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Old December 12th, 2002, 07:55
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2002.10.01 General Medical Pearls

Wednesday, October 30, 2002

Vigorous Activity During Pregnancy Decreases Risk of Preterm Birth
This study of 1699 women found that vigorous leisure activity--especially during the 1st and 2nd trimesters--significantly decreased the risk of preterm birth. Vigorous activity in the 1st trimester decreased the risk by 20%, and vigorous leisure activity in the 2nd trimester decreased the risk by 48%. Comment: this study found specifically that vigorous leisure activity prior to pregnancy did not decrease the risk of preterm birth. [ Epidemiology 2002; 13(6):653-659 ]__posted at 10/30/2002 05:36:37 AM by Tom Heston, MD___comment on this article

Tuesday, October 29, 2002

Sales of Kava Stopped Due to Health Concerns
Due to concerns over hepatotoxicity associated with the herb Kava, Health Canada has stopped sales of the over-the-counter herbal supplement. [ CMAJ October 29, 2002; 167 (9) ]__posted at 10/29/2002 11:40:56 PM by Tom Heston, MD___comment on this article



In Women Who Already Have Osteoporosis, Does Exercise Reduce the Risk for Falls?
This study evaluates whether or not an exercise program (called "Osteofit") can help reduce the risk factors for falls in women aged 65 - 75 years with osteoporosis. The authors conclude that the exercise program works. Comment: this is a very misleading article. First of all, the authors state that they have no conflicts of interest, yet two of them are founding members of the "Osteofit" program, which is funded by the Royal Bank Financial Group, has copyrighted the name and is promoting its adoption all across British Columbia (to get more funding). Clearly, the founding members of this funded program have a competing interest--yet they chose not to mention it. Furthermore, out of the 456 women identified as potential participants, only 80 were able to complete the course (due to a wide range of problems including other medical problems, travel/time constraints, etc.). This means that the program as defined by the researchers was only appropriate for 18% of the women aged 65 - 75 with osteoporosis they could identify. So, right off the bat, we see that the large majority of women 65-75 years old with osteoporosis are not candidates for the "Osteofit" program. Among this highly selected subset of women with osteoporosis, there was no difference between the control and the intervention groups at baseline or after the 20 week "Osteofit" program. But the authors weren't satisfied, and engaged in questionable statistics to finally find a statistic with a p value of < 0.05. This study screams "data mining" and seems to be of very little usefulness----except to those who want more funding for the "Osteofit" program. Still---exercise is good for you as shown by many other studies. Balance training also does seem to help women with osteoporosis, as shown by a different study which looked at the usefulness of Tai Chi. At this point, my recommendation would be to consider Tai Chi more strongly than "Osteofit" [ CMAJ October 29, 2002; 167 (9) ]__posted at 10/29/2002 11:35:37 PM by Tom Heston, MD___comment on this article



Is Pharmaceutical Marketing Safe for Patients?
This article discusses the issues of marketing pharmaceuticals, balancing the needs of patients with market and financial pressures. [ Canadian Medical Journal, October 29, 2002; 167 (9): 981 ] __posted at 10/29/2002 06:58:44 PM by Tom Heston, MD___comment on this article



Orgasmic Headaches More Common in Men Than in Women
German researchers have concluded that men--not women--are more likely to get headaches that come on suddenly around the point of orgasm. [ article ]__posted at 10/29/2002 01:44:30 AM by Tom Heston, MD___comment on this article

Monday, October 28, 2002

Low Folate Increases Risk of Miscarriage
Low plasma folate levels increase the risk of miscarriage according to research from Sweden and the US. Compared to women with normal plasma folate levels, those with low levels had a 47% increase risk. [ BMJ 2002;325:924 ( 26 October ) ]__posted at 10/28/2002 12:03:04 AM by Tom Heston, MD___comment on this article

Sunday, October 27, 2002

Lower Respiratory Infections Such as Pneumonia the Leading Cause of Premature Deaths Worldwide
This review from the Harvard School of Public Health concludes that lower respiratory infections are the leading cause of premature death worldwide, followed by diarrhoeal diseases then conditions arising during the perinatal period. Comment: These diseases primarily affect the developing countries, and could be greatly reduced by antibiotics---- which the developing countries cannot afford. [ article ]__posted at 10/27/2002 11:32:17 PM by Tom Heston, MD___comment on this article



Eating Fish Decreases Risk of Dementia, and so does Meat
This study found that eating fish or other seafood decreased the risk of dementia. Also, meat consumption at least time to time (less than weekly) also decreased the risk of dementia compared to those who never ate meat. Comment: the data on fish and seafood are very compelling because there is a dose relationship. That is, those who ate fish or seafood daily had the lowest risk of dementia, those that ate fish at least once a week (but not every day) had also had a decreased risk, but not as much. Of note, those that never ate meat had the highest risk for dementia. Those that never ate fish or seafood had the next highest risk. Those that ate fish or seafood once a day had the lowest risk for dementia. The thought is that the omega 3 fatty acids improve blood circulation, which as a result decreases dementia. [ BMJ 2002;325:932-933 ( 26 October ) ]__posted at 10/27/2002 11:19:06 PM by Tom Heston, MD___comment on this article

Thursday, October 24, 2002

Mobile Phones Possibly Linked to Leukemia
Italian scientists report that when exposed to continuous radio waves for 24 hours, leumia cells initially die off, but then start replicating more rapidly. Comment: it makes sense that excessive use of mobile phones may cause health problems, but continuous exposure for 24 hours? The overall risk risk still seems to be pretty low. [ article ]__posted at 10/24/2002 02:16:59 AM by Tom Heston, MD___comment on this article

Wednesday, October 23, 2002

Live Journal Club Broadcast- Starts Now
To listen to our live discussion about the latest journal club article, go to our radio broadcast. This broadcast will end in about 1 hour. The discussion is about warfarin. This broadcast will not be archived. Listen Now__posted at 10/23/2002 08:02:23 PM by Tom Heston, MD___comment on this article

Tuesday, October 22, 2002

European Union Unable to Significantly Decrease Tobacco Advertising
A small group of members of the Eurpoean parliament were able to severely limit the effect of new proposals to restrict tobacco advertising throughout the European Union. Legislation to limit tobacco advertising was successfully blocked for the previous 16 months, and when finally approved by the legal affairs committee, the legislation contained a number of amendments that severely decreased the impact of the legislation. Comment: politicians are not immune to big tobacco company influence. This is unfortunate, given that now lung cancer--not breast cancer--causes the most cancer deaths in women (and men). Why are the tobacco companies able to get away with promoting such a lethal product? [ bmj.com Watson 325 (7369): 853 ]__posted at 10/22/2002 08:49:15 PM by Tom Heston, MD___comment on this article

Monday, October 21, 2002

Atorvastatin Better Than Pravachol in Reducing Carotid Wall Cholesterol Plaques
This study compared atorvastatin (Lipitor) at 80 mg/d with pravastatin (Pravachol) at 40 mg/d in a randomized trial of 161 volunteers and found that those on atorvastatin had a decrease in their carotid intima-media thickness. Those on the pravastatin did not experience any change in their carotid artery thickness. Comment: this study found that those on atorvastatin had their LDL cholesterol reduced to 76 +/- 23 mg/dl compared to 110 +/- 30 mg/dl for the pravastatin group. This suggests that the primary reason for the regression of the cholesterol plaques was a low LDL cholesterol level, not the specific medication used. Would 80 mg/d of pravastatin given the same benefit? [ Circulation. 2002;106:2055 ]__posted at 10/21/2002 02:24:33 AM by Tom Heston, MD___comment on this article

Sunday, October 20, 2002

Spiritual Beliefs Help Resolve Grief
This study looked at 135 people who had a close friend or relative die. During the follow up period of 14 months, the researchers found that those with no spiritual belief had not resolved their grief. Those with strong spiritual beliefs had resolved their grief by that time. Comment: it is important to note that a strong spiritual belief---not a specific religion--was the important factor. [ BMJ 2002;324:1551 ( 29 June ) ]__posted at 10/20/2002 01:54:07 AM by Tom Heston, MD___comment on this article



Iron Deficiency Still Prevalent
Iron deficiency is the most common nutritional deficiency worldwide. In the US, iron deficiency is still a problem. According to the NHANES data, 7% of toddlers 1--2 years old have iron deficiency. Among women aged 12 -- 49 years old, 9% to 16% have iron deficiency. Iron deficiency causes decreased work capacity, decreased motor and mental development in infants, and in women may increase the risk of low birthweight and preterm delivery. [ article ]__posted at 10/20/2002 01:41:21 AM by Tom Heston, MD___comment on this article

Tuesday, October 15, 2002

CoEnzyme Q10 May Slow Progression of Parkinson's Disease
A small, preliminary study found that coenzyme Q10 may be of benefit to Parkinson's patients. Comment: adding to the evidence is their findings that there was a dose related effect, i.e. that those taking higher doses had the best results, those taking lower doses had positive benefits, and those taking a placebo had no benefit. [ BBC NEWS | Health | Supplement slows Parkinson's decline, Tues Oct 15, 2002__posted at 10/15/2002 07:40:44 PM by Tom Heston, MD___comment on this article



Indians Continue to Sell Human Organs Despite Ban
Despite a government ban, there continues to be a large trade in human organs in India. Many people are selling one of their kidneys for just 400 GBP (UK Pounds, equivalent to $620 USD). Comment: although people apparently sell their kidney for financial reasons, a recent research article found that donors in the long run did not benefit financially, their health significantly declined, and most would not recommend that anyone else donate a kidney for money. [ BBC NEWS | Health | Tues Oct 15, 2002__posted at 10/15/2002 07:27:26 PM by Tom Heston, MD___comment on this article

Monday, October 14, 2002

WHO Calls For Increases in Cigarette Taxes
The World Health Organization has called for a global increase in the price of cigarettes and tobacco, stating that a 5% increase in price would result in saving 10 million lives. Comment: the primary goal of price increases is to make it more likely that young people will not take up the habit. Another recent news article states that each new smoker is worth approximately $56 000 US to the tobacco industry. BMJ 2002;325:844 ( 12 October ) [ BBC Health, October 14, 2002 ]__posted at 10/14/2002 06:29:10 PM by Tom Heston, MD___comment on this article



No Imaging Often Recommended for Patients With Low Back Pain
This review of the literature re-affirmed a strategy similar to the 1994 Agency for Health Care Policy and Research Guidelines for the evaluation of low back pain. In general, for adults under 50 years of age, symptomatic treatment with no imaging is recommended; for those 50 and older, or with findings suggestive of systemic disease, plain x-rays and simple laboratory tests almost always can rule out underlying systemic disease. Further imaging is appropriate when surgery is being considered or when systemic disease is strongly suspected. [ Annals of Internal Medicine, 1 October 2002 Volume 137 Number 7 ]__posted at 10/14/2002 06:16:47 PM by Tom Heston, MD___comment on this article



Calcium Enriched Orange Juice Significantly Decreases Absorption of Ciprofloxacin
This review of a recent article notes that when the antibiotic ciprofloxacin is taken along with calcium enriched orange juice, the absorption of the antibiotic is decreased significantly. The amount of antibiotic reaching the blood stream was decreased by 40% in the research study. [ American Medical News, Oct. 14, 2002 ]__posted at 10/14/2002 06:09:16 PM by Tom Heston, MD___comment on this article



US Government Issues Guidelines to Pharmaceutical Company Reps
The Department of Health and Human Services has issued guidelines to pharmaceutical companies, restricting their previous practices of giving gifts and incentives to physicians to prescribe their medications. Comment: the guidelines apparently were intended to bring down the cost of pharmaceuticals by decreasing the pharmaceutical company's marketing costs. Unfortunately, this strategy won't work. The pharmaceutical companies are simply going to increase their direct-to-consumer advertising. [ BMJ 2002;325:795 ( 12 October ) ]__posted at 10/14/2002 01:50:35 AM by Tom Heston, MD___comment on this article



Jury Awards Smoker $28 Billion
A jury in Los Angeles awarded a 64 year old woman with cancer $28 billion dollars, mostly in punitive damages. Comment: most of this money will end up in the hands of the legal system. [ article ]__posted at 10/14/2002 01:39:12 AM by Tom Heston, MD___comment on this article

Thursday, October 10, 2002

Exercise Reduces Knee Pain From Osteoarthritis
This study of 786 men and women 45 years of age and older with knee pain found that regular home exercising significantly reduced their pain. The exercise program was designed to increase muscular strength around the knee, increase range of motion and locomotor function. Comment: this is yet another study that shows that regular exercise is healthy and reduces pain. Yet only a minority of adults regularly exercise. [ BMJ 2002;325:752 ( 5 October ) ]__posted at 10/10/2002 05:23:04 PM by Tom Heston, MD___2 comments

Monday, October 07, 2002

World Health Organization Releases Report on Violence
WHO has released the first comprehensive report on the global impact of violence. Key points include: a) 50% of the deaths due to violence were suicides, b) 32% of the deaths were due to homicides, and c) 19% of the deaths from violence were due to armed conflicts. Comment: one of the editorial comments of the report was that violence can be both predicted and prevented. This report closely mirrors the ideas discussed in detail by Gavin de Becker in his excellent books Fear Less and The Gift of Fear . [ BMJ 2002;325:731 ( 5 October ) ]__posted at 10/7/2002 01:19:32 AM by Tom Heston, MD___comment on this article

Friday, October 04, 2002

Intensive Screening for Prostate Cancer Does Not Reduce Mortality
This study found that intensive screening for prostate cancer does not reduce prostate-specific mortality. Comment: this is the latest in a number of recent studies that have all shown that current methods of screening for prostate cancer to not lead to a meaningful health benefit. [ BMJ 2002;325:740 ( 5 October) ]__posted at 10/4/2002 09:19:55 PM by Tom Heston, MD___comment on this article



Medjournal.com in Compliance With AMA Guidelines
A recent editorial in the American Medical News (a publication of the American Medical Association) lists several guidelines for publishers of Internet content.

* Editorial content should indicate the author or source, the date of posting, review content for quality, and indicate any funding or sponsorship for that particular content.
* Advertising content must be clearly distinguished from editorial content.
* The site should have a privacy policy, and a link to that policy should be on the home page.
* Sites should give users the right to opt in or out of having their personal information tracked.
[ Amer Med News Article ]__posted at 10/4/2002 03:45:54 PM by Tom Heston, MD___comment on this article

Thursday, October 03, 2002

US Task Force Recommends All Women Over 65 Get Screened for Osteoporosis
The US Preventive Services Task Force recommends that all women over 65 be routinely screened for osteoporosis. Women at high risk should get screening starting at age 60. DEXA screening is recommended, up to once every 2 years. [article]__posted at 10/3/2002 12:57:03 AM by Tom Heston, MD___comment on this article

Wednesday, October 02, 2002

Waist Circumference More Predictive of Cardiovascular Disease Risk Than Body Mass Index
This study of 9019 found that waist circumference was more predictive than body mass index of having 1 or more of the following cardiovascular disease risk factors: low HDL cholesterol, high LDL cholesterol, high blood pressure, or high glucose. Comment: a waist circumference of under 90 cm (~ 35 inches) in men and 83 cm (~ 33 inches) in women is low risk. From the abstract, it appears that these waist circumferences would place a person in the lowest quartile for the cardiovascular disease risk factors studied. The waist circumference cut-off values associated with being overweight (a body mass index of > 25) is 90 in men and 83 in women. For obesity (corresponding to a BMI of > 30) the cut-off waist circumferences are 100 cm (~ 39 inches) for men and 93 cm (~ 37 inches) for women. It is too bad that the AJCN only allows free access to abstracts and not the full articles. [ AJCN 2002;76 (4): 743] __posted at 10/2/2002 05:56:09 PM by Tom Heston, MD___comment on this article

Tuesday, October 01, 2002

Need Some Money? Sell a Kidney
This study looked at 305 people who sold one of their kidneys in Chennai, India. The average amount received was $1070 US. Approximately 86% of the donors reported a deterioration in their health status after the donation; their average family income declined by one third; and the number of participants living below the poverty line decreased. Seventy-nine percent would not recommend that others sell a kidney. [ JAMA. 2002;288:1589-1593 ]__posted at 10/1/2002 11:05:42 PM by Tom Heston, MD___comment on this article
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