In The News This Week … July 06–12, 2008: Male Fertility, Weight Loss, Preventive Medicine, Behavior, Cancer, Drugs, & Guns

Men's Age & Assisted Reproduction

People think about maternal age as a factor in the likelihood of successful assisted-reproduction pregnancies – but what about paternal age? A study presented at this week's meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona, which looked at more than 12,200 couples having fertility treatment and undergoing intrauterine inseminations, suggests the chance of a successful pregnancy falls when the man is over 35, and success rates are significantly lower if he is over 40. The likely reason for the lower success rates: DNA damage in the sperm.

New Fertility Technique for Men: Lose Weight

Also from the ESHRE meeting in Barcelona is a study suggesting that obese men are more likely to have abnormal sperm and less semen, which may contribute to fertility problems. The findings were based on 2,037 men attending Scotland's Aberdeen Fertility Centre.

Food Diaries & Weight Loss

A paper published online in the August issue of the American Journal of Preventive Medicine has found that keeping a detailed diary of everything consumed – and the calories the items consumed contain – is an effective weight-loss tool. The study, which looked at 1,685 middle-aged men and women, found that those who kept a detailed diary almost every day for six months lost about twice as much weight as those who did not. Also see the July 8 news release from Kaiser Permanente's Center for Health Research in Portland.

Impact of Heart Disease Prevention Tips

An article published online on July 7 in Circulation sought to determine the effects of 11 nationally recommended prevention activities (e.g., losing weight, stopping smoking, lowering cholesterol, taking an aspirin a day) on CVD-related morbidity, mortality, and costs in the United States. The researchers calculated that about 78% of American adults aged 20 to 80 years are candidates for at least one prevention activity and that if everyone adhered 100% to the prevention activities relevant to them (which is unlikely), MIs and strokes would be reduced by 63% and 31%, respectively. But even if "more feasible levels of performance are assumed," MIs and strokes could still be reduced by 36% and 20%, respectively. Implementation of all prevention activities would add an average of 1.3 years of life expectancy for all adults.

New Guidelines for Lipid & Heart Health Screening in Kids

On July 7, the American Academy of Pediatrics announced new guidelines for screening kids for lipids and cardiovascular health. The guidelines recommend cholesterol screening for kids and adolescents with a family history of high cholesterol or heart disease, those patients whose family history is unknown, and those who have other factors for heart disease, including obesity, high blood pressure, or diabetes. This is shocking enough, but what's more, the recommendations state screening should take place as early as age two, and that for kids aged eight and older with high cholesterol, cholesterol-reducing medications should be considered. For more on the recommendations, see the clinical report in the July issue of Pediatrics.

Ending Intimidating and Disruptive Behaviors

On July 9, The Joint Commission issued an alert on the Behaviors that Undermine a Culture of Safety, in which they state: "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments." Examples of behavior include "…overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. Intimidating and disruptive behaviors are often manifested by health care professionals in positions of power. Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions …." To deal with the problem, effective January 1, 2009, facilities must have codes of conduct and processes for dealing with inappropriate behavior by staff in place; hospitals without such systems risk losing their accreditation.

Higher Education & Cancer Death

Findings published online on July 8 in the Journal of the National Cancer Institute suggest that education levels have an impact on cancer mortality. The findings were based on individual education and mortality data from death certificates for non-Hispanic whites and non-Hispanic blacks between the ages of 25 and 64 who died from one of the four major cancers (lung, colorectal, breast, or prostate) between 1993 and 2001. They findings show that there was a statistically significant decline in mortality from prostate, lung, and colorectal cancer for white and black men who had 16 or more years of education (i.e., a college degree), and decreased death rates among black and white women who had 16 or more years of education for colorectal, breast, and lung cancers (but the decline in lung cancer mortality did not reach statistical significance in black women).

Cancer & Spouses

An article published in the July 10 issue of the Journal of Clinical Oncology, which was based on a survey of 691 Swedish widowers, found that although a large majority of the men would have preferred to have had an immediate disclosure of the incurable state of their wife's cancer, 41% of these men only received the information during the last week of their wife's life, or not at all. The researchers believe that the findings are not unique to Sweden, and the situation would be similar in other Western nations.

Online Drug Purchasing

A National Center on Addiction and Substance Abuse at Columbia University white paper entitled "You've Got Drugs!" V: Prescription Drug Pushers on the Internet has found that despite a decline in the number of online sites advertising or selling controlled prescription drugs, like OxyContin, Valium, Xanax, Vicodin, Ritalin, and Adderall in the past year, 85% of the sites that do sell these drugs do not require a prescription. How many sites are there selling these drugs? Researchers trolled the internet for 210 hours in the first quarter of 2008, and found 365 sites advertising or selling controlled prescription meds. Another notable finding: The DEA estimates that in 2007, 11% of prescriptions filled by traditional pharmacies were for controlled substances, compared to 80% of prescriptions filled by online pharmacies. And parents take note: There are no blocks on these sites to prevent access by kids and teens.

Doctors Talk Guns

An editorial entitled Guns and Health, which was published in the July 9 issue of The New England Journal of Medicine, says the recent 5-4 Supreme Court decision about gun control doesn't bode well:

In our opinion, there is little reason to expect an optimistic result; research has shown and logic would dictate that fewer restrictions on handguns will result in a substantial increase in injury and death. …

The Centers for Disease Control and Prevention, in concert with health authorities across the country, keeps careful records on the number of injuries and deaths that result from handgun use. In 2005, the last year with complete data, there were more than 30,000 deaths and 70,000 nonfatal injuries from firearms. About one quarter of the nonfatal injuries and a tenth of the deaths were in children and adolescents. To place these numbers in perspective, 10 times as many Americans die each year from firearms as have died in the Iraq war during the past 5 years. Firearm injuries represent a major public health problem that seems certain to be exacerbated with less handgun regulation. …

With the Supreme Court's decision and the expectation of a substantial reduction in gun regulation, we are poised to witness another epidemiologic study of the effect of regulation on gun violence. With this experiment, which may play out in many American cities, we will know in the coming years whether the overturned laws reduced death and injury from handguns. The Court has heard the arguments and made its decision; we will now learn the human ramifications of this landmark case.

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