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Americans Fatter in 37 States “The report's state-by-state rankings find Mississippi, West Virginia, and Alabama to be the most obese states. Colorado, Hawaii, and Connecticut are the least obese states — yet Colorado's obesity rate continues to climb toward 20% of adults, a level already surpassed by Hawaii and Connecticut. "The crisis is getting worse," Levi said at a news conference. "The 2008 report shows some states and communities have taken positive steps, but overall we are not treating the obesity epidemic with the seriousness it deserves." The most shocking figure in last year's report was that more than 30% of Mississippi adults were obese. This year, Mississippi's problem is even worse — and now Alabama and West Virginia have adult obesity rates over 30%. “

Brain damage risk linked to migraine frequency “Migraine patients who have frequent attacks or a long history of migraines have an increased risk of progressive brain damage according to findings on magnetic resonance imaging (MRI), researchers form the Netherlands in the current issue of Headache. Previous research on brain imaging has shown that migraine patients are more likely to show "silent brain damage," or damage with no signs or symptoms, than are control subjects, the authors explain. But the brain sites that are affected have not been specified; only white matter hyperintensities have been investigated. “

Elderly Not Getting Enough Vitamin D, Study Finds “When you don't have enough vitamin D in your system you can't absorb calcium, which is needed to maintain bone health and prevent osteoporosis, says Joseph Vande Griend, a doctor of pharmacy and assistant professor who was the lead author of the study. There is also evidence that vitamin D can help prevent falls in the elderly, Vande Griend says. Sunshine -- another way to acquire vitamin D -- would seem to provide ample opportunity for the body to make vitamin D, but seniors don't get outdoors as much as younger people, and they also may not be getting much vitamin D from foods like milk and orange juice, which are commonly fortified with the vitamin. … The government recommendation of 400 to 600 IU of vitamin D isn't enough, concluded CU researchers, who suggest elderly patients get 1,200 IU per day. Of the 80 patients studied, almost three-fourths were found to be vitamin D deficient at the beginning of the study, even though the majority were getting more than the recommended daily dose. Vande Griend says the safe upper limit for vitamin D, which is fat soluble, is about 2,000 IU per day. The 27-year- old pharmacy professor says that he takes a multivitamin and an additional 400 IU of vitamin D each day.“

[Functional decline during hospitalization in elderly patients. Benefits of admission to the geriatrics service] (Rev Esp Geriatr Gerontol. 2008) “CONCLUSIONS: Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.”

Health and Economic Implications of HPV Vaccination in the United States

Human Papillomavirus Vaccination — Reasons for Caution “Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer. Several strains of human papillomavirus (HPV) can cause cervical cancer, and two vaccines directed against the currently most important oncogenic strains (i.e., the HPV-16 and HPV-18 serotypes) have been developed. That is the good news. The bad news is that the overall effect of the vaccines on cervical cancer remains unknown. As Kim and Goldie1 point out in this issue of the Journal, the real impact of HPV vaccination on cervical cancer will not be observable for decades. … With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs. Instead, we should concentrate on finding more solid answers through research rather than base consequential and costly decisions on yet unproven assumptions.”

Hospitalization Linked to Increased Fracture Risk in Elderly “In the Health ABC Study, two thirds of elderly participants were admitted to a hospital during follow-up of approximately 6 years, and more than one quarter had 3 or more hospitalizations. After adjustment for age, race, and sex, hospitalization was associated with twice the risk for fracture and with more than twice the risk for hip fracture. Risk for hip fracture was increased 2.42-fold in patients with 2 hospitalizations during follow-up and 3.66-fold in those with 3 or more hospitalizations. “

Hypercholesterolemia and prostate cancer: a hospital-based case-control study. (Cancer Causes Control. 2008) “CONCLUSION: This study adds to recent evidence that hypercholesterolemia may increase the risk of prostate cancer in white men.”

Media Coverage About Breast Self-Exam Misleading, Say Experts “ “"The news stories seem to suggest that this is the final word on breast self-exam, and that the practice is ineffective or even harmful," said Dr. Goldstein, senior scientist and chairman of the board at MammaCare, in Gainesville, Florida. "And that's not the case at all." … The American College of Obstetricians and Gynecologists has kept BSE in its most recent breast cancer screening guidelines. "Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended," the guidelines state. Several advocacy groups also continue to recommend BSE, including San Francisco–based Breast Cancer Action, which states that annual clinical breast exams by trained health professionals and breast self-exams are essential aspects of breast cancer screening. Our Bodies Ourselves, also known as the Boston Women’s Health Book Collective, a nonprofit public-interest women’s health education and advocacy organization, points out that BSE is rarely used as a sole screening method, is generally combined with clinical breast exam and mammography, and is the only detection method that women have control over with their own 2 hands. Most breast cancers are palpable and are usually discovered by the women themselves, Drs. Goldstein and Pennypacker note. When the biomedical research team at the University of Florida and MammaCare were first investigating optimal palpation procedures, they found that skill training using tactually accurate breast models with small simulated lesions enabled women and healthcare practitioners to reliably detect 3 mm breast lesions, which is 10 times smaller than the average lesion found by accident. "Published evidence documents that a large proportion of breast cancers are palpable and self-detected, that some breast cancers are mammographically invisible, that the components of effective breast self-examination are now known and validated, that the skill can be learned, and that women who learn and practice proficient breast examination possess an advantage in protecting their health and their life," they write.”

Migraine with and without aura and risk for cardiovascular disease. (Curr Atheroscler Rep. 2008) “Although many prior studies have demonstrated increased risks in women with migraine with aura, an emerging body of evidence is showing similar risks in men. These risks are further compounded with increased migraine frequency, smoking, and the use of oral contraceptive pills. Because the overall risk for stroke and myocardial infarction in migraineurs remains relatively low, recommendations at this time are limited to the modification of cardiovascular risk factors, such as smoking cessation and the avoidance of oral contraceptive pills, especially in women suffering from migraine with aura.”

Skin Cancer May Foretell Cancers to Come “The new study, from Johns Hopkins and the Medical University of South Carolina, tracked 769 patients who had non-melanoma skin cancer -- the most common form in the United States -- and 18,405 people who had not had the illness and found that those who had skin cancer were twice as likely to develop another form. “

Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. (Sleep. 2008) “CONCLUSIONS: Moderate-to-severe sleep apnea is independently associated with a large increased risk of all-cause mortality in this community-based sample.”

Vaccine-wary parents spark public health worry “Skeptical of government mandates and leery of feared links to disorders from asthma to autism, parents say they’re exercising their rights to protect their kids from risk. But health officials say there’s no question that the risk of vaccination is far outweighed by the benefits of inoculation, and that those who don’t immunize endanger not only their own kids, but also the collective resistance that keeps everyone else safe, too. “When more than 10 percent of a community opts out of vaccinations, it leaves the entire community at risk because germs have a greater chance of causing an epidemic,” said Dr. Ari Brown, an Austin, Texas, pediatrician who represents the American Academy of Pediatrics. Scientists worry that vaccine resisters increasingly are breaching "herd immunity," the necessary level of protection that keeps disease from spreading. When enough people in a community are immune to a disease, they provide a buffer that keeps germs from infecting those too vulnerable for vaccination, or those for whom a vaccine doesn't work or wears off. “

Vitamin D Deficiency May Lurk in Babies “Physicians have known for more than a century that exclusive breast-feeding may be associated with vitamin D deficiency and rickets, and that the condition is easily prevented and treated with inexpensive vitamin drops or cod liver oil. But doctors are reluctant to say anything that might discourage breast-feeding. Now some researchers are also linking vitamin D deficiency with other chronic diseases like diabetes, autoimmune disorders and even cancer, and there have been calls to include blood tests of vitamin D levels in routine checkups. “I completely support breast-feeding, and I think breast milk is the perfect food, and the healthiest way to nourish an infant,” said Dr. Catherine M. Gordon, director of the bone health program at Children’s Hospital Boston and an author of several studies on vitamin D deficiency, including Aleanie’s case. “However,” Dr. Gordon continued, “we’re finding so many mothers are vitamin D deficient themselves that the milk is therefore deficient, so many babies can’t keep their levels up. They may start their lives vitamin D deficient, and then all they’re getting is vitamin D deficient breast milk.” “

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Healthy Living

Mediterranean diet 'cuts cancer' “The biggest effect they found - a 9% reduction in risk - was achieved simply by eating more "unsaturated" fats such as olive oil. But just two changes - eating less red meat, and more peas, beans and lentils, cut the risk of cancer by 12%. … Their findings raised the possibility that broccoli, or other "cruciferous" vegetables, such as cauliflower and Brussels sprouts, could help prevent or slow down the disease, particularly if the man had a particular gene variant - GSTM1. Professor Richard Mithen, who led the research, published in the Public Library of Science journal, said: "Eating two or three portions of cruciferous vegetables per week, and maybe a few more if you lack the GSTM1 gene - should be encouraged." “

Oily fish consumption, dietary docosahexaenoic acid and eicosapentaenoic acid intakes, and associations with neovascular age-related macular degeneration (American Journal of Clinical Nutrition 2008) “Conclusions: Eating oily fish at least once per week compared with less than once per week was associated with a halving of the OR for NV-AMD.”

Physical Activity and Incidence of Atrial Fibrillation in Older Adults. The Cardiovascular Health Study (Circulation 2008) “Conclusions—Light to moderate physical activities, particularly leisure-time activity and walking, are associated with significantly lower AF incidence in older adults.”

Reduced Disability and Mortality Among Aging Runners (Arch Intern Med. 2008) “Conclusion Vigorous exercise (running) at middle and older ages is associated with reduced disability in later life and a notable survival advantage. “

Running Slows the Effects of Aging: Study Shows Older Runners Have Fewer Disabilities Than Non-Runners “"If you had to pick one thing to make people healthier as they age, it would be aerobic exercise," James Fries, MD, an emeritus professor of medicine at the medical school and the study's senior author, says in a news release.”

Spices May Protect Against Consequences Of High Blood Sugar “Hargrove explained that when blood sugar levels are high, a process known as protein glycation occurs in which the sugar bonds with proteins to eventually form what are known as advanced glycation end products, also known as AGE compounds. The acronym is fitting because these compounds activate the immune system, resulting in the inflammation and tissue damage associated with aging and diabetes. The researchers found a strong and direct correlation between the phenol content of common herbs and spices and their ability to inhibit the formation of AGE compounds. Spices such as cloves and cinnamon had phenol levels that were 30 percent and 18 percent of dry weight, respectively, while herbs such as oregano and sage were eight and six percent phenol by dry weight, respectively. For comparison, blueberries – which are widely touted for their antioxidant capabilities – contain roughly five percent phenol by dry weight. … “If you set up a good herb and spice cabinet and season your food liberally, you could double or even triple the medicinal value of your meal without increasing the caloric content,” she said. She added that controlling blood sugar and the formation of AGE compounds can also decrease the risk of cardiovascular damage associated with diabetes and aging. She explained that high blood sugar accelerates heart disease partly because AGE compounds form in the blood and in the walls of blood vessels. The AGE compounds aggravate atherosclerosis, which produces cholesterol plaques.“

Stroke Risk Plummets With Healthy Lifestyle “Living a healthy lifestyle can cut your risk of stroke by about 80 percent, new research suggests. Women who pursued healthy habits -- not smoking, maintaining a healthy weight, exercising regularly and drinking moderate amounts of alcohol -- had a 79 percent reduced risk of any stroke, and an 81 percent decreased risk of ischemic stroke. Men living healthy lives cut their overall risk of stroke by 69 percent and their risk of ischemic stroke by 80 percent. An ischemic stroke is the most common type of stroke, and it occurs when a blood vessel in the brain is blocked. "We've previously found that a low-risk lifestyle was very important in preventing coronary heart disease and diabetes, and now we've also found that these healthy habits can lower your risk of stroke," said study author Stephanie Chiuve, a research associate in the department of nutrition at the Harvard School of Public Health.“

Tai Chi Program Helps Prevent Falls Among Older Adults

Vitamin D intake and breast cancer risk: a case-control study in Italy. (Ann Oncol. 2008) “CONCLUSIONS: This study adds to the existing evidence that vitamin D intake in inversely associated with breast cancer risk.”

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Inflammation and Oxidative Stress

Epidemic Inflammation: Pondering Obesity. (Mol Med. 2008) “Over the past two decades, inflammation has been recognized as a major driver in the pathogenesis of several common diseases, including atherosclerosis, diabetes, cancer and asthma. Over the same period, there has been a steep rise in the incidence of obesity, a major risk factor for these disorders. Inflammation of adipose tissue is now recognized to accompany obesity and contribute to its sequellae. Thus, while obesity is primarily a disorder of energy balance, it may be helpful to consider it also as a form of epidemic inflammation that predisposes to other forms of epidemic inflammation. … Recognition of the link between inflammation and obesity dates to 1993, when the inflammatory cytokine tumor necrosis factor-a (TNF) was shown to arise from adipose tissue in obese rodents and contribute to their insulin resistance (3). Insulin resistance is a state in which fat, muscle and liver cells fail to respond normally to insulin, which can lead to increased glucose and fatty acids in the circulation. Ten years later, it emerged that adipose tissue is infiltrated by macrophages in obese children and adults (4) and in mice (5), in proportion to how far they exceed normal body weight. These macrophages express TNF, inducible nitric oxide synthase (iNOS), and other inflammatory substances. Very recently, changes diagnostic of inflammation—increased leakiness of vessels and adhesion of leukocytes and platelets-- were documented in the microcirculation of visceral but not subcutaneous adipose tissue in obese but not lean mice (6). The products arising from inflamed adipose tissue (adipositis) contribute to an inflammatory state in distant cells, such as endothelium, arterial and bronchial smooth muscle and pancreatic islets. This systemic inflammation helps drives insulin resistance, endothelial dysfunction and high blood pressure (hypertension), conditions that often progress to diabetes and atherosclerosis, and also predisposes to asthma and certain cancers (7).”

Inflammation“ … persistent inflammation is associated with many chronic human conditions and diseases, including allergy, atherosclerosis, cancer, arthritis and autoimmune diseases.”

Inflammation and Alzheimer's disease: possible role of periodontal diseases. (Alzheimers Dement. 2008) “Recently, chronic periodontitis has been associated with several systemic diseases including AD. In this article we review the pathogenesis of chronic periodontitis and the role of inflammation in AD. In addition, we propose several potential mechanisms through which chronic periodontitis can possibly contribute to the clinical onset and progression of AD. Because chronic periodontitis is a treatable infection, it might be a readily modifiable risk factor for AD.”

Inflammation and lung cancer: roles of reactive oxygen/nitrogen species. (J Toxicol Environ Health B Crit Rev. 2008) “During inflammation, enhanced ROS/RNS production may induce recurring DNA damage, inhibition of apoptosis, and activation of proto-oncogenes by initiating signal transduction pathways. Therefore, it is conceivable that chronic inflammation-induced production of ROS/RNS in the lung may predispose individuals to lung cancer. This review describes the complex relationship between lung inflammation and carcinogenesis, and highlights the role of ROS/RNS in cancer development.”

Inflammation in the vascular bed: Importance of vitamin C. (Pharmacol Ther. 2008) “For endothelial cells, ascorbate helps to prevent endothelial dysfunction, stimulates type IV collagen synthesis, and enhances cell proliferation. For vascular smooth muscle cells, ascorbate inhibits dedifferentiation, recruitment, and proliferation in areas of vascular damage. For macrophages, ascorbate decreases oxidant stress related to their activation, decreases uptake and degradation of oxidized LDL in some studies, and enhances several aspects of their function. Although further studies of ascorbate function in these cell types and in novel animal models are needed, available evidence generally supports a salutary role for this vitamin in ameliorating the earliest stages of atherosclerosis.”

Oxidative Stress and Inflammation Are Associated with Adiposity in Moderate to Severe CKD. (J Am Soc Nephrol. 2008) “We conclude that increased adiposity may amplify the oxidative stress and inflammation that accompany moderate to severe CKD. Interventions focused on weight loss may decrease the inflammatory and oxidative burden in CKD, which may ultimately attenuate cardiovascular risk in this population.”

Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases. (Mol Nutr Food Res. 2008)

Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease. (Br J Nutr. 2008)

The development of allergic inflammation (Nature 2008)

The effect of nuts on inflammation. (Asia Pac J Clin Nutr. 2008) “The relationship observed between frequent nut consumption and the reduced risk of cardiovascular mortality and type 2 diabetes in some prospective studies could be explained by the fact that nuts are rich in all of these modulator nutrients. In fact, frequent nut consumption has been associated with lower concentrations of some peripheral inflammation markers in cross-sectional studies. Nut consumption has also been shown to decrease the plasma concentration of CRP, IL-6 and some endothelial markers in recent clinical trials.”

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Patient Safety

Adverse Reactions To Antibiotics Send Thousands Of Patients To The ER “Half of the visits were for reactions to penicillins and the other half were from reactions to other antibiotics used to treat a wide variety of bacterial infections. After accounting for how often antibiotics were prescribed, children less than one year old were found to have the highest rate of adverse drug events. Almost 80 percent of all antibiotic adverse events in the study were allergic reactions, ranging from rash to anaphylaxis, and the remaining 20 percent were caused by errors and overdoses. Unlike errors and overdoses from other drugs, allergic reactions to antibiotics typically can only be prevented by avoiding exposure to the drug in the first place.”

Cancer Survival Rates Vary by Country: Study Shows U.S., Japan, and France Have Highest Cancer Survival Rates “The highest survival rates were found in the U.S. for breast and prostate cancer, in Japan for colon and rectal cancers in men, and in France for colon and rectal cancers in women, Coleman's team reports. In Canada and Australia, survival was also high for most cancers. The lowest cancer survival rates for all four cancers were found in Algeria.“

Deadly Infections in Hospitals “Deadly infections are on the upswing in hospitals around the world. Overcrowding and understaffing may be at least partially to blame.”

Does the Leapfrog program help identify high-quality hospitals? (Jt Comm J Qual Patient Saf. 2008) “DISCUSSION: Consumers who choose hospitals identified by Leapfrog as having begun to implement patient safety practices will likely find hospitals with better process quality and lower mortality rates.”

How Independent Are Vaccine Defenders? “The vaccine industry gives millions to the Academy of Pediatrics for conferences, grants, medical education classes and even helped build their headquarters. The totals are kept secret, but public documents reveal bits and pieces.”

Older Patients Less Likely to Be Taken to Trauma Centers “Older trauma patients are less likely to be transported to an official trauma center for immediate care than younger patients, a new study found. The finding was based on a review of a decade's worth of Maryland's statewide emergency medical services (EMS) records. And it suggests that the difference in care first comes into play as patients reach age 50 and worsens again at age 70. “

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