Analysis of US adults meeting fruit and vegetable intake recommendations
CDC calculated the median daily frequency of fruit and vegetable intake by adults based on 2013 BRFSS data. Overall, 13.1% of respondents met fruit intake recommendations (consume 1.5-2.0 cup equivalents of fruit daily), ranging from 7.5% in Tennessee to 17.7% in California; and 8.9% met vegetable recommendations (consume 2-3 cups of vegetables daily), ranging from 5.5% in Mississippi to 13.0% in California. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm?s_cid=mm6426a1_w
ASPPH/CDC Public Health Fellowship Program now accepting applications - due September 17, 2015
Bodybuilder supplement abuse a growing concern
CDC: 53 million adults in the US live with a disability
Doctors perform first double hand transplant in a child
Magnetic pulses to brain may ease ringing in the ears
Paralyzed men gain movement without surgery
A noninvasive treatment helped 5 men with complete muscle paralysis in the lower body voluntarily move their legs in a step-like pattern. The finding suggests that stimulation may help reactivate dormant nerve connections between the brain and spinal cord in some paralyzed patients. http://www.nih.gov/researchmatters/august2015/08102015paralyzed.htm
Urine test might find pancreatic cancer early, study suggests
Interactive online map illustrating the prevalence of HIV in the United States. Users can visually explore the HIV epidemic alongside critical resources such as HIV testing center locations, HIV treatment center locations, and NIH-Funded HIV Prevention & Vaccine Trials Sites. http://aidsvu.org/
Could a saliva test help spot Alzheimer's?
EPA releases updated environmental and public health indicators in online database
FDA wants to strengthen sugar labeling
Genetic and Rare Diseases Information Center
This website provides accurate, up-to-date information about thousands of rare and genetic diseases. Learn about symptoms, treatment options, and current research. Information specialists are available to discuss questions online, by mail, or by phone (888-205-2311) in English or Spanish. https://rarediseases.info.nih.gov/GARD
New skin cancer drug approved by FDA
Positive emotions and your health
To sway anti-vaccine beliefs, focus on consequences: study
Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data fromrandomised trials [published online ahead of print July 23, 2015]. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Lancet. pii: S0140-6736(15)60908-4. doi: 10.1016/S0140-6736(15)60908-4.
BACKGROUND: Bisphosphonates have profound effects on bone physiology, and could modify the process of metastasis. We undertook collaborative meta-analyses to clarify the risks and benefits of adjuvant bisphosphonate treatment in breast cancer. METHODS: We sought individual patient data from all unconfounded trials in early breast cancer that randomised between bisphosphonate and control. Primary outcomes were recurrence, distant recurrence, and breast cancer mortality. Primary subgroup investigations were site of first distant recurrence (bone or other), menopausal status (postmenopausal [combining natural and artificial] or not), and bisphosphonate class (aminobisphosphonate [eg, zoledronic acid, ibandronate, pamidronate] or other [ie, clodronate]). Intention-to-treat log-rank methods yielded bisphosphonate versus control first-event rate ratios (RRs). FINDINGS: We received data on 18 766 women (18 206 [97%] in trials of 2-5 years of bisphosphonate) with median follow-up 5•6 woman-years, 3453 first recurrences, and 2106 subsequent deaths. Overall, the reductions in recurrence (RR 0•94, 95% CI 0•87-1•01; 2p=0•08), distant recurrence (0•92, 0•85-0•99; 2p=0•03), and breast cancer mortality (0•91, 0•83-0•99; 2p=0•04) were of only borderline significance, but the reduction in bone recurrence was more definite (0•83, 0•73-0•94; 2p=0•004). Among premenopausal women, treatment had no apparent effect on any outcome, but among 11 767 postmenopausal women it produced highly significant reductions in recurrence (RR 0•86, 95% CI 0•78-0•94; 2p=0•002), distant recurrence (0•82, 0•74-0•92; 2p=0•0003), bone recurrence (0•72, 0•60-0•86; 2p=0•0002), and breast cancer mortality (0•82, 0•73-0•93; 2p=0•002). Even for bone recurrence, however, the heterogeneity of benefit was barely significant by menopausal status (2p=0•06 for trend with menopausal status) or age (2p=0•03), and it was non-significant by bisphosphonate class, treatment schedule, oestrogen receptor status, nodes, tumour grade, or concomitant chemotherapy. No differences were seen in non-breast cancer mortality. Bone fractures were reduced (RR 0•85, 95% CI 0•75-0•97; 2p=0•02). INTERPRETATION: Adjuvant bisphosphonates reduce the rate of breast cancer recurrence in the bone and improve breast cancer survival, but there is definite benefit only in women who were postmenopausal when treatment began.
Arginine vasopressin Is a blood-based biomarker of social functioning in children with autism. Carson DS, Garner JP, Hyde SA, et al. PLoS One. 2015;10(7):e0132224. doi: 10.1371/journal.pone.0132224.
Brain arginine vasopressin (AVP) critically regulates normative social behavior in mammals, and experimental disruption of the AVP signaling pathway produces social impairments in rodent models. We therefore hypothesized that AVP signaling deficits may contribute to social impairments in children with autism spectrum disorder (ASD). Since blood measures (which are far easier to obtain than brain measures) of AVP are most meaningful if they are related to brain AVP activity, Study 1 tested the relationship between AVP concentrations in concomitantly collected blood and CSF samples from children and adults (N = 28) undergoing clinical procedures. Study 2 tested whether blood AVP concentrations: 1) differed between children with ASD (N = 57), their ASD discordant siblings (N = 47), and neurotypical controls (N = 55); and 2) predicted social functioning (using the NEPSY-II Theory of Mind and Affect Recognition tasks and the Social Responsiveness Scale) in this large, well-characterized child cohort. Blood AVP concentrations significantly and positively predicted CSF AVP concentrations (F1,26 = 7.17, r = 0.46, p = 0.0127) in Study 1. In Study 2, blood AVP concentrations did not differ between groups or by sex, but significantly and positively predicted Theory of Mind performance, specifically in children with ASD, but not in non-ASD children (F1,144 = 5.83, p = 0.017). Blood AVP concentrations can be used: 1) as a surrogate for brain AVP activity in humans; and 2) as a robust biomarker of theory of mind ability in children with ASD. These findings also suggest that AVP biology may be a promising therapeutic target by which to improve social cognition in individuals with ASD.
Cleaning hospital room surfaces to prevent health care-associated infections: a technical brief [published online ahead of print August 11, 2015]. Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Ann Intern Med. doi: 10.7326/M15-1192.
The cleaning of hard surfaces in hospital rooms is critical for reducing health care-associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci were included. Eighty studies were identified-76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.
High glycemic index diet as a risk factor for depression: analyses from the Women's Health Initiative. Gangwisch JE, Hale L, Garcia L. Am J Clin Nutr. 2015;102(2):454-63. doi: 10.3945/ajcn.114.103846.
BACKGROUND: The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load. OBJECTIVE: We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression. DESIGN: This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women's Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954). RESULTS: We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth compared with first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth compared with first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression. CONCLUSIONS: The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women. The Women's Health Initiative was registered at clinicaltrials.gov as NCT00000611.
Regional nodal irradiation in early-stage breast cancer. Whelan TJ, Olivotto IA, Parulekar WR, et al. N Engl J Med. 2015;373(4):307-16. doi: 10.1056/NEJMoa1415340.
Most women with breast cancer who undergo breast-conserving surgery receive whole-breast irradiation. We examined whether the addition of regional nodal irradiation to whole-breast irradiation improved outcomes. METHODS: We randomly assigned women with node-positive or high-risk node-negative breast cancer who were treated with breast-conserving surgery and adjuvant systemic therapy to undergo either whole-breast irradiation plus regional nodal irradiation (including internal mammary, supraclavicular, and axillary lymph nodes) (nodal-irradiation group) or whole-breast irradiation alone (control group). The primary outcome was overall survival. Secondary outcomes were disease-free survival, isolated locoregional disease-free survival, and distant disease-free survival. RESULTS: Between March 2000 and February 2007, a total of 1832 women were assigned to the nodal-irradiation group or the control group (916 women in each group). The median follow-up was 9.5 years. At the 10-year follow-up, there was no significant between-group difference in survival, with a rate of 82.8% in the nodal-irradiation group and 81.8% in the control group (hazard ratio, 0.91; 95% confidence interval [CI], 0.72 to 1.13; P=0.38). The rates of disease-free survival were 82.0% in the nodal-irradiation group and 77.0% in the control group (hazard ratio, 0.76; 95% CI, 0.61 to 0.94; P=0.01). Patients in the nodal-irradiation group had higher rates of grade 2 or greater acute pneumonitis (1.2% vs. 0.2%, P=0.01) and lymphedema (8.4% vs. 4.5%, P=0.001). CONCLUSIONS: Among women with node-positive or high-risk node-negative breast cancer, the addition of regional nodal irradiation to whole-breast irradiation did not improve overall survival but reduced the rate of breast-cancer recurrence.
Robust association between inflammatory bowel disease and generalized anxiety disorder: findings from a nationally representative Canadian study [July 24, 2015]. Fuller-Thomson E, Lateef R, Sulman J. Inflamm Bowel Dis.
BACKGROUND: Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD. METHODS: Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalizedanxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis. RESULTS: Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates ofanxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder. CONCLUSIONS: Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.
Use of Community Assessments for Public Health Emergency Response (CASPERs) to rapidly assess public health issues - United States, 2003-2012. Bayleyegn TM, Schnall AH, Ballou SG, et al. Prehosp Disaster Med. 2015:1-8.
Introduction Community Assessment for Public Health Emergency Response (CASPER) is an epidemiologic technique designed to provide quick, inexpensive, accurate, and reliable household-based public health information about a community's emergency response needs. The Health Studies Branch at the Centers for Disease Control and Prevention (CDC) provides in-field assistance and technical support to state, local, tribal, and territorial (SLTT) health departments in conducting CASPERs during a disaster response and in non-emergency settings. Data from CASPERs conducted from 2003 through 2012 were reviewed to describe uses of CASPER, ascertain strengths of the CASPER methodology, and highlight significant findings. METHODS: Through an assessment of the CDC's CASPER metadatabase, all CASPERs that involved CDC support performed in US states and territories from 2003 through 2012 were reviewed and compared descriptively for differences in geographic distribution, sampling methodology, mapping tool, assessment settings, and result and action taken by decision makers. RESULTS: For the study period, 53 CASPERs were conducted in 13 states and one US territory. Among the 53 CASPERS, 38 (71.6%) used the traditional 2-stage cluster sampling methodology, 10 (18.8%) used a 3-stage cluster sampling, and two (3.7%) used a simple random sampling methodology. Among the CASPERs, 37 (69.9%) were conducted in response to specific natural or human-induced disasters, including 14 (37.8%) for hurricanes. The remaining 16 (30.1%) CASPERS were conducted in non-disaster settings to assess household preparedness levels or potential effects of a proposed plan or program. The most common recommendations resulting from a disaster-related CASPER were to educate the community on available resources (27; 72.9%) and provide services (18; 48.6%) such as debris removals and refills of medications. In preparedness CASPERs, the most common recommendations were to educate the community in disaster preparedness (5; 31.2%) and to revise or improve preparedness plans (5; 31.2%). Twenty-five (47.1%) CASPERs documented on the report or publications the public health action has taken based on the result or recommendations. Findings from 27 (50.9%) of the CASPERs conducted with CDC assistance were published in peer-reviewed journals or elsewhere. CONCLUSION: The number of CASPERs conducted with CDC assistance has increased and diversified over the past decade. The CASPERs' results and recommendations supported the public health decisions that benefitted the community. Overall, the findings suggest that the CASPER is a useful tool for collecting household-level disaster preparedness and response data and generating information to support public health action. Bayleyegn TM , Schnall AH , Ballou SG , Zane DF , Burrer SL , Noe RS , Wolkin AF . Use of Community Assessments for Public Health Emergency Response (CASPERs) to rapidly assess public health issues - United States, 2003-2012. Prehosp Disaster Med. 2015;30(4):1-8.
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