Cognitive function not improved by lowered homocysteine levels
A study published in The New England Journal of Medicine reports that the reduction of elevated plasma homocysteine concentrations with B vitamin supplements doesn't decrease the risk of dementia or improve cognitive function. New Zealand researchers observed 276 healthy patients age 65 and older with homocysteine levels of 13 micromoles/L or more. A vitamin supplement (composed of 1,000 mcg of folate, 500 mcg of B12, and 10 mg of B6) or placebo was administered to patients daily, and patients' cognitive function was tested periodically over the next 2 years. The homocysteine levels of those receiving the vitamin supplement decreased by an average of 4.36 micromoles/L, compared to the placebo group. However, cognitive function didn't improve among patients in the vitamin group; actually their cognitive scores lowered over time. These results appear to contradict theories linking homocysteine to dementia, indicating that homocysteine should be considered an indicator for disease rather than a risk factor.
Source: Kerr M. Lowering homocysteine does not improve cognitive function. Reuters Health.
Available at: http://www.reutershealth.com/archive/2006/06/29/professional/links/20060629clin0. Accessed October 13, 2006.
Infection control concerns revealed in survey
The 2006 Study of Needlestick Injuries and Safety Devices, an independent survey of 147 directors of infection control (DICs) and 188 nurses, reports that 64% of nurses have had needlestick injuries (NSIs) on the job, and 47% have been stuck by a contaminated needle. Nurses and DICs agree that these incidents are underreported, citing a variety of reasons, including lack of time to report and follow-up on NSIs, and fear of workplace consequences. Both groups are concerned by the frequency of NSIs and believe that retro-fitted safety syringes, currently 95% of the sharps market, aren't effectively protecting healthcare workers. Among many suggestions for improvement are calls for safety features that are integral to the syringe's original design and that enable a one-handed technique.
Source: Nurses.com. Needlestick injuries continue to cause significant concern for healthcare workers according to national study. Available at: http://www.nurses.com/content/news/article.asp?docid={822a92f2-7164-4bf6-a7f6-cc}. Accessed October 13, 2006.
Adult diabetics' risk for CVD increases with age
Current guidelines recommend that all adults with diabetes receive the same efforts for reduction of cardiovascular disease (CVD) risk, regardless of age. However, new findings suggest that adult diabetics have a similar risk of CVD as nondiabetics who are 15 years older, and that diabetic patients don't progress from moderate to high risk until middle age. A recent population-based study examined the residential databases of medical facilities in Ontario, Canada, between April 1994 and March 2000, monitoring the cases of more than 9 million patients, all over the age of 20. Of the patients observed, 379,003 had diabetes. Nearly 600,000 patients, among them 104,702 diabetic patients, had died or suffered a cardiovascular event by the study's end. Mortality and myocardial infarction rates were two to four times higher overall among diabetic patients. The research team encourages more intensive treatment strategies for diabetic patients over the age of 40.
Source: Reuters Health. Increased cardiovascular risk not seen in young diabetics. Available at: http://www.reutershealth.com/archive/2006/06/29/professional/links/20060629epid0. Accessed October 13, 2006.
C-reactive protein levels indicate prognosis after stroke
Findings reported in Stroke suggest that an elevated level of C-reactive protein (CRP) indicates an unfavorable outcome for patients receiving tissue plasminogen activator (tPA) therapy following stroke. These findings stem from a study of ischemic stroke patients, whose CRP levels were recorded prior to their treatment with tPA therapy. At 3-month follow-up, the 132 surviving patients had lower CRP levels than the 19 patients who died, averaging 0.53 and 0.85 mg/dL, respectively. Age was also considered an indicator for mortality rates. Researchers found that early treatment had little to no effect on the final prognosis of patients with elevated CRP.
Source: Douglas D. Early CRP predicts mortality in stroke thrombolysis candidates. Reuters Health. Available at: http://www.reutershealth.com/archive/2006/05/29/professional/links/20060529clin0. Accessed October 13, 2006.
Risk of BPH increased by metabolic factors
The risk of benign prostatic hyperplasia (BPH), already a widespread health problem, is increased by metabolic conditions such as obesity, elevated fasting plasma glucose concentration, and diabetes. Investigating the association between BPH and metabolic factors, examiners measured the prostate volumes of 422 men between the ages of 27 and 84, of whom 91 (21.6%) had enlarged prostates. These men tended to have a higher body mass index than those with normal-sized prostates. In addition, BPH was twice as common among men with diabetes and three times as likely among those with elevated fasting blood glucose levels. Obese men had the highest risk for BPH, 3.5 times that of the study's other participants. Researchers are hopeful that further study will clarify the association between metabolism and BPH.
Source: Boggs W. Metabolic factors increase benign prostatic hyperplasia risk. Reuters Health. Available at: http://www.reutershealth.com/archive/2006/07/27/professional/links/20060727epid0. Accessed October 13, 2006.
Oophorectomy decreases cancer risk for BRCA carriers
Women carrying the BRCA1 or BRCA2 mutation who undergo prophylactic oophorectomy are at an estimated 80% reduced risk for cancers of the ovaries, fallopian tubes, and peritoneum, as reported in the Journal of the American Medical Association. In the study, a team of researchers monitored 1,828 women with BRCA mutations until a cancer diagnosis, death, or the study's end. Of these women, 30% had already undergone prophylactic oophorectomy, 27% had the surgery during the course of the study, and 43% did not have the surgery at all. At follow-up, 50 incidences of cancer occurred, over half in women who didn't have preventive surgery. The majority of cancer diagnoses took place in women approximately 38 years of age. Based on these findings, BRCA carriers are encouraged to consider prophylactic oophorectomy as they near the age of 35 for the greatest reduction of cancer risk.
Source: Kerr M. Oophorectomy reduces cancer risk in BRCA carriers. Reuters Health. Available at: http://www.reutershealth.com/archive/2006/07/12/professional/links/20060712clin0. Accessed October 13, 2006.
Patient discomfort more common after late-afternoon surgery
Adverse effects related to anesthesia, such as pain and post-operative nausea, are more common following surgeries conducted after 3 p.m. Researchers assessed 90,159 surgeries performed over a 4-year period, discovering that incidence of nausea, wound infection, pain, or other adverse event was three times higher following late-afternoon surgeries than those performed earlier in the day. Thirty-one late-afternoon surgeries were marked by error, and 2,662 by adverse events during the procedure or after. These outcomes may be the effects of doctor fatigue, shift rotations, or administrative delays, all of which are more common during late afternoon. Patient stress, building up over the course of the day, is also a possible factor. A follow-up study will be conducted to examine the surgery process and determine which elements contribute to problems with afternoon surgery.
Source: Reuters Health. More problems seen with late-afternoon surgery. Available at: http://www.reutershealth.com/archive/2006/08/10/eline/links/20060810elin022.html. Accessed October 13, 2006.
Increased physical activity decreases PAD mortality
While most peripheral arterial disease (PAD) patients remain inactive, studies show that those patients who engage in daily physical activity decrease their risk of mortality and cardiovascular events. Examiners observed 460 patients over 57 months, beginning with a survey of current physical activity. A group of 225 patients were then monitored for 1 week with vertical accelerometers to measure physical activity. During the follow-up period, 134 patients died, including 75 patients from the accelerometer group. Patients with higher baseline levels of physical activity, such as walking or climbing flights of stairs, were found to have lower total mortality. Examiners advised encouraging all PAD patients to increase their physical activity.
Source: Reuters Health. Daily physical activity linked to lower peripheral arterial disease mortality. Available at: http://www.reutershealth.com/archive/2006/07/05/professional/links/20060705epid0. Accessed October 15, 2006.
Lower PSA threshold recommended for African American men
Among men with prostate cancer, African American patients appear to have a higher tumor volume than white patients, though both groups may have similar prostate-specific antigen (PSA) levels and preoperative prostate biopsy scores. Study findings, published in Cancer, report that following prostatectomy, Gleason scores were upgraded in 49% of African American men surveyed, versus 26% of white men. Based on these outcomes, researchers advise lowering the PSA threshold from the current standard of 4 to 2.5 ng/mL to improve the chances of effectively detecting and treating cancers, particularly among African American patients younger than age 65.
Source: Boggs W. Data support lower prostate specific antigen threshold for African American men. Reuters Health. Available at: http://www.reutershealth.com/archive/2006/08/09/professional/links/20060809clin0. Accessed October 13, 2006.
Hyperpyrexia in children likely to signal bacterial infection
Children presenting with unusually high body temperatures are at increased risk for serious bacterial infections or viral illnesses, according to findings published in Pediatrics. Over 2 years, researchers examined a total of 103 hyperpyrexic (defined as rectal temperature 106[degrees]F or higher) children, 19 of them with preexisting medical conditions, 84 without the condition. Of the total number, 18.4% were found to have a bacterial infection and 21.4% had a viral illness. Children with an existing illness were more likely to have a bacterial infection, 36.8% as compared with 15.5% of children without existing illness. Aside from this finding, no symptoms appeared to be specifically associated with either illness. Treatment with antibiotics is recommended for all hyperpyrexic children if no viral infection can be verified.
Source: Rauscher M. Hyperpyrexia warrants work up for bacterial infection: study. Reuters Health. Available at: http://www.reutershealth.com/archive/2006/07/05/professional/links/20060705clin0. Accessed October 13, 2006.