Wednesday, December 8, 2004
Two NEJM Articles on the War
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NEJM: Notes of a Surgeon: Casualties of War — Military Care for the Wounded from Iraq and Afghanistan (free full text)
NEJM: From the War Zone to the United States: Caring for the Wounded in Iraq — A Photo Essay (free full text)
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Friday, December 3, 2004
Ten troublesome trends in TV health news
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Ten troublesome trends in TV health news:
- Too brief to matter
- No full time health journalists
- No data to back up sensational claims
- Hyperbole
- Commercialism
- Single source stories
- Baseless predictions from basic science
- FDA approval treated as a fait accompli
- Little coverage of health policy
- No time for enterprise
[Via bmj.com -- latest BMJ headline]
Wednesday, December 1, 2004
That's Why We Call Them 'Donorcycles'
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Picked from Trends in Motorcycle Fatalities Associated with Alcohol-Impaired Driving --- United States, 1983--2003 [CDC]
""Motorcycles are the most dangerous type of motor vehicle to drive. These vehicles are involved in fatal crashes at a rate of 35.0 per 100 million miles of travel, compared with a rate of 1.7 per 100 million miles of travel for passenger cars.""
Monday, November 29, 2004
Cocoa, Flavanols and Cardiovascular Risk
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Cocoa, Flavanols and Cardiovascular Risk:
""The Kuna Indians in Panama, living in their indigenous island home in the Caribbean, do not show the typical rise in blood pressure with age, and hypertension is very rare.[34] In a study that began with the search for protective genes, the observation that migration to Panama City led to a loss of the protection against hypertension made it clear that an environmental factor was involved. Examination of their diet uncovered the fact that they drank large volumes of a flavanol-rich cocoa.[2] Subsequent in vitro studies suggesting that cocoa extracts can induce endothelium-dependent relaxation[4] led to studies in healthy volunteers,[9] and in patients with vascular risk or disease.[1] In the studies of Heiss et al. ingestion of flavanol-rich cocoa led to an increase in flow-mediated vasodilation of the brachial artery following five minutes of ischaemia, a response that correlated with biochemical evidence of increased nitric oxide bioavailability.[8] In the normal volunteers studied by Fisher et al. flavanol-rich cocoa induced striking dilatation of the vessels of the finger, which was reversed completely by an arginine analogue that blocks nitric oxide synthesis (figure 1).[9]""
and
""Endothelial dysfunction with a consequent reduction in nitric oxide production has achieved a central conceptual role in the pathogenesis of atherosclerosis and coronary artery disease, diabetes mellitus and hypertension. Recent evidence that flavanol-rich cocoa activates vascular nitric oxide synthesis in the intact human raises an interesting possibility of a therapeutic potential.""
Potentially very good news for Hershey foods, what, what?
[Via Medscape Headlines]
Abortion Surveillance --- United States, 2001
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Abortion Surveillance --- United States, 2001:
""A total of 853,485 legal induced abortions were reported to CDC for 2001 from 49 reporting areas, representing a 0.5% decrease from the 857,475 legal induced abortions reported by the same 49 reporting areas for 2000. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2001, compared with 245 reported for 2000. This represents a 0.4% increase in the abortion ratio. The abortion rate was 16 per 1,000 women aged 15--44 years for 2001, the same as for 2000. For both the 48 and 49 reporting areas, the abortion rate remained relatively constant during 1997--2001.""
These numbers exclude Alaska, California, and New Hampshire.
I post this not because I am anti-choice, but because I was surprised by the abortion ratio of 246 abortions per 1,000 live births--much higher than I would have guessed. My sincere (but admittedly naive) hope is that abortions are not being relied on as a means of birth control.
[Via MMWR]
Saturday, November 27, 2004
Lancet: Risk of cardiovascular events and rofecoxib
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Lancet: Risk of cardiovascular events and rofecoxib: cumulative meta-analysis (pdf)
""Findings: We identified 18 randomised controlled trials and 11 observational studies. By the end of 2000 (52 myocardial infarctions, 20742 patients) the relative risk from randomised controlled trials was 2·30 (95% CI 1·22-4·33, p=0·010), and 1 year later (64 events, 21432 patients) it was 2·24 (1·24-4·02, p=0·007). There was little evidence that the relative risk differed depending on the control group (placebo, non-naproxen NSAID, or naproxen; p=0·41) or trial duration (p=0·82). In observational studies, the cardioprotective effect of naproxen was small (combined estimate 0·86 [95% CI 0·75-0·99]) and could not have explained the findings of the VIGOR trial.""
Friday, November 26, 2004
Making The Flu Vaccine Go Further
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NEJM: Dose Sparing with Intradermal Injection of Influenza Vaccine (free full text)
NEJM: Serum Antibody Responses after Intradermal Vaccination against Influenza (free full text)
Tuesday, November 23, 2004
New Female Sterilization Technique Quicker, Easier and Cheaper
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New Female Sterilization Technique Quicker, Easier and Cheaper:
""Mayo Clinic gynecologists have discovered that hysteroscopic sterilization, a new method of plugging the fallopian tubes to prevent conception, will save patients money compared to laparoscopic tubal ligation, the most commonly used method of sterilization for women. This technique involves inserting a nickel-titanium and stainless steel springlike device into the fallopian tubes using a hysteroscope, a tiny, fiberoptic camera. The metal device encapsulates and holds in place white polyester fibers able to cause scarring and thus block the fallopian tubes within 12 weeks, preventing the possibility of future pregnancy.""
Of course, it's still not as easy as a man having a vasectomy, but this technique would not require laparoscopy and would thus be safer for the woman.
[Via Science Blog - Science News Stories]
Saturday, November 20, 2004
Brain imaging study of drunk drivers pinpoints neurological changes
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Alcohol Intoxication Effects on Simulated Driving: Exploring Alcohol-Dose Effects on Brain Activation Using Functional MRI
""The areas most profoundly affected by alcohol were the orbital frontal and anterior cingulate areas, which help control motor functions. The medial frontal regions of the brain involved in making decisions, and working memory, were not affected until the person was beyond the legal limit of intoxication. A function of working memory might be to find one's way home, the researchers said.
Impairment of the cerebellum area of the brain, which related strongly to speeding, was clearly correlated with the alcohol dose. Changes in the frontal and parietal cortex, which govern alertness and attention, were correlated with weaving while driving. ""
[Via Medical News Today]
Thursday, November 18, 2004
Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002
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Prevalence of Overweight and Obesity Among Adults with Diagnosed Diabetes --- United States, 1988--1994 and 1999--2002:
""Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure, and cholesterol (1), placing persons with diabetes at higher risk for both cardiovascular and microvascular disease (2). Conversely, intentional weight loss is associated with reduced mortality among overweight persons with diabetes (3). CDC analyzed the prevalence of overweight and obesity among U.S. adults aged >20 years with previously diagnosed diabetes by using data from two surveys: the Third National Health and Nutrition Examination Survey (NHANES III), 1988--1994, and NHANES 1999--2002. This report summarizes the results of that analysis, which indicated that most adults with diagnosed diabetes were overweight or obese. During 1999--2002, the prevalence of overweight or obesity was 85.2%, and the prevalence of obesity was 54.8%. Encouraging patients to achieve and maintain a healthy weight should be a priority for all diabetes-care programs.""
[Via MMWR]
Sunday, November 14, 2004
Vioxx Non-Cox2 Effect Demonstrated
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It's worth pointing out that discussion of a drugs action typically focus on one known effect. That there may be others and that those can be harmful is amply demonstrated by the Vioxx example. An article just published in the journal 'Atherosclerosis' may explain what the second effect is in the case of Vioxx:
Sulfone COX-2 inhibitors increase susceptibility of human LDL and plasma to oxidative modification: comparison to sulfonamide COX-2 inhibitors and NSAIDs
Bottom line: "Abnormal changes in the structure or shape of lipids caused by Vioxx, especially in LDL, may explain why they are more susceptible to oxidative damage, and therefore, contribute to cardiovascular damage. Similar effects on susceptibility of lipids to oxidative damage have been observed with cigarette smoking, diabetes and in patients who have had a recent heart attack."
[Via Medical News Today]
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Nov Jan
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