Sunday, March 27, 2011

Journal/News Watch 3/27/11

People with asthma may have a higher risk of developing diabetes and heart disease, according to a new study that looked at the relationship between asthma and four other inflammatory conditions.

Health reform one year later: The haves and the have nots

HEPA Filters Reduce Cardiovascular Health Risks Associated with Air Pollution: Using inexpensive air filters may help reduce cardiovascular disease risk that results from exposure to air pollution, according to researchers from Canada, who studied healthy adults living in a small community in British Columbia where wood burning stoves are the main sources of pollution. The researchers found that high efficiency particle air (HEPA) filters reduced the amount of airborne particulate matter, resulting in improved blood vessel health and reductions in blood markers that are associated with an increased risk of cardiovascular disease. American Journal of Respiratory and Critical Care Medicine On-line.

Vitamin D's role in preventing cancer: The research is inconsistent and doesn't establish a cause–effect relationship. Other recent reviews have reached similar conclusions.. No large-scale randomized clinical trial of vitamin D has been completed with cancer as the primary prespecified outcome. Most evidence is derived from laboratory studies, ecologic correlations, and observational investigations of serum 25-hydroxyvitamin D levels in association with cancer outcomes. Although this serum measure is a useful marker of current vitamin D exposure, associational studies have important limitations. Specifically, low serum 25-hydroxyvitamin D levels are also linked with confounding factors related to higher cancer risk, including obesity (vitamin D becomes sequestered in adipose tissue), lack of physical activity (correlated with less time outdoors and less solar exposure), dark skin pigmentation (less skin synthesis of vitamin D in response to sun), and diet or supplementation practices. Reverse-causation bias may also occur if poor health reduces participation in outdoor activities and sun exposure or adversely affects diet, resulting in lower vitamin D levels. Association therefore cannot prove causation. Many micronutrients that seemed promising in observational studies (e.g., beta carotene, vitamins C and E, folic acid, and selenium) were not found to reduce cancer risk in randomized clinical trials, and some were found to cause harm at high doses. NEJM 3/23/11

In a study of more than 180,000 people, scientists saw the same number of deaths from cancer and heart disease among multivitamin-takers and those who did not take the supplements. Some small studies in the past have shown that specific vitamins, not multivitamins, may be protective against heart disease or cancer later in life. However these studies looked at undernourished people, not generally healthy adults like the U.S. population. On its web site, the U.S. National Institutes of Health advise that doctors should prescribe multivitamins only "for patients who need extra vitamins, who cannot eat enough food to obtain the required vitamins, or who cannot receive the full benefit of the vitamins contained in the food they eat." The researchers did not find that taking multivitamins hurts anyone. American Journal of Epidemiology, online February 22, 2011

In an unusual health study, researchers analyzing toxin levels in tens of thousands of toenail clippings determined that mercury from eating fish does not raise the risk of heart disease or stroke. Health experts have long urged people to eat fish to lower heart risks, but some have worried that the mercury in certain types of fish like shark and swordfish might offset any benefits. Earlier studies on mercury and heart problems in adults have yielded contradictory results. The latest government-funded work is the largest to look at this question. Instead of relying on what people said they ate, it measured mercury in their toenails — a good gauge of long-term exposure to the metal from fish consumption. No differences were seen in the rates of heart and stroke among those with the highest concentrations of mercury compared to those with the lowest. NEJM 3/23/11

Researchers found that the more people exercise, the less their blood pressure will rise in response to a high-salt diet. American Heart Association's meeting on nutrition, physical activity and cardiovascular disease

A study of 6,500 nurses and nurse managers across the United States, found that too often, nurses don't alert their colleagues when they see a safety measure being violated. About 85 percent of nurses said a safety measure had warned them about a problem that might have been missed and could have resulted in patient harm. However, 58 percent of these workers admitted that even though they received the warning, they failed to speak up and solve the problem. On the issue of shortcuts, more than 50 percent of the study participants said they had witnessed events in which dangerous shortcuts led to near misses or caused harm to patients, but only 17 percent of those nurses discussed their concerns with colleagues. Disrespect, was cited as the reason why more than half of the study participants could not get others to listen to them or value their professional opinion. Only 16 percent of those who felt ignored actually confronted their disrespectful colleague, the study noted. The findings show that while safety measures can help prevent medical errors, cultures of silence in U.S. hospitals may undermine their effectiveness, the researchers noted. American Association of Critical-Care Nurses, news release, March 22, 2011

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