Science Weblog

A new analysis finds that when colorectal cancer patients seek out health information from the internet and news media, they are more likely to be aware of and receive the latest treatments for their disease. Published in the April 1, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that patients can influence their own treatment, in some cases in inappropriate ways.

In their review, authors led by Stacy Gray, M.D. of the Dana-Farber Cancer Institute in Boston note that in the last several decades, patients have become more involved in their health care as patient autonomy has become increasingly important. That change has been accompanied by unprecedented growth in the amount of health information available to patients. Studies show nearly four out of ten of cancer patients seek cancer information on the internet. But the authors say it is unclear how these phenomena influence a cancer patient’s treatment.

Dr. Gray and colleagues from the NCI Center of Excellence in Cancer Communication Research at the University of Pennsylvania Annenberg School designed a study to examine the relationship between information-seeking among 633 colorectal cancer patients chosen at random from the Pennsylvania Cancer Registry and the use of novel new agents for the disease. The investigators focused on the use of the targeted therapies bevacizumab (Avastin) and cetuximab (Erbitux) because of these drugs’ clinical importance, significant media coverage, and recent approval by the U.S. Food and Drug Administration.

Dr. Gray and her team hypothesized that there would be a relationship between information seeking and awareness of these targeted therapies among colorectal cancer patients. They also hypothesized that patients who seek information may ask their physicians about these targeted therapies and may be more likely to receive them than patients who do not seek information.

The researchers found that high levels of information seeking were strongly associated with both awareness of and receiving treatment using targeted therapies. Patients who sought information about treatments for colorectal cancer were 2.83 times more likely to have heard about targeted therapies and 3.22 times more likely to have received targeted therapies than people who did not seek information. These associations were present for patients with advanced disease where use of targeted therapies is FDA approved as well as for patients with early stages of the disease where their use is not FDA approved.

“These findings emphasize the importance of exploring patient influence on physician prescribing patterns and understanding the impact of information seeking on cancer outcomes,” the authors write.

Source: American Cancer Society

Washington, DC – A new study finds that kids who are allowed to watch R-rated movies are much more likely to believe it’s easy to get a cigarette than those who aren’t allowed to watch such films.

“We don’t know why this is so. It may have to do with a parenting style that is permissive of activities that are not age-appropriate. Or it may be an outcome of all the smoking scenes in R-rated movies,” says lead author of the study Chyke Doubeni, PhD, with the University of Massachusetts Medical School. The study appears in the February 21 issue of the American Journal of Preventive Medicine.

“But we do know that kids who believe it is easy to get a cigarette are at risk of smoking. Our prior research has already shown that kids who perceive cigarettes as readily accessible are more likely to end up as regular smokers,” Doubeni said.

The researchers found that parental permission to watch R-rated movies was one of the strongest predictors of the perception that cigarettes are available, about as strong as having friends that smoked. If allowed to watch R-rated films, nonsmokers were almost twice as likely, and smokers were almost three times as likely to say it would be easy for them to get cigarettes.

The researchers looked at data from the second Development and Assessment of Nicotine Dependence in Youth, a four-year study of 1246 sixth-grade students in Massachusetts who were interviewed 11 times from 2002 to 2006. Students were asked if they agreed or disagreed with the statement: “It would be easy for me to get a cigarette.” They were also asked “Is anybody allowed to smoke inside your home?” and “How often do your parents let you watch movies or videos that are rated R?”

The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.

“Parents need to be mindful about the movies their children watch for a variety of obvious reasons. This study points out one more reason for not allowing children to watch movies that are not appropriate for their age,” added co-author Dr. Joseph DiFranza with the University of Massachusetts Medical School.

The study also found that having a favorite tobacco advertisement was significantly associated with perceived accessibility, as was knowing the Joe Camel cartoon mascot for Camel cigarettes. Unsurprisingly, kids with parents who smoke or allow smoking in the home tended to think it would be very easy to obtain cigarettes.

“This implies that parental smoking likely contributes to youth smoking through increased perceived accessibility,” says Doubeni. “Parents need to understand that your kids are more likely to get cigarettes if you smoke, particularly if you smoke in the home or allow someone else to smoke in the home.”

Source: Substance Abuse Policy Research Program

Tampa, Fla. (Feb. 3rd, 2009) – Oral tissue engineering for transplantation to aid wound healing in mouth (oral cavity) reconstruction has taken a significant step forward with a Netherlands-based research team’s successful development of a gum tissue (gingival) substitute that can be used for reconstruction in the oral cavity. Their work was reported in the current issue of Cell Transplantation (17:10/11).

According to the study’s lead author, Dr. Susan Gibbs of the VU University Medical Centre in Amsterdam, skin substitutes have been far more advanced than oral gingiva substitutes and, until now, no oral tissue-engineered products have been available for clinical applications. The team was the first to develop an autologous (same patient) full thickness skin substitute that Dr. Gibbs says is “proving to be very successful.” However, they wanted to develop an autologous, full thickness oral substitute with the correct oral characteristics.

“Reconstructive surgery within the oral cavity is required during tumor excision, cleft palate repair, trauma, repair of diseased tissue and for generating soft tissue around teeth and dental implants,” explained Dr. Gibbs. “Drawbacks of using skin as an autograft material in the oral cavity include bulkiness, sweating and hair formation and the limited amount of donor tissue available.”

Their current study was aimed at constructing analogous, full-thickness oral substitutes in a similar manner to their skin substitute while maintaining the needed characteristics for successful oral transplantation. They used small amounts of patient oral tissue obtained from biopsies, then cultured and expanded the tissues in vitro over a three-week period.

Results of their study with a small number of patients showed that the gingiva substitute was “promising” and supported the need to carry out a larger patient study in the future.

“This study emphasized the importance of closely matching the donor site with the area to be transplanted,” said Dr. Gibbs. “Our results represent a large step forward in the area of clinical applications in oral tissue engineering which, until now, have lagged behind skin tissue engineering.”

“The reported study provides great encouragement in the clinical setting, for the ability to repair gingivitis and other gum diseases that affect a large number of people” said Dr. Amit Patel, a section editor of the journal Cell Transplantation.

Source: Cell Transplantation Center of Excellence for Aging and Brain Repair

Analysis in Journal of the American College of Surgeons shows newer method results in high costs and increased complications

CHICAGO (February 2, 2009) – New research published in the February issue of the Journal of the American College of Surgeons suggests that a traditional, “open” appendectomy may be preferable to a less-invasive laparoscopic appendectomy for the majority of patients with acute appendicitis, contrary to recent trends.

Approximately 250,000 appendectomies are performed in the United States each year to treat appendicitis, an inflammation of the appendix that is considered a medical emergency. If treatment is delayed, the appendix can rupture, causing infection and even death.

For almost a century, open appendectomy was the standard treatment for appendicitis, until the 1980s when laparoscopic appendectomy first gained popularity. This transition was based on data that suggested the operation, in which an instrument called a laparoscope is inserted through small incisions in the abdomen, was associated with reduced pain, faster recovery and better cosmetic results.

“The results of this study challenge the current trend toward increased use of laparoscopic appendectomy,” said Klaus Thaler, MD, FACS, department of surgery, University of Missouri, Kansas City. “Although laparoscopic surgery is associated with shorter hospital stays, it actually increases costs and may raise the risk of complications in the majority of appendectomy patients.”

This retrospective study examined 235,473 patients who underwent open or laparoscopic appendectomy between 2000 and 2005. Length-of-stay, costs and complications were assessed by stratified analysis for uncomplicated (n=169,094) and complicated (n=66,379) appendicitis. Regression methods were used to adjust for covariates and to detect trends.

The study demonstrated that the odds of having any kind of complication were significantly higher in the laparoscopic group among patients with uncomplicated appendicitis (p<0.05, odds ratio = 1.07), and that there was no difference among patients with complicated appendicitis (p=0.74). The only complications reduced by using the laparoscopic approach were infections in the uncomplicated group, and infections and pulmonary complications in the complicated group.

The adjusted costs for laparoscopic appendectomy were 22 percent higher in uncomplicated appendicitis and 9 percent higher in patients with complicated appendicitis (p<0.001). The increased expense for laparoscopic appendectomy are likely related to higher operating room costs, including greater expense for operative instruments and longer operative times. According to the study, laparoscopic appendectomy did result in a reduced length of hospital stay for both the uncomplicated and complicated groups (p<0.001 and p<0.0001, respectively).

Source: Weber Shandwick Worldwide

Analysis shows athletes aren’t the only ones who benefit from this practice

CHICAGO (February 2, 2009) – New research published in the February issue of the Journal of the American College of Surgeons shows a warm-up of 15 to 20 minutes with simple surgical exercises prior to an operation leads to a substantial increase in proficiency of surgical skills in surgeons of all experience levels. The researchers found that a warm-up of both psychomotor and cognitive skills raises surgeons’ alertness to a higher level for surgical procedures and improves performance for fatigued surgeons.

The advent of minimally invasive surgery has created new challenges for surgeons, requiring them to perform procedures with difficult-to-manipulate tools that constrain movement. Although new developments such as surgical robotics and more intuitive surgical instruments have addressed some of these issues, modern-day surgical practice often entails prolonged, strenuous cognitive performance as well.

“Warm-up exercises are a ‘common sense’ practice in many high-stakes professions, such as professional sports or dance,” said Kanav Kahol, Ph.D., department of biomedical informatics, Arizona State University, Tempe. “This study begins to lay a scientific foundation for adopting this approach in routine surgical practice, which has become increasingly rigorous and demanding.”

Forty-six surgeons across varying specialties and experience levels participated in the study. Subjects performed standardized exercises as a preoperative warm-up. Afterwards, the standardized exercises were repeated in randomized order to examine proficiencies in psychomotor and cognitive skills involved in surgical procedures. Proficiencies were measured by gesture-level proficiency, hand-movement smoothness, tool-movement smoothness, time elapsed and cognitive errors. Additionally, the researchers investigated generalizability of preoperative warm-up by following it with a different task, electrocautery simulation. They also examined the effect of the warm-up on fatigued participants based on their performance before and after night call.

The results showed statistically significant improvements after all of the post warm-up exercises (p<0.01) and across all experience levels. In addition, the warm-up exercises led to a significant increase in proficiency in follow-up electrocautery simulation (p<0.0001). There was also a significant improvement in performance of the fatigued group compared to baseline performance (p<0.05), although the surgeons in this group were still not able to reach optimal potential performance.

Source: Weber Shandwick Worldwide

Pitt researchers explore coverage gap in Health Affairs study and suggest policy change to protect seniors

PITTSBURGH, Feb. 3 – Beneficiaries enrolled in Medicare Part D who reached a gap in health care coverage known as the “doughnut hole” were much less likely to use prescription drugs than those with an employer-based plan, according to a University of Pittsburgh Graduate School of Public Health study. The findings, published in the Feb. 3 online issue of Health Affairs, raise concerns about health consequences and increased costs from hospitalizations and physician visits that may arise from lack of coverage. To protect seniors, the authors suggest a change in policy that would mandate the coverage of generic drugs in the doughnut hole through a modest increase in initial prescription co-pays.

Medicare Part D, which offers prescription drug coverage for Medicare beneficiaries, took effect in January 2006. A controversial aspect of its design is the doughnut hole, a gap in coverage of prescription drugs that in 2006 occurred when annual individual drug expenditures reached $2,250. The purpose of the annual spending cap is to keep the cost of the program within federally approved limits. Since its inception, “there have been few studies to tell us what happens to beneficiaries once they enter the doughnut hole,” said the study’s lead author, Yuting Zhang, Ph.D., assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health.

Dr. Zhang and colleagues compared two groups of senior citizens with Medicare drug coverage provided by a large Pennsylvania insurer in 2006. One group was covered through more generous employer-sponsored plans with full coverage in the doughnut hole and the other was covered through Medicare Advantage prescription drug plans (MA-PD) with either no doughnut hole drug coverage or generic coverage only.

They found that one in four (25 percent) of Pennsylvanians enrolled in an MA-PD reached the doughnut hole, but only one in 20 (5 percent) of that subset of individuals went on to reach the catastrophic phase of coverage – when annual drug spending reached $5,100 and Part D coverage of drugs resumed.

In addition, Medicare beneficiaries who lacked coverage in the doughnut hole reduced their monthly prescriptions by 14 percent per month once they entered the doughnut hole. Those with generic coverage in the doughnut hole decreased their monthly prescriptions by only 3 percent, and those who were enrolled in employer-based plans had no changes in monthly prescriptions when they reached the doughnut hole spending level.

The study also found that Medicare beneficiaries with diabetes were more likely to reach the doughnut hole than those with hypertension, and they reached it sooner. Those with more than one chronic illness also were much more likely to reach the doughnut hole – 34 percent with both hypertension and diabetes reached it, and 61 percent of those with hypertension, hyperlipidemia, congestive heart failure and diabetes did so.

“Our findings raise concerns about whether people with chronic illnesses who lack doughnut hole coverage are able to effectively manage their conditions,” said Dr. Zhang. “Without needed prescriptions, we could potentially see an increase in hospital and physician costs.”

To fill the gap, Dr. Zhang and colleagues suggest mandating the coverage of generic drugs in the doughnut hole and off-setting government costs by allowing plans to assess larger co-pays on prescription drugs prior to entering the doughnut hole. Increasing the current initial 25 percent co-pay by 6 to 9 percentage points, they suggest, would finance generic drug coverage in the doughnut hole with up to $10 co-pay for each monthly prescription, thus providing needed protection to seniors who would otherwise face a gap in coverage.

Source: University of Pittsburgh Schools of the Health Sciences

PHILADELPHIA – Vacationing at the shore led to a 5 percent increase in nevi (more commonly called “moles”) among 7-year-old children, according to a paper published in Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Number of nevi is the major risk factor for malignant melanoma, the most dangerous form of skin cancer. Melanoma rates have been rising dramatically over recent decades. More than 62,000 Americans are diagnosed with melanoma each year and more than 8,000 die.

The study was conducted among children who lived in Colorado, but lead author Lori Crane, Ph.D., M.P.H., chair of the Department of Community and Behavioral Health at the Colorado School of Public Health, said the findings are applicable worldwide.

“Parents of young children need to be cautious about taking their kids on vacations that are going to be sun-intensive at waterside locations, where people are outside for whole days at a time in skin-exposing swimsuits,” said Crane.

Crane said parents often mistakenly believe that sunscreen is a cure-all. Although it does offer some protection, the likelihood is that children stay out in the sun longer, thus increasing their risk.

“We recommend that, for young children, parents keep the kids involved in indoor activities from 10:00 a.m. to 4:00 p.m. to decrease risk, or if they are to be outside, that they wear shirts with sleeves,” said Crane.

Crane and colleagues examined 681 white children born in 1998 who were lifetime residents of Colorado. Vacation histories were assessed by interview and skin exams were used to evaluate the development of nevi.

Researchers observed that each waterside vacation one or more years prior to the exam at age 7 was linked to a 5 percent increase in nevi, or skin moles, less than two mm. “Daily sun exposure at home did not seem to be related to the number of moles, while waterside vacations were. Vacations may impart some unique risk for melanoma,” said Crane.

Crane and colleagues also found that young boys had a 19 percent higher risk than young girls for nevi development. “This may be due to an increased likelihood among boys to want to stay outdoors,” said Crane.

Finally, higher incomes were associated with greater risk, as those with higher incomes were more likely to take waterside vacations.

Source: American Association for Cancer Research

Chevy Chase, MD— Growth hormone treatment for six months after weight loss surgery reduces patients’ losses in lean body mass and skeletal muscle mass, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Weight loss surgery techniques, such as gastric banding, have been shown to be effective in reducing body weight and obesity-related diseases, such as diabetes. Although the results of these procedures are widely beneficial, there are some complications. Following surgery, patients are at risk of losing needed lean body mass and skeletal muscle mass due to the serious complications associated with rapid and sustained weight loss. This new study investigated whether growth hormone treatment could prevent or reduce these losses.

“Besides its more commonly known effect on linear growth during childhood, growth hormone benefits body composition throughout life by increasing muscle mass and reducing fat mass,” said Dr. Silvia Savastano, M.D., Ph.D., researcher at University Federico II of Naples in Italy and lead author of the study. “The results of our study show that the use of short-term treatment with growth hormone during a standardized program of low calorie diet and physical exercise is effective in reducing the loss of muscle mass and increasing the loss of fat mass after bariatric surgery.”

In this study, Dr. Savastano and her colleagues evaluated women who underwent laparoscopic-adjustable silicone gastric banding surgery and were diagnosed with growth hormone deficiency after the procedure. These women were divided into two groups where both groups participated in a standardized diet and exercise program, but only one group also received growth hormone. After a follow-up period of six months, women receiving growth hormone experienced a significant decrease of fat mass and an increase in lean body and skeletal muscle mass.

“This evidence opens a new frontier for growth hormone therapy in the management of morbidly obese patients,” said Dr. Savastano. “However, growth hormone treatment can be costly and a careful cost-benefit analysis that also takes into account the cost of commonly used therapy for management of morbidly obese patients is needed.”

Source: The Endocrine Society

Chevy Chase, MD—Vitamin D is significantly associated with muscle power and force in adolescent girls, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

Although vitamin D is naturally produced in the body through exposure to direct sunlight, vitamin D deficiency has become widely common in the United States. Vitamin D deficiency has been shown to have a significant negative impact on muscle and bone health, and can lead to conditions including osteoporosis and rickets.

“We know vitamin D deficiency can weaken the muscular and skeletal systems, but until now, little was known about the relationship of vitamin D with muscle power and force,” said Dr. Kate Ward, Ph.D., of the University of Manchester in the U.K., and lead author of the study. “Our study found that vitamin D is positively related to muscle power, force, velocity and jump height in adolescent girls.”

For this study, researchers followed 99 adolescent girls between the ages of 12 and 14 years. Dr. Ward and her colleagues took blood samples to measure the girls’ serum levels of vitamin D. Many of these girls were found to have low levels of vitamin D despite not presenting any symptoms.

Researchers used a novel outcome measure called jumping mechanography to measure muscle power and force. Jumping mechanography derives power and force measurements from a subject’s performance in a series of jumping activities. Dr. Ward says this method of testing is ideal as the muscles required to jump are those most often affected in subjects with vitamin D deficiency. Girls without vitamin D deficiency performed significantly better in these tests.

“Vitamin D affects the various ways muscles work and we’ve seen from this study that there may be no visible symptoms of vitamin D deficiency,” said Dr. Ward. “Further studies are needed to address this problem and determine the necessary levels of vitamin D for a healthy muscle system.”

Source: The Endocrine Society

A team of Monash University researchers led by Professor James Whisstock has made a major breakthrough in the international fight against malaria, which claims the life of a child across the world every 30 seconds.

The research, performed in collaboration with Professor John Dalton at the University of Technology, Sydney, provides a new approach to treating and controlling the disease that is contracted by half a billion people and causes around 1 million deaths a year.

The team, based at the Monash University ARC Centre of Excellence in Structural and Functional Microbial Genomics, has been able to deactivate the final stage of the malaria parasite’s digestive machinery, effectively starving the parasite of nutrients and disabling its survival mechanism. This process of starvation leads to the death of the parasite.

Professor Whisstock said the results had laid the scientific groundwork to further develop a specific class of drugs to treat the disease.

“About forty percent of the world’s population are at risk of contracting malaria. It is only early days but this discovery could one day provide treatment for some of those 2.5 billion people across the globe,” Professor Whisstock said.

“Drug-resistant malaria is an ever increasing problem, meaning that there is an urgent requirement to develop new therapeutic strategies.”

Researchers used the Australian Synchrotron, located adjacent to Monash University’s Clayton campus. The results are published today in the prestigious Proceedings of the National Academy of Sciences U.S.A.

Lead author of the research paper, Dr Sheena McGowan, from the Monash University NHMRC program on protease systems biology said their findings prove their concept.

“We had an idea as to how malaria could be starved and we have shown this, chemically, can be done,” Dr McGowan said.

“A single bite from an infected mosquito can transfer the malaria parasite into a human’s blood stream. The malaria parasite must then break down blood proteins in order to obtain nutrients. Malaria carries out the first stages of digestion inside a specialised compartment called the digestive vacuole – this can be considered to be like a stomach. However, the enzyme we have studied (known as PfA-M1), which is essential for parasite viability, is located outside the digestive vacuole meaning that it is easier to target from a drug perspective.”

This breakthrough is in addition to existing malaria drug discovery research advances at Monash University. A new drug candidate which aims to provide a single dose cure, discovered by a major international project involving the Monash Institute of Pharmaceutical Sciences, is currently progressing to first human studies with support from the Medicines for Malaria Venture, Geneva, Switzerland.

Source: Monash University