of Health" blog reported. Investigators eventually discovered that physicians "trained abroad provide medical care as good as that offered by US-trained physicians." On the other hand, "Americans who trained overseas had higher patient death rates."

        Specifically, the "percentage of in-hospital deaths for congestive heart failure was 3.4% for domestically trained doctors and 3.1% for internationally trained physicians," Modern Healthcare (8/3, Robeznieks) reported. "For foreign-trained doctors who were not US citizens during medical school, the rate death was 3%; for US citizens who trained abroad, it was 3.5%. For heart attack patients, the in-hospital death rate was 13.1% for domestically trained doctors, and 12.7% for those trained abroad."

        The team at the Foundation for Advancement of International Medical Education and Research "offered two possible reasons the Americans who went to foreign medical schools might not perform as well as doctors trained in the United States, or as well as foreign-born doctors," the New York Times (8/3, D7, Grady ) reported. "One is that many of the Americans who study medicine elsewhere do so because their grades and test scores were too low to get into medical school in the United States -- so they may be less capable in the first place. Another possibility is that some of the overseas medical schools Americans attend may not be up to par."

        Bloomberg News (8/3, Wechsler), the Wall Street Journal (8/3, Wang) "Health Blog" and HealthDay (8/3, Goodwin) also covered the study.

Moral of the story: Childhood obesity can be a rather complicated milieu of neglect, abuse, and violence.  Physicians and friends should be aware of these links and look out for them.

Source: BMJ Press Release


(5) When does obesity become a child protection issue?
(Analysis: Childhood protection and obesity: framework for practice)
http://www.bmj.com/cgi/doi/10.1136/bmj.c3074
Childhood obesity alone is not a child protection concern, nor is failure to control weight. But consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children, say experts in a paper published on bmj.com today.
The suggestion that childhood obesity may raise child protection concerns is highly contentious, but there is little published evidence on the issue and no official guidelines for professionals.
So a group of child health experts, led by Dr Russell Viner at the UCL Institute of Child Health in London, set out to review existing evidence and propose a framework for practice.
They found increasing evidence linking adolescent and adult obesity with childhood sexual abuse, violence, and neglect, but found no studies examining the relation between child protection actions and childhood obesity. Data are also lacking on the long term outcomes of child protection strategies in relation to weight control, other metabolic disorders such as diabetes, and psychological health.
In the absence of evidence, the authors suggest that child protection actions are not warranted for childhood obesity alone or failure to control weight. “The aetiology of obesity is so complex that we believe it is untenable to institute child protection actions relating parental neglect to the cause of their child’s obesity” or “to criticise parents for failing to treat it successfully, if they engage adequately with treatment,” they write.
However, they do believe that consistent failure by parents to change lifestyle and engage with professionals or with weight management initiatives would constitute neglect. This is of particular concern if an obese child is at imminent risk of disorders like obstructive sleep apnoea, hypertension, type 2 diabetes or mobility restrictions, they say.
Where child protection concerns are raised, the authors suggest that obesity is likely to be one part of wider set of concerns about the child’s welfare. It is therefore essential to evaluate other aspects of the child’s health and wellbeing and determine if concerns are shared by other professionals, they say.
Finally, in cases of severe childhood obesity, they recommend a wider assessment of family and environmental factors.
“In all areas of child health, we have a duty to be open to the possibility of child neglect or abuse in any form,” they conclude. “Guidelines for professionals are urgently needed, as is further research on the outcomes of child protection actions in obesity and links between early adversity and later obesity.”
Contact:
Hayley Dodman, press officer
Email: dodmah@gosh.nhs.uk

Multilayered efficiency system saves Denver health money, jobs. The Denver Post (7/29, Auge) reports that "a multilayered efficiency system known as Lean...has swept through Denver Health over the past five years with the fervor of a religious conversion." And "in an era marked by soaring healthcare costs and epidemic layoffs, even as it serves more and more uninsured patients while public funding dwindles, Denver Health has saved money and jobs -- and improved patient care -- using decades-old Toyota practices" emphasizing cost-cutting and high-quality, consistent work. "Since its Lean conversion in 2005, the city's public health system has benefited to the tune of $54 million in increased revenue, money not spent and expenses cut, according to chief financial officer Peg Burnette."

Moral of the story: Denver is awesome

Source: AMA Morning Rounds 7/29/2010

Multilayered efficiency system saves Denver health money, jobs.

The Denver Post (7/29, Auge) reports that "a multilayered efficiency system known as Lean...has swept through Denver Health over the past five years with the fervor of a religious conversion." And "in an era marked by soaring healthcare costs and epidemic layoffs, even as it serves more and more uninsured patients while public funding dwindles, Denver Health has saved money and jobs -- and improved patient care -- using decades-old Toyota practices" emphasizing cost-cutting and high-quality, consistent work. "Since its Lean conversion in 2005, the city's public health system has benefited to the tune of $54 million in increased revenue, money not spent and expenses cut, according to chief financial officer Peg Burnette."

Americans are consuming fewer medical services, data show

Moral of the story: Tough times means less medical procedures, all fair and well.  But lower insurance rates? I'll believe that when I see it.

Source: AMA Morning Rounds 7/29/2010

Americans are consuming fewer medical services, data show.

The Wall Street Journal (7/29, Johnson, Rockoff, Mathews) reports that health insurers, including Aetna and WellPoint, have released data indicating that people with coverage are using fewer medical services. Overall, the number of lab tests, elective surgeries such as knee replacement, and drug prescriptions decreased during the second quarter, compared to the same time period last year. Experts attribute this trend to the weak economy, high unemployment rates, the loss of health coverage among people who have been laid off, as well as a greater number of subscribers to high-deductible health plans. Some insurers say that if the trend persists, they will have to decrease premiums to reflect the lower rate of consumption.

Several cases of dengue fever found in Florida, Texas

Moral of the story: Global warming won't just cause polar bears to drown.  It might kill you.  Tropical weather = tropical diseases.

Source: AMA Morning Rounds 7/30/2010

Several cases of dengue fever found in Florida, Texas.

ABC World News (7/29, story 8, 2:30, Sawyer) reported, "Tonight, a new government report says global warming is undeniable, and it's happening fast. Scientists at NOAA cite data from around the world, documenting this first decade of the century is the warmest on record. And it's long been feared that with heat will come tropical diseases," such as Dengue Fever. ABC (Besser) added, "There is no treatment for Dengue Fever," which "causes headache, eye pain, rash. It's often called 'break bone fever' because of the crushing pain it can cause. It's spread by mosquitoes and the nearly two dozen cases in Key West, Florida, are the first cases there in more than 70 years." Several cases have also been reported in Texas, Besser said, and there is concern that someone could be infected with both strains, which "can be deadly."

Ketamine may be promising treatment for depression among patients with bipolar disorde

Moral of the story:  While it may sound scary, Ketamine has been used for a variety of purposes and may hold promise in an area still looking for a good drug.

Source: AMA Morning Rounds 8/3/2010

Ketamine may be promising treatment for depression among patients with bipolar disorder.

The Los Angeles Times (8/2, Roan) "Booster Shots" blog reported that the prescription medication ketamine [ketamine hydrochloride], which is "used as an anesthetic -- and used illegally as a party drug at raves -- may have a role in treating people with bipolar depression, according to astudy " published August 2 in the Archives of General Psychiatry. In a study of 18 patients, "researchers at the National Institute of Mental Health found that 71% of the bipolar patients who had not responded to other treatments, experienced significant improvement in depression symptoms after a single intravenous infusion of ketamine. Most of these patients responded within 40 minutes of receiving the drug," and the effects lasted for approximately three days.

        Time (8/3, Cloud) reports, "All patients were randomly and blindly given one 0.5 mg/kg dose of ketamine and one equal dose of placebo saline through an IV drip two weeks apart. Patients taking ketamine were significantly more likely than those on the placebo to show short-term improvement in their depression symptoms. This is crucial for bipolar patients who are in depressive crisis and at high risk of suicide: if you can give them something to block short-term suicidal impulses, you may be able to settle them -- and then treat them for long-term problems."

        "Ketamine acts on the brain's glutamatergic system, which plays a role in information processing and memory formation,"HealthDay (8/2, Preidt) reported. "Recent research suggests that dysfunction in this brain system may contribute to bipolar disorder, noted Dr. Nancy Diazgranados and colleagues at the US National Institute of Health." But, even though "ketamine has been used off-label as an experimental treatment for depression, it has not been approved by the US Food and Drug Administration for that use, according to the US National Institutes of Health." WebMD (8/2, Woznicki) also covered the study.