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Obesity Beats Adiposity For Cardiovascular Risk

Obesity contributes to cardiovascular risk no matter where a person carries the weight, concluded researchers after looking at outcomes for nearly a quarter-million people worldwide.

Body mass index, (BMI) waist circumference, and waist-to-hip ratio do not predict cardiovascular disease risk any better when physicians recorded systolic blood pressure, history of diabetes and cholesterol levels, researchers reported in The Lancet.

The research group used individual records from 58 prospective studies with at least one year of follow up. In each study, participants were not selected on the basis of having previous vascular disease. Each study provided baseline for weight, height, and waist and hip circumference. Cause-specific mortality or vascular morbidity were recorded according to well defined criteria.

Individual records included 221,934 people in 17 countries. In people with BMI of 20 kg/m2 or higher, hazard ratios for cardiovascular disease were 1.23 (95 percent CI, 1.17 to 1.29) with BMI, 1.27 (95 percent CI, 1.20 to 1.33) with waist circumference, and 1.25 (95 percent CI, 1.19 to 1.31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After adjusting for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding hazard rations were 1.07 (95 percent CI, 1.03 to 1.11) with BMI, 1.10 (95 percent CI, 1.05 to 1.14) with waist circumference, and 1.12 (95 percent CI, 1.08 to 1.15) with waist-to-hip ratio.

BMI, waist circumference, or waist-to-hip ratio did not importantly improve risk discrimination or predicted 10-year risk, and the findings remained the same when adiposity — the carrying of adipose tissue (fat) — measures were considered. Read more »

*This blog post was originally published at ACP Internist*

Nearly 12 Million Cancer Survivors In The U.S.

The number of cancer survivors in the United States increased to 11.7 million in 2007, according to a report released by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH). Women survive more often, and survive longer, according to the report.

There were 3 million cancer survivors in 1971 and 9.8 million in 2001. Researchers attributed longer survival to a growing aging population, early detection, improved diagnostic methods, more effective treatment and improved clinical follow-up after treatment.

The study, “Cancer Survivors in the United States, 2007,” is published today in the CDC’s Morbidity and Mortality Weekly Report.

To determine the number of survivors, the authors analyzed the number of new cases and follow-up data from NCI’s Surveillance, Epidemiology and End Results Program between 1971 and 2007. Population data from the 2006 and 2007 Census were also included. The researchers estimated the number of persons ever diagnosed with cancer (other than non-melanoma skin cancer) who were alive on Jan. 1, 2007. Read more »

*This blog post was originally published at ACP Internist*

5 Avoidable Air Travel Health Risks

For those of you planning air travel to your next medical conference (and ACP Internist isn’t too shameless to plug Internal Medicine 2011 — we hope to see you there), TIME reports that there are five health risks that are rare yet have recently happened. Tips on avoiding these maladies include:

E. Coli and MRSA on the tray table. Microbiologists found these two everywhere when they swabbed down flights. Bring your own disinfecting wipes.

Bedbugs in the seat. British Airways fumigated two planes after a passenger posted pictures online about her experience. Wrap clothes in plastic and wash them.

Sick seatmates. Everyone has experienced (or been) this person. Wash your hands.

Deep vein thrombosis (DVT). Tennis star Serena Williams experienced a pulmonary embolism, possibly related to recent foot surgery. But DVT can happen to anyone restrained to a cramped position for long periods of time. Move around in-flight (but not during the beverage service, of course.)

Dehydration. Dry cabin air may make it more difficult to fight off infections. Drink more water.

*This blog post was originally published at ACP Internist*

Healthcare Reform Continues As Judge Relents

A federal judge who’d ruled healthcare reform was unconstitutional and that his decision as a federal judge was the equivalent of an injunction has relented. Healthcare reform can continue in the states, pending appellate and Supreme Court review.

“The sooner this issue is finally decided by the Supreme Court, the better off the entire nation will be,” wrote federal judge Roger E. Vinson, who’d decided that the healthcare reform act’s mandate that people buy insurance or face penalties overextended Congress’ powers under the commerce clause of the constitution.

One reason for granting a stay, despite his previous clear intent that healthcare reform cease, includes his statement (on page 18) that:

“Can (or should) I enjoin and halt implementation of the Act in a state where one of its federal courts has held it to be Constitutional? In addition, many of the plaintiff states have publicly represented that they will immediately halt implementation of the Act in light of my declaratory judgment, while at least eight plaintiff states (as identified by the defendants in their motion and reply) have suggested that, in an abundance of caution, they will not stop implementing the Act pending appeal. In addition to these apparent disagreements among the plaintiff states, there is even disagreement within the plaintiff states as to whether the implementation should continue pending appeal. For example, while the plaintiffs (a group that includes the Attorney General of Washington) have requested that I enjoin the defendants from implementing the Act, the Governor of Washington has just filed an amicus brief specifically opposing that request.”

The decision gives the Obama administration seven days to file an appeal against his decision, which a U.S. Department of Justice spokesperson said the administration intends to do. Read more »

*This blog post was originally published at ACP Internist*

CDC Campaign Hasn’t Slowed Inappropriate Antibiotic Use

issue brief 2011 02 coverHigh rates of inappropriate antibiotic use continued despite a 15-year campaign by the Centers for Disease Control and Prevention (CDC) aimed at Michigan physicians and consumers on the dangers of antibiotic overuse.

The Center for Healthcare Research & Transformation (CHRT) released an issue brief detailing overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members. (The project is a non-profit partnership between the University of Michigan and BCBSM.)

While antibiotic prescribing in adults decreased 9.3 percent from 2007 to 2009, it increased 4.5 percent for children during the same time period. The studies found significant differences in prescribing patterns between rural southeast Michigan and the rest of the state, particularly for children. Children in rural southeastern Michigan were prescribed an average of .93 antibiotics per year, while elsewhere children were prescribed an average of 1.0 per year.

“The continuing high rate of antibiotic use for viral infections in children and adults — particularly outside of southeast Michigan — is of great concern, as is the increase in the use of broad spectrum antibiotics in children,” said Marianne Udow-Phillips, CHRT’s director. “Using antibiotics when they are unnecessary — or treating simple infections with drugs that should be reserved for the most serious infections — are practices that contribute to antibiotic resistance, making future infections harder to treat.”

Nearly half (49.1 percent) of antibiotic prescriptions in the study population were for broad spectrum antibiotics in 2009, compared to the national rate of 47 percent. Between 2007 and 2009, prescriptions for what the National Committee for Quality Assurance calls “antibiotics of concern” declined slightly in adults, decreasing 0.4 percent during that time period. In the same time period, antibiotics of concern prescribed to children increased 3.4 percent, from 44.9 percent to 46.4 percent.

One possible explanation for the rising rate in children is a rise in resistant pathogens in ear infections, according to the study brief. Other possible reasons are that kids get different infections than adults, and that some drugs that are used in adults are not used for pediatric patients. Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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