In The News This Week … September 7–13, 2008: Brains, Diabetes, Exercise, Knees, Cancer, Palliative Care, Primary Care, & Stress

B12 & Brains

A paper published in the September 9 issue of Neurology looked at 107 community-dwelling individuals aged 61 to 87 without cognitive impairment at enrollment, and found that those with lower than average vitamin B12 levels were more than six times more likely to experience brain shrinkage. The finding led researchers to conclude, "Low vitamin B12 status should be further investigated as a modifiable cause of brain atrophy and of likely subsequent cognitive impairment in the elderly."

Weekly Shot for Diabetes?

An article published online on September 8 in The Lancet reports that a stronger, once-a-week injection of the diabetes drug exenatide seems to lower blood sugar better – and have fewer side effects – than the drug's original twice-daily dose. As reported in a news release, in this international multicentre six-month clinical trial involving 300 eligible patients, 75% of subjects who received the weekly injection got their diabetes under control as defined by reaching target glucose levels, experienced fewer side effects, had no increased risk of hypoglycemia, and saw reductions in body weight.

"Fat Gene" Versus Exercise

Good news for those who carry the obesity-related FTO gene variants: FTO is no match for exercise. To determine this, researchers looked at members of Pennsylvania's Old Order Amish population, who live a rural lifestyle, and avoid modern conveniences. The researchers found that those individuals who had the genetic variant, but who got at least three to four hours of moderate activity a day, were no more likely to be overweight than those who had the regular version of the gene. The findings were published in the September 8 issue of Archives of Internal Medicine.

Parents' Estimates of Kids' Exercise

An article published online on September 9 in Archives of Disease in Childhood has found that parents are clueless about how much their kids exercise. According to the findings, parents substantially overestimate how much their kids exercise, on average claiming the kids engage in about two hours of exercise daily … when in reality it's less than 30 minutes. The findings were based on 130 six- and seven-year-old kids in the UK.

Knee Osteoarthritis & Arthroscopy

A study published in the September 11 issue of The New England Journal of Medicine has concluded that arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.

Pain Relievers and Prostate Cancer Screening

Research published on September 8 in Cancer, which looked at 1,319 American men aged 40+, has found that those who took NSAIDs (e.g., aspirin, ibuprofen, and naproxen) nearly every day had PSA levels about 10% lower than men who did not take them. Unfortunately, researchers say that they are unsure if this means that these men have a lower risk for developing prostate cancer or these medications may make it harder to detect prostate cancers using common screening.

Lung Cancer in Nonsmokers

A study published in PLoS Medicine looked at information on lung cancer incidence and/or death rates among self-reported never-smokers from 13 large cohort studies, and found that death rates from lung cancer among never-smokers is higher in men than in women, and is higher in Asians residing in Asia and in African Americans than in individuals of European descent. The findings also showed contradicted assertions that risk is increasing and that women have a higher incidence rate than men.

Palliative Care Teams & Cost Saving

An investigation published in the September 8 issue of Archives of Internal Medicine looked at whether hospital palliative care teams, which have been shown to improve care for adults with serious illness, also are cost-effective. The answer is a clear yes. In comparing the records of palliative care patients (some who were discharged alive, and some who died in hospital) to a similar number of matched patients who received typical care, researchers found that the palliative care patients who were discharged alive had an adjusted net savings of $1,696 in direct costs per admission and $279 in direct costs per day, including significant reductions in laboratory and ICU costs compared with usual care patients. Those palliative care patients who died had an adjusted net savings of $4,908 in direct costs per admission and $374 in direct costs per day, including significant reductions in pharmacy, laboratory, and ICU costs compared with usual care patients. The amount translates into savings of $1.3 million a year for a 300-bed community hospital.

Fewer Medical Students Choosing Primary Care

Responses to a web-based cross-sectional survey of 1,177 fourth-year medical students at 11 US medical schools in spring 2007 found that only 2% of the students planned to work in primary care internal medicine. According to the responses, three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Factors negatively affecting students views of primary care included internal medicine requires more paperwork, it requires a greater breadth of knowledge, and would pay less than more lucrative specialties. The findings were published in the September 10 issue of The Journal of the American Medical Association.

Who is Using Retail Clinics?

A paper published in the September/October issue of Health Affairs has found that 39% of individuals who use retail clinics lack a primary care physician. They also found that 90% of retail clinic visits were for 10 common clinical issues (e.g., upper respiratory, sinus, and urinary tract infections, sore throats, immunizations), while in primary care physician visits, the same 10 clinical issues make up only 13% of adult visits and 30% of pediatric visits.

Boss's Sex and Employee Stress

A study published in the September issue of the Journal of Health and Social Behavior looked at data from a 2005 national telephone survey of working adults in the United States. The survey looked at psychological stress symptoms (e.g., depression, anxiety, difficulty focusing, sleep problems) and physiological stress symptoms (e.g., headaches, stomach pain) of men and women working under a male boss, a female boss, or both a male and female boss. They found:

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