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Doctor Housecalls Blog

Healthcare related news and updates



It has long been thought that environmental influences and lifestyle choices were risk factors for cancer incidence.  The Los Angeles Times (12/17, Healy) reports on a research study released this past month that confirms such a premise.  The study, published in Nature, indicates that a large majority of cancers are caused by extrinsic factors.  These are external factors such as cigarette smoking, obesity, ultraviolet radiation, and viruses.

This recent study seems to be at odds with controversial research released by a team at John’s Hopkins in January 2015.  That study seemed to indicate that most incidents of cancer were nothing more than bad luck.  As reported by STAT (12/17, Begley), researchers at Hopkins concentrated on intrinsic factors, concluding that two-thirds of cancers are due to cell division errors.

While the two studies seem to come to opposite conclusions, many believe that they both have merit.  In fact, it is possible that external elements can contribute to intrinsic risk factors, such as cell division.   According to a San Diego Union-Tribune (12/17, Fikes) report, the authors of the studies continue to debate their findings on the origins of certain cancers.   It is the opinion of most experts that both intrinsic and external factors play a role in cancer incidence.  Therefore, those patients who control their environmental factors will have a much more positive outcome overall.

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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



If you watch or read the news, you’ve probably read about the E. coli infections linked to the Chipotle restaurant chain.  While these outbreaks were large, with 52 people in nine states infected, they are merely the tip of the iceberg when it comes to foodborne illness outbreaks in the U.S.  According to a New York Times (12/15, Bakalar) report, the Centers for Disease Control’s (CDC) Morbidity and Mortality Weekly Report found that from 2010 to 2014, there were 120 multi-state foodborne infection outbreaks.  These outbreaks caused a total of 7,929 illnesses, 1,460 hospitalizations, and 66 deaths.

While these numbers are alarming, the Boston Globe (12/15, Rocheleau) reports that CDC data reflects a downward trend in the numbers.  The number of outbreaks actually peaked in 2000, with 1,405 cases reported.  Since then the numbers have leveled off to about 800 cases per year.  No one state had more outbreaks than another and imported foods account for only 18 percent of the outbreaks.  The main sources of the outbreaks are fruit, beef, sprouts, and vegetable row crops like lettuce.  Other contamination has come from dairy products, turkey, chicken, eggs, and fish.
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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



Approximately 33 million Americans have an alcohol problem, according to a new article on Time.com by Alexandra Sifferlin.  New data that has been compiled on the drinking behaviors of American adults shows that almost 14% have some type of alcohol related problem.

The DSM-5 handbook details a new definition of an alcohol problem, and a study published in JAMA Psychiatry looks at the pervasiveness of alcohol related problems based on this new definition.

According to the new parameters, a problem drinker is defined as someone who has 2 of 11 symptoms associated with drinking.  These symptoms include continuing to drink even if it harms relationships, negatively affects performance at work, and an inability to quit.  The number of symptoms a person has determines the severity of their problem.
The findings are based off of interviews from more than 36,000 people regarding their lifetime drinking habits.  The data shows that while 14% of people currently have a problem, 30% had a problem at one time in their life and most have never sought help (6/13, Sifferlin).

In an June 4 article on NPR.org, Alyson Hurt reports that alcohol disorders are most prevalent among men, Native Americans, young adults, and singles.  The problem is the worst among young adults, with more than 26% of those under 30 reporting that they had had trouble with drinking in the past year.

[author] [author_image timthumb=’off’]http://www.drhousecallsofpv.com/wp-content/uploads/2013/02/sjlphoto1sm.jpg[/author_image] [author_info]
Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 36 years. Steve Lipsky on Google Plus[/author_info] [/author]



New HPV Vaccine Results

A study released April 21, 2015 by the American Association for Cancer Research found that the HPV vaccine can protect against infection across multiple site on the body, even in women who have been infected in the past.

4186 women between the ages of 18 and 25 were vaccinated with either the HPV 16/18 vaccine or a control Heptatitis A vaccine.  The randomized controlled trial sought to determine if the HPV vaccine could protect women against oral, anal, and cervical HPV.

According to an April 21st Tmes article by Alexendra Stifferlin, “efficacy for the vaccine in all three sites was 83% among the women with no evidence of prior HPV exposure and infection, 58% among women with prior HPV exposure, and a 25% among women with active cervical HPV16/18 infection (the percentage was considered nonsignificant).”

Overall, the efficacy of the vaccine in all three sites was 65%, and 91% for two sites.  These results support the CDC’s recommendation for women up to age 26, and men up to age 21 to get the vaccine if they did not receive it at a younger age.



A new research study recently released indicates gender differences in risk factors related to sleep apnea.  The New York Times (10/20, D6, Bakalar) “Well” blog reports on a Circulation-published study by a group of Epidemiologists who examined sleep disorders and heart risk factors. The study looked at gender differences in the likelihood of the development of cardiovascular complications by measuring such things as troponin T, a protein that is released into the bloodstream when there is damage to the heart.

The study followed 752 men and 893 women over the course of 14 years and measured the incidence of obstructive sleep apnea (OSA) against incidents of coronary artery disease, heart failure, and death from cardiovascular disease.   The study found that OSA was independently associated with increased levels of troponin T, heart failure and incidents of death in women.  This was not the case with men.  Also, sleep apnea was found to be associated with an enlarged heart in women.



REPRINTED FROM the Arizona College of Emergency Physicians

Periodically, as the AzCEP Executive Team sees fit, we will forward alerts that we deem pertinent to you.

 

At the request of the Arizona Health Alert Network:

In late August, the Centers for Disease Control and Prevention (CDC) was notified by two states of an increase in children hospitalized with severe respiratory illness. Enterovirus D68 (EV-D68) was identified in many of these patients. There are now several other states reporting increases in admissions for severe respiratory illness. It is possible that these are also associated with EV-D68.

EV-D68 appears to spread via close contact (e.g., saliva, sputum, feces) with infected individuals. Currently, there is no vaccine to prevent EV-D68 and no specific antiviral treatment recommended.

However, patients can help protect themselves and others from respiratory illnesses by:
o avoiding close contact with people who are sick;
o avoiding touching eyes, nose, and mouth with unwashed hands;
o washing hands often with soap and water, especially after changing diapers;
o cleaning/disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick;
o ensuring vaccinations, including the influenza vaccine, are up to date.

Clinicians should be aware of EV-D68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to their local public health agency: http://www.azdhs.gov/phs/oids/contacts.htm.

Please refer to this MMWR for more detailed information: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm

Thank you,
Arizona Health Alert Network



The research is in and experts are speaking out. The verdict…let your teens sleep!

Doctors are urging middle schools and high schools to delay the start of classes to help students get the sleep they need to effectively learn and grow. The nation’s largest group of pediatricians is weighing in on the issue. USA Today (8/25, Healy) reports the American Academy of Pediatrics published a statement online in Pediatrics saying to delay “the start of high school and middle school classes to 8:30 a.m. or later is ‘an effective countermeasure to chronic sleep loss’ and the ‘epidemic’ of delayed, insufficient, and erratic sleep patterns among the nation’s teens.” US Education Secretary Arne Duncan and other major health organizations including the American Medical Association and the Centers for Disease Control and Prevention, are also weighing in, highlighting insufficient sleep in adolescents as a serious health risk.

USA Today (8/25, Healy) goes on to explain multiple negative factors that are cited as interfering with a teen’s ability to get enough sleep including biological changes associated with puberty, extracurricular activities, after-school jobs, homework, lifestyle choices, and academic demands. Due to the increased demands, high school seniors were getting an average of less then seven hours of sleep a night. Dr. Judith Owens, director of sleep medicine at Children’s National Medical Center in Washington, a lead author of the AAP statement, cites several consequences resulting from a lack of sleep including increased risk for obesity, stroke and type 2 diabetes; increased risk for anxiety and depression; higher rates of automobile accidents; and lower academic achievement to name a few. By pushing back the school start times teen’s can achieve the optimal level of sleep needed, between 8 ½ to 9 ½ hours a night.

The complexity of the issue is addressed by NBC News (8/25, Fox, Edwards). “It’s a complex issue with school boards, educators and parents struggling to balance bus schedules, after-school activities and, for older students, work schedules.” Regardless of the inconveniences, Dr. Owens says “the AAP is both promoting the compelling scientific evidence that supports school start time delay as an important public health measure, and providing support and encouragement to those school districts around the country contemplating (the change).’”

The story was also covered by Reuters (8/25, Seaman) and the Wall Street Journal (8/25, Reddy, Subscription Publication).


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