More on Bisphenol A Risks

In April, we reported on a news warning of potential health risks of Bisphenol A (BPA), a chemical widely used in consumer plastics. Now, an article published early online on September 16 in The Journal of the American Medical Association is warning of new risks. Using data from 1,455 adults aged 18 to 74 who were participating in the National Health and Nutrition Examination Survey 2003-2004, researchers found that those with higher BPA exposure had higher urinary concentrations of BPA, which was associated with an increased prevalence of cardiovascular disease, diabetes, and liver enzyme abnormalities. As noted in the accompanying editorial, the article is "based on a cross-sectional study and therefore cannot establish causality, so follow-up longitudinal studies should be a high priority."

Acetaminophen Risks for Young Children

A study published on September 20 in The Lancet looked at 205,487 children aged six or seven from 73 centers in 31 countries who were participants in Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Researchers found that acetaminophen (commonly known as Tylenol in North America, but referred to by its UK name, paracetamol, in the article) use in the first year of life was associated with a 46% higher risk of asthma by the time the children were six or seven, compared to those never exposed to the drug. Medium use of the drug – more than once per year, but less than once per month – within the past 12 months meant asthma risk was boosted by 61%, while high use was associated with three times the risk. Use of acetaminophen was also associated with an increased risk of rhinoconjunctivitis and eczema.

"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.

Selecting Snacks

If you were presented with four snack choices, two of which were types of fruit and two of which were unhealthy sweets, which would you choose? A study published in the September issue of the Journal of Nutrition Education and Behavior has found that the choice is not simple. In the study of 585 Dutch office workers, 49% said that they would select one of the two healthy snacks from among the four options; however, when later presented with the actual snacks and asked to choose, 27% chose an unhealthy snack instead. At the same time, 92% of those who initially said they would go with an unhealthy snack in fact did select the unhealthy snack. So while there's a discrepancy between what people say they'll eat and what they do eat, those who plan to eat healthy are more likely to do so than those who have no such intention.

To Live Longer

In January, we had reported on healthy behaviors that could add 14 years to your life. These behaviors included not smoking, being physically active, having a moderate alcohol intake, and having high fruit and vegetable intake. Now, research published on September 16 in the British Medical Journal, which looked at 77,782 female participants aged 34 to 59 at outset in the Nurses Health Study for 24 years, has found that those who follow common sense health messages about not smoking, eating a healthy diet, and exercising can halve their risk of premature death: "A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality."

More Benefits of Positive Lifestyle Changes

A small study of 30 men with biopsy-diagnosed low-risk prostate cancer were asked to make lifestyle changes, which included eating a diet rich in fruits, vegetables, whole grains, legumes, and soy products, participating in moderate exercise for a half hour a day, and participating in an hour of stress management methods per day. After three months, these activities significantly increased the subjects' levels of telomerase – which normally adds short sequences of DNA (telomeres) to the ends of chromosomes, thus preventing damage and the loss of genetic information when cells divide – by an average of 29%. (Shortening of telomeres is seen as an indicator of disease risk and premature death in some types of cancer.) Researchers wrote, "Given this finding and the pilot nature of this study, we report these increases in telomerase activity as a significant association rather than inferring causation. Larger randomised controlled trials are warranted to confirm the findings of this study." The findings were published online on September 16 in The Lancet Oncology.

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.

Experimental Breast Cancer Vaccine

Research published in the September 15 issue of Cancer Research reports that scientists have completely eliminated HER2+ breast tumors in mice using an experimental vaccine. Currently, there are drugs to treat this cancer, such as Herceptin (trastuzumab), but the drugs don't work for all patients. Approximately 20% to 30% of breast cancer patients have this type of disease.

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.

Presidential Candidates' Plans for Healthcare

Two articles published on September 16 in Health Affairs looked at the health plans of presidential candidates Barack Obama and John McCain. The conclusions? Obama's will mean "More Regulation, Unsustainable Spending" and McCain's "will tend to raise costs, reduce the generosity of benefits, and leave people with fewer consumer protections."

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.

Work Hours & Surgical Mistakes

In a discovery that should surprise few people, researchers have found that since residents' work hours were maximized at 80 hours per week in 2003, rates of surgical problems, specifically the bile duct injury rate and the overall complication rate for patients who had undergone laparoscopic cholecystectomy, have decreased. The findings, which were based on 2,470 patients who had undergone laparoscopic cholecystectomy at a major public teaching hospital, were published in the September issue of Archives of Surgery.

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."

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:

Migraines & Blood Clots

Researchers performed ultrasound scans on the necks and thighs of 574 individuals aged 55 to 94 years, of whom 111 were migraine suffers. They found that 19% of the migraine suffers had one or more clots in their legs, compared with only 8% of the migraine-free group. The findings were published in the September 16 issue of Neurology.

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.

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.