Tuesday, February 28, 2012

From U Conn: Ethical considerations in alleged dermatologic malpractice


Clin Dermatol. 2012 Mar;30(2):174-80.
Ethical considerations in alleged dermatologic malpractice.
Anderson J, Kels BD, Grant-Kels JM.
Department of Dermatology, University of Connecticut Health Center, 21 South Road, Farmington, CT 06030-6231, USA.

Although dermatology does not lead the list of specialties most commonly sued for malpractice, anyone who has been the recipient of a malpractice claim is often traumatized both personally and professionally. Every day dermatologists must address various ethical concerns that have legal implications. Herein, we chose to discuss the following such issues: (1) the ethical and legal necessity of submitting a clinically benign appearing lesion for dermatopathologic review; (2) the ethical and legal considerations regarding frequency of screening after a patient has been diagnosed with melanoma; (3) the multiple ethical and legal considerations involved with the misdiagnosis of a melanoma; (4) the complex ethical and legal considerations of a dermatologist making a clinical diagnosis in a nonprofessional social and public setting; and (5) the ethical and legal implications of sharing care of patients with other dermatologists and specialists.

From U Florida: Preparing the psychology workforce for health care reform


J Clin Psychol Med Settings. 2012 Feb 14. [Epub ahead of print]
Health Care Reform: Preparing the Psychology Workforce.
Rozensky RH.
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 100165, Gainesville, FL, 32610, USA, rozensky@phhp.ufl.edu.

This article is based on the opening presentation by the author to the Association of Psychologists in Academic Health Centers' 5th National Conference, "Preparing Psychologists for a Rapidly Changing Healthcare Environment" held in March, 2011. Reviewing the patient protection and affordable care act (ACA), that presentation was designed to set the stage for several days of symposia and discussions anticipating upcoming changes to the healthcare system. This article reviews the ACA; general trends that have impacted healthcare reform; the implications of the Act for psychology's workforce including the growing focus on interprofessional education, training, and practice, challenges to address in order to prepare for psychology's future; and recommendations for advocating for psychology's future as a healthcare profession.

From U Sydney and U New South Wales: Human rights and compulsory treatment


Aust N Z J Psychiatry. 2012 Feb 21. [Epub ahead of print]
Rising to the Human Rights Challenge in Compulsory Treatment - new Approaches to Mental Health law in Australia.
Callaghan S, Ryan CJ.
University of Sydney and University of New South Wales, Sydney, Australia.

To analyse, and explain to Australasian psychiatrists, recent proposed changes to the terms of coercive treatment for mental illness in Tasmania and Victoria and to place the proposals in the context of a broader human rights framework that is likely to impact the future shape of mental health legislation more generally.

The Australian law reform proposals are reviewed against the requirements of numerous human rights instruments, including the recently ratified United Nations Convention on the Rights of Persons with Disabilities. Ethical and legal arguments are made to support the proposed changes and to introduce others, taking into account academic commentary on mental health law and recent empirical work on the ability to usefully categorise patients by their likelihood of harm to self and others.

The Victorian and Tasmanian draft mental health bills propose a new basis for compulsory psychiatric treatment in Australasia. If they become law, coercive psychiatric treatment could only be applied to patients who lack decision-making capacity. The Tasmanian draft bill also sets a new benchmark for timely independent review of compulsory treatment. However both jurisdictions propose to retain an 'additional harm' test which must be satisfied before patients may be treated without consent. This differs from non-psychiatric cases, where if patients are unable to consent to medical treatment for themselves, they will be entitled to receive coercive treatment if it is in their best interests.

The proposed changes under the Tasmanian and Victorian draft mental health bills will ensure that, in line with local and international human rights obligations, only patients who lack decision-making capacity may be coercively treated for mental illness. However the continuing 'additional harm' criteria may breach human rights obligations by imposing a discriminatory threshold for care on patients who are unable to consent to treatment for themselves. This could be avoided by replacing the 'additional harm' test with a 'best interests' test.

"The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury"


Addiction. 2012 Jan 11. doi: 10.1111/j.1360-0443.2012.03793.x. [Epub ahead of print]
Multi-Level Analysis of Alcohol-Related Injury and Drinking Pattern: Emergency Department Data from 19 Countries.
Cherpitel CJ, Ye Y, Bond J, Borges G, Chou P, Nilsen P, Ruan J, Xiang X.
Alcohol Research Group, 6475 Christie Avenue Suite 400, Emeryville, CA 94608 USA Universidad Autonoma Metropolitana, Instituto Nacional de Psiquiatria, Tlalpan, Mexico DF, MEXICO National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA Linköping University, Linköping, SWEDEN National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA Central South University, Changsha, Hunan, CHINA.

While drinking in the event is an important factor in injury occurrence, pattern of usual drinking may also be important in risk of injury. Explored here is the relationship of an alcohol-related injury with individual usual drinking pattern.

Alcohol-related injury is examined using Hierarchical Linear models, taking into account individual usual volume of consumption over the past 12 months, as well as aggregate-level detrimental drinking pattern (DDP) and alcohol policy measures. Setting Data analyzed are from emergency departments (EDs) in 19 countries, comprising three collaborative studies on alcohol and injury, all of which used a similar methodology.

The sample consists of 14,132 injured drinkers across 46 ER studies.

Alcohol-related injury was measured, separately, by any self-reported drinking prior to injury, a blood alcohol concentration (BAC) ≥.08, and self-reported causal attribution of injury to drinking.

While individual usual volume strongly predicted an alcohol-related injury for all three measures, usual drinking pattern also predicted an alcohol-related injury (controlling for volume), with episodic heavy and frequent heavy drinking both more predictive of alcohol-related injury than other drinking patterns. When individual usual volume and drinking pattern were controlled, DDP was no longer a significant predictor of alcohol-related injury. Alcohol policy measures were predictive of both BAC and causal attribution (the stronger the policy the lower the rates of alcohol-related injury).

Volume of alcohol typically consumed and occurrence of heavy drinking episodes are independently associated with incidence of alcohol-related injury. The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury.

From Rush U: Colonic microbiome is altered in alcoholism


Am J Physiol Gastrointest Liver Physiol. 2012 Jan 12. [Epub ahead of print]
Colonic microbiome is altered in alcoholism.
Mutlu EA, Gillevet PM, Rangwala H, Sikaroodi M, Naqvi A, Engen PA, Kwasny M, Lau CK, Keshavarzian A.
1Rush University Medical School.

Several studies indicate the importance of colonic microbiota in metabolic and inflammatory disorders and importance of diet on microbiota composition. The effects of alcohol, one of the prominent components of diet, on colonic bacterial composition is largely unknown. Mounting evidence suggests that gut-derived bacterial endotoxins are co-factors for alcohol-induced tissue injury and organ failure like alcoholic liver disease (ALD) that only occur in subset of alcoholics .We hypothesized that chronic alcohol consumption results in alterations of the gut microbiome in a sub-group of alcoholics and this may be responsible for the observed inflammatory state and endotoxemia in alcoholics. Thus, we interrogated the mucosa associated colonic microbiome in 48 alcoholics with and without ALD as well as 18 healthy subjects.

Colonic biopsy samples from subjects were analyzed for microbiota composition using Length Heterogeneity PCR (LH-PCR) fingerprinting and Multitag Pyrosequencing (MTPS).

A sub-group of alcoholics have an altered colonic microbiome (dysbiosis). The alcoholics with dysbiosis had lower median abundances of Bacteroidetes and higher ones of Proteobacteria. The observed alterations appear to correlate with high levels of serum endotoxin in a subset of the samples. Network topology analysis indicated that alcohol use is correlated with decreased connectivity of the microbial network and this alteration is seen even after an extended period of sobriety.

We show that the colonic mucosa associated bacterial microbiome is altered in a subset of alcoholics. The altered microbiota composition is persistent and correlates with endotoxemia in a sub-group of alcoholics.

Alcohol milestones, risk factors, and religion/spirituality in young adult women


J Stud Alcohol Drugs. 2012 Jan;73(1):34-43.
Alcohol milestones, risk factors, and religion/spirituality in young adult women.
Haber JR, Grant JD, Jacob T, Koenig LB, Heath A.
Palo Alto Veterans Affairs Health Care System, Menlo Park, California 94025, USA.

The alcoholism research literature has long reported a significant, reliable, and inverse association between alcohol use disorders and religion/spirituality (R/S), and this is also evident in the period of highest risk--adolescence and young adulthood. In the treatment area, both clinical and mutual-help programs for alcohol use disorders often include a spiritual component, and outcome studies validate the efficacy of such programs. Even so, the alcoholism-R/S relationship is little understood.

The current study examined data from an existing sample of 4,002 female adolescents/young adults and their families. Data analyses examined five demographic, nine R/S, and eight risk-factor variables as predictors of five alcohol milestones: initial drink, first intoxication, regular use, heavy consumption, and alcohol dependence.

Results affirmed the known association between alcoholism risk factors and alcohol use milestones and also found moderate to strong associations between most R/S variables and these risk factors and milestones. A multivariate model simultaneously examining both sets of variables found that specific risk factors and specific R/S variables remained significant predictors of alcohol use milestones after accounting for all other variables. Mediation and moderation tests did not find evidence that R/S accounted for or qualified the relationship between alcohol risk factors and alcohol milestones.

This study confirmed the multidimensional role of R/S influences within the etiological network of alcoholism risk and protective factors in adolescents/young adults and found R/S dimensions to be independent and substantial influences on alcohol use disorders rather than mediators or moderators of other risks.

Screening for unhealthy alcohol drinkers among surgical patients


J Stud Alcohol Drugs. 2012 Jan;73(1):126-33.
Use of the screening suggested by the National Institute on Alcohol Abuse and Alcoholism and of a newly derived tool for the detection of unhealthy alcohol drinkers among surgical patients.
Agabio R, Gessa GL, Montisci A, Finco G, Contu P, Bedogni G, Marchi A.
Bernard B Brodie Department of Neuroscience, University of Cagliari, Monserrato, CA, Italy. agabio@unica.it

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed a two-question tool for the detection of unhealthy drinking (NIAAA-2Q) that investigates excessive alcohol consumption per single occasion. NIAAA-2Q can be commuted into a four-question tool (NIAAA-4Q) by the addition of two questions aimed at investigating excessive weekly alcohol intake. NIAAA-2Q and NIAAA-4Q may prove useful in busy settings such as an anesthesiological environment. However, to date, no study has evaluated their efficacy in a surgical setting. The purpose of this study was to evaluate the accuracy of NIAAA-2Q and NIAAA-4Q in detecting unhealthy drinking among surgical patients using the more complex Alcohol Use Disorders Identification Test (AUDIT) comprising 10 questions as the criterion method.

NIAAA-4Q and AUDIT were administered to 200 surgical patients by three anesthetists.

A total of 23.5%, 12.5%, and 28.5% surgical patients were unhealthy drinkers according to AUDIT, NIAAA-2Q, and NIAAA-4Q, respectively. NIAAA-2Q negative and positive predictive values were 0.78 and 0.36, respectively, and positive and negative likelihood ratios were 1.80 and 0.90, respectively. NIAAA-4Q negative and positive predictive values were 0.93 and 0.65, respectively, and positive and negative likelihood ratios were 6.00 and 0.24, respectively.

NIAAA-4Q demonstrated a better satisfactory agreement than NIAAA-2Q with AUDIT in detecting unhealthy alcohol drinking among surgical patients. These results suggest that the detection of unhealthy alcohol drinking may be increased by the administration of questions aimed at assessing the weekly average of alcohol intake. The modest time required for NIAAA-4Q administration is a major advantage in clinical practice with respect to AUDIT. Further research will compare NIAAA-2Q and NIAAA-4Q with other brief alcohol screening tests.

Sleep disturbance and alcoholism


Alcohol Alcohol. 2012 Mar;47(2):133-9. Epub 2012 Jan 4.
Sleep disturbance in alcoholism: proposal of a simple measurement, and results from a 24-week randomized controlled study of alcohol-dependent patients assessing acamprosate efficacy.
Perney P, Lehert P, Mason BJ.
Corresponding author: pascal.perney@chu-nimes.fr.

Sleep disturbance symptom (SDS) is commonly reported in alcoholic patients. Polysomnography studies suggested that acamprosate decreased SDS. We assessed this hypothesis by using data of a randomized controlled trial. As a secondary objective, we suggested and tested the validity of a simple measurement of SDS based on the Hamilton depression and anxiety inventory subset.

We re-analysed a multi-center study evaluating the efficacy of acamprosate compared with placebos on alcohol-dependent patients in concentrating on SDS change in time. The Sleep sum score index (SAEI) was built from check-lists on adverse effects reported at each visit and constituted our main endpoint. We also tested the validity of the short sleep index (SSI) defined by the four sleep items of the Hamilton depression and anxiety scales. Statistical analyses were conducted on an intention to treat basis.

A total of 592 patients were included, and 292 completed the 6-month trial. Compared with SAEI considered as our reference, the observed specificity and sensitivity of SSI were 91.6 and 87.6%. From 40.2% of patients experiencing SDS at baseline, this proportion decreased until 26.1% at M6 in the placebo group and 19.5% in the acamprosate group (relative risk placebo/acamprosate = 1.49, 95% confidence interval 1.10, 1.98, P = 0.04).

Treating alcoholic patients to enhance abstinence has a beneficial effect in reducing SDS, and the duration of abstinence during the treatment constitutes the main positive factor. An additional effect of acamprosate is conjectured from its effect on the glutamatergic tone. The SSI constitutes a simple, reasonably sensitive and specific instrument tool to measure SDS.

Small intestinal malabsorption in chronic alcoholism


Scand J Gastroenterol. 2012 Jan 10. [Epub ahead of print]
Small intestinal malabsorption in chronic alcoholism: a retrospective study of alcoholic patients by the (14)C-d-xylose breath test.
B Hope H, Skar V, Sandstad O, Husebye E, Medhus AW.
Medical Department, Lovisenberg Diakonale Hospital , Oslo , Norway.

Abstract Objective. The (14)C-d-xylose breath test was used at Ullevål University Hospital in the period from 1986-1995 for malabsorption testing. The objective of this retrospective study was to reveal whether patients with chronic alcoholism may have intestinal malabsorption. Materials and methods. The consecutive (14)C-d-xylose breath test database was reviewed and patients with the diagnosis of chronic alcoholism were identified. (14)C-d-xylose breath test results of the alcoholic patients were compared with the results of untreated coeliac patients and patient and healthy controls. In the (14)C-d-xylose breath test, (14)C-d-xylose was dissolved in water and given orally after overnight fast. Breath samples were taken at 30-min intervals for 210 min, and (14)CO(2) : (12)CO(2) ratios were calculated for each time point, presenting a time curve for (14)C-d-xylose absorption. Urine was collected after 210 min and the fraction of the total d-xylose passed was calculated (U%). (14)CO(2) in breath and (14)C-d-xylose in urine were analyzed using liquid scintillation. Results. Both breath and urine analysis revealed a pattern of malabsorption in alcoholics comparable with untreated coeliac patients, with significantly reduced absorption of d-xylose compared with patient and healthy controls. Conclusion. Alcoholic patients have a significantly reduced (14)C-d-xylose absorption, comparable with untreated coeliac patients. This indicates a reduced intestinal function in chronic alcoholism.

From UNC: Models of chronic alcohol exposure and dependence


Methods Mol Biol. 2012;829:205-30.
Models of chronic alcohol exposure and dependence.
Knapp DJ, Breese GR.
Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. djkjas@med.unc.edu

Alcoholism is a chronic treatment-resistant disorder typically presenting with recurrent/cyclic periods of abusive drinking, withdrawal, abstinence, and relapse. Various strategies that attempt to model these processes in animals have been developed to elucidate the behavioral and neural processes underlying alcoholism. Many of these have involved chronic ethanol exposure and withdrawal with the most widely employed methods involving mice or rats. Prominent features of these methods include alcohol vapor or intragastric forced exposure, cyclic or intermittent periods of alcohol availability with various lengths of forced abstinence, voluntary consumption, the use of genetically alcohol-preferring animals, and inclusion of various pharmacological or environmental challenges to worsen or mitigate symptoms. This chapter emphasizes alcohol exposure and withdrawal and discusses representative metrics used to monitor the consequences of employing these methods. These include but are not limited to intensity and pattern of alcohol exposure, seizure sensitivity during withdrawal, and emotional responding.

Risk decision-making among youth at high risk for alcoholism


Alcohol Clin Exp Res. 2012 Jan 17. doi: 10.1111/j.1530-0277.2011.01650.x. [Epub ahead of print]
Risky Decision-Making: An fMRI Study of Youth at High Risk for Alcoholism.
Cservenka A, Nagel BJ.
From the Department of Behavioral Neuroscience (AC, BJN), Oregon Health & Science University, Portland, Oregon; and Department of Psychiatry (BJN), Oregon Health & Science University, Portland, Oregon.

Adolescents with a family history of alcoholism (FHP) are at risk for developing an alcohol use disorder (AUD), and some studies indicate that FHP individuals show deficits in executive functioning. The ability to make adaptive decisions is one aspect of successful executive functioning that is often measured during risk-taking tasks; however, this behavior has not been examined in FHP youth. As impaired decision-making could predispose FHP youth to make poor choices related to alcohol use, the current study examined the neural substrates of risk-taking in FHP adolescents and their family history negative (FHN) peers.

Thirty-one (18 FHP, 13 FHN) youth between 13 and 15 years old were included in this study. All youth had used little to no alcohol prior to study involvement. Functional magnetic resonance imaging was used to examine the neural substrates of risk-taking during the Wheel of Fortune (WOF) decision-making task (Ernst et al., 2004) in FHP and FHN youth.

FHP youth did not differ from FHN youth in risk-taking behavior, but showed less brain response during risky decision-making in right dorsolateral prefrontal cortex and right cerebellar regions compared with FHN peers.

Despite no behavioral differences on the WOF decision-making task, FHP youth exhibited atypical neural response during risk-taking compared with FHN peers. Atypical brain activity, in regions implicated in executive functioning could lead to reduced cognitive control, which may result in risky choices regarding alcohol use. This could help explain the higher rates of AUDs seen in FHP adolescents. Further examination of risky behavior and associated brain response over the course of adolescence is necessary to characterize the vulnerabilities of FHP youth in the absence of alcohol abuse.

Alcohol administration and HPA activity in low and high risk men


Addict Biol. 2012 Jan 19. doi: 10.1111/j.1369-1600.2011.00420.x. [Epub ahead of print]
Alcohol administration attenuates hypothalamic-pituitary-adrenal (HPA) activity in healthy men at low genetic risk for alcoholism, but not in high-risk subjects.
Mick I, Spring K, Uhr M, Zimmermann US.
Department of Psychiatry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany Max-Planck-Institute of Psychiatry, Germany.

Acute alcohol challenge studies in rodents and naturalistic observations in drinking alcoholics suggest that alcohol stimulates the hypothalamic-pituitary-adrenal (HPA) system. The literature on respective studies in healthy volunteers is more inconsistent, suggesting differential alcohol effects depending on dosage, recent drinking history, family history of alcoholism and alcohol-induced side effects. These papers and the putative pharmacologic mechanisms underlying alcohol effects on the HPA system are reviewed here and compared with a new study, in which we investigated how secretion of adrenocorticotrophin (ACTH) and cortisol is affected by ingestion of 0.6 g/kg ethanol in 33 young healthy socially drinking males with a paternal history of alcoholism (PHP) versus 30 family history negative (FHN) males. Alcohol and placebo were administered in a 2-day, double-blind, placebo controlled crossover design with randomized administration sequence. After administration of placebo, ACTH and cortisol decreased steadily over 130 minutes. In FHN subjects, secretion of both hormones was even more attenuated after alcohol, resulting in significantly lower levels compared with placebo. In PHP subjects, no alcohol effect on hormone secretion could be detected. The ratio of cortisol to ACTH secretion, each expressed as area under the secretion curve, was significantly increased by alcohol in FHN and PHP participants. These results argue against HPA stimulation being a mechanism that promotes the transition from moderate to dependent drinking. The fact that alcohol-induced HPA suppression was not detected in PHP males is consistent with the general concept that subjects at high risk for alcoholism exhibit less-pronounced alcohol effects.

From U Montreal: Cognitive deficits in alcoholism


Addict Biol. 2012 Jan 20. doi: 10.1111/j.1369-1600.2011.00418.x. [Epub ahead of print]
Widespread and sustained cognitive deficits in alcoholism: a meta-analysis.
Stavro K, Pelletier J, Potvin S.
Centre de Recherche Fernand-Seguin, Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada Hôpital Louis-H. Lafontaine, Canada.

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (<1 month), intermediate- (2 to 12 months) and long- (>1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.

From Harvard U: Marital and family therapy in alcoholism treatment


J Marital Fam Ther. 2012 Jan;38(1):122-44. doi: 10.1111/j.1752-0606.2011.00242.x. Epub 2011 Aug 30.
Review of outcome research on marital and family therapy in treatment for alcoholism.
O'Farrell TJ, Clements K.
VA Boston Healthcare System and Harvard Medical School.

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.

From UNC: Binge drinking and alcohol dependence


Alcohol Clin Exp Res. 2012 Feb;36(2):193-6. doi: 10.1111/j.1530-0277.2011.01734.x.
Commentary: studies on binge-like ethanol drinking may help to identify the neurobiological mechanisms underlying the transition to dependence.
Thiele TE.
Department of Psychology and Bowles Center for Alcohol Studies, University of North Carolina, Chapel Hill, North Carolina.

The goals of this commentary are to discuss the important contributions of the work by Kaur and colleagues titled "Corticotropin-releasing factor acting on corticotropin-releasing factor receptor type 1 is critical for binge alcohol drinking in mice," published in this issue of Alcoholism: Clinical and Experimental Research, and to highlight the importance of preclinical research aimed at identifying the neurobiology of binge ethanol drinking.

The work by Kaur and colleagues provides an important extension of previous pharmacological evidence implicating the corticotropin-releasing factor (CRF) type-1 receptor (CRF1R) in binge-like ethanol drinking by verifying the role of the CRF1R using genetic tools, and by establishing that CRF, but not urocortin 1 (Ucn1), is the primary neuropeptide associated with the CRF system that modulates binge-like ethanol drinking in C57BL/6J mice.

It is suggested that the evidence for a critical role of the CRF1R in excessive ethanol intake observed in both models of binge-like ethanol drinking and dependence-like ethanol intake indicates that overlapping mechanisms may be involved, and that studies that employ models of binge-like ethanol drinking may provide insight into the neurobiological mechanisms that underlie the transition to ethanol dependence

From the NIH: Correlates of recovery from alcohol dependence


Alcohol Clin Exp Res. 2012 Feb 6. doi: 10.1111/j.1530-0277.2011.01729.x. [Epub ahead of print]
Correlates of Recovery from Alcohol Dependence: A Prospective Study Over a 3-Year Follow-Up Interval.
Dawson DA, Goldstein RB, Ruan WJ, Grant BF.
Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland; Kelly Government Services, Bethesda, Maryland.

Correlates of recovery from alcohol dependence have been identified through a variety of study designs characterized by different strengths and limitations. The goal of this study was to compare correlates of recovery based on a 3-year prospective design with those based on cross-sectional analyses of data from the same source.

Data from the 2001 to 2002 Wave 1 and 2004 to 2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine baseline characteristics associated with Wave 2 recovery from alcohol dependence, among those who classified with past-year DSM-IV alcohol dependence at Wave 1 (n = 1,172).

Abstinent recovery was significantly associated with Black/Asian/Hispanic race/ethnicity, children <1 year of age in the household at baseline, attending religious services greater than or equal to weekly at follow-up, and having initiated help-seeking that comprised/included 12-step participation within <3 years prior to baseline. Nonabstinent recovery was positively associated with being never married at baseline, having job problems or being unemployed in the year preceding baseline, attending religious services less than weekly at follow-up, baseline smoking and volume of ethanol intake, and having terminated a first marriage within <3 years prior to baseline. Findings, including others of marginal significance (0.05 < p < 0.10), generally supported results from prior pseudo-prospective survival analyses with time-dependent covariates but differed in many ways from cross-sectional analyses of Wave 1 NESARC data.

Various aspects of study design must be considered when interpreting correlates of recovery. Cross-sectional analyses of lifetime correlates of recovery are highly subject to misinterpretation, but pseudo-prospective survival analyses with time-dependent covariates may yield results as valid as those from prospective studies.

From U Penn: Human laboratory paradigms in alcohol research


Alcohol Clin Exp Res. 2012 Feb 6. doi: 10.1111/j.1530-0277.2011.01704.x. [Epub ahead of print]
Human Laboratory Paradigms in Alcohol Research.
Plebani JG, Ray LA, Morean ME, Corbin WR, Mackillop J, Amlung M, King AC.
Department of Psychiatry, University of Pennsylvania, Pennsylvania.

Human laboratory studies have a long and rich history in the field of alcoholism. Human laboratory studies have allowed for advances in alcohol research in a variety of ways, including elucidating neurobehavioral mechanisms of risk, identifying phenotypically distinct subtypes of alcohol users, investigating the candidate genes underlying experimental phenotypes for alcoholism, and testing mechanisms of action of alcoholism pharmacotherapies on clinically relevant translational phenotypes, such as persons exhibiting positive-like alcohol effects or alcohol craving. Importantly, the field of human laboratory studies in addiction has progressed rapidly over the past decade and has built upon earlier findings of alcohol's neuropharmacological effects to advancing translational research on alcoholism etiology and treatment.

To that end, the new generation of human laboratory studies has focused on applying new methodologies, further refining alcoholism phenotypes, and translating these findings to studies of alcoholism genetics, medication development, and pharmacogenetics. The combination of experimental laboratory approaches with the recent developments in neuroscience and pharmacology has been particularly fruitful in furthering our understanding of the impact of individual differences in alcoholism risk and in treatment response.

This review of the literature focuses on human laboratory studies of subjective intoxication, alcohol craving, anxiety, and behavioral economics. Each section discusses opportunities for phenotype refinement under laboratory conditions, as well as its application to translational science of alcoholism. A summary and recommendations for future research are also provided.

From U Toronto: The risks associated with alcohol and alcoholism


Alcohol Res Health. 2011;34(2):135-43.
The risks associated with alcohol use and alcoholism.
Rehm J.
University of Toronto, Toronto, Canada.

Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.

From the NIH: Defining risk drinking


Alcohol Res Health. 2011;34(2):144-56.
Defining risk drinking.
Dawson DA.
Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.

Many efforts to prevent alcohol-related harm are aimed at reducing risk drinking. This article outlines the many conceptual and methodological challenges to defining risk drinking. It summarizes recent evidence regarding associations of various aspects of alcohol consumption with chronic and acute alcohol-related harms, including mortality, morbidity, injury, and alcohol use disorders, and summarizes the study designs most appropriate to defining risk thresholds for these types of harm. In addition, it presents an international overview of low-risk drinking guidelines from more than 20 countries, illustrating the wide range of interpretations of the scientific evidence related to risk drinking. This article also explores the impact of drink size on defining risk drinking and describes variation in what is considered to be a standard drink across populations. Actual and standard drink sizes differ in the United States, and this discrepancy affects definitions of risk drinking and prevention efforts.

From U Missouri: Patterns of alcohol use among empirically derived sexual minority subgroups


J Stud Alcohol Drugs. 2012 Mar;73(2):290-302.
Patterns of alcohol use and consequences among empirically derived sexual minority subgroups.
Talley AE, Sher KJ, Steinley D, Wood PK, Littlefield AK.
University of Missouri and the Midwest Alcoholism Research Center, Columbia, Missouri.

The current study develops an empirically determined classification of sexual orientation developmental patterns based on participants' annual reports of self-identifications, sexual attractions, and sexual behaviors during the first 4 years of college. A secondary aim of the current work was to examine trajectories of alcohol involvement among identified subgroups.

Data were drawn from a subsample of a longitudinal study of incoming first-time college students at a large, public university (n = 2,068). Longitudinal latent class analysis was used to classify sexual minority participants into empirically derived subgroups based on three self-reported facets of sexual orientation. Multivariate repeated-measures analyses were conducted to examine how trajectories of alcohol involvement varied by sexual orientation class membership.

Four unique subclasses of sexual orientation developmental patterns were identified for males and females: one consistently exclusively heterosexual group and three sexual minority groups. Despite generally similar alcohol use patterns among subclasses, certain sexual minority subgroups reported elevated levels of alcohol-related negative consequences and maladaptive motivations for use throughout college compared with their exclusively heterosexual counterparts.

Elevations in coping and conformity motivations for alcohol use were seen among those subgroups that also evidenced heightened negative alcohol-related consequences. Implications and limitations of the current work are discussed.

Alcohol dependence and social brain function


Addict Biol. 2012 Feb 17. doi: 10.1111/j.1369-1600.2012.00437.x. [Epub ahead of print]
The impact of alcohol dependence on social brain function.
Gizewski ER, Müller BW, Scherbaum N, Lieb B, Forsting M, Wiltfang J, Leygraf N, Schiffer B.
Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany Department of Neuroradiology, University Hospital Giessen and Marburg, Justus-Liebig University, Germany Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany Department of Forensic Psychiatry, University of Duisburg-Essen, Germany.

The impact of alcoholism (ALC) or alcohol dependence on the neural mechanisms underlying cognitive and affective empathy (i.e. the different routes to understanding other people's minds) in schizophrenic patients and non-schizophrenic subjects is still poorly understood. We therefore aimed at determining the extent to which the ability to infer other people's mental states and underlying neural mechanisms were affected by ALC. We examined 48 men, who suffered either from ALC, schizophrenia, both disorders or none of these disorders, using functional magnetic resonance imaging while performing on a mind reading task that involves both cognitive and affective aspects of empathy. Using voxel-based morphometry, we additionally examined whether between-group differences in functional activity were associated with deficits in brain structural integrity. During mental state attribution, all clinical groups as compared with healthy controls exhibited poor performance as well as reduced right-hemispheric insular function with the highest error rate and insular dysfunction seen in the schizophrenic patients without ALC. Accordingly, both behavioral performance and insular functioning revealed schizophrenia × ALC interaction effects. In addition, schizophrenic patients relative to non-schizophrenic subjects (regardless of ALC) exhibited deficits in structural integrity and task-related recruitment of the left ventrolateral prefrontal cortex (vlPFC). Our data suggest that ALC-related impairment in the ability to infer other people's mental states is limited to insular dysfunction and thus deficits in affective empathy. By contrast, mentalizing in schizophrenia (regardless of ALC) may be associated with insular dysfunction as well as a combination of structural and functional deficits in the left vlPFC.

Alcoholism and global DNA methylation disturbances


Gene. 2012 Feb 13. [Epub ahead of print]
Global DNA promoter methylation in frontal cortex of alcoholics and controls.
Manzardo AM, Henkhaus RS, Butler MG.

To determine if ethanol consumption and alcoholism cause global DNA methylation disturbances, we examined alcoholics and controls using methylation specific microarrays to detect all annotated gene and non-coding microRNA promoters and their CpG islands. DNA was isolated and immunoprecipitated from the frontal cortex of 10 alcoholics and 10 age and gender-matched controls then labeled prior to co-hybridization. A modified Kolmogorov-Smirnov test was used to predict differentially enriched regions (peaks) from log-ratio estimates of amplified vs input DNA. More than 180,000 targets were identified for each subject which correlated with >30,000 distinct, integrated peaks or high probability methylation loci. Peaks were mapped to regions near 17,810 separate annotated genes per subject representing hypothetical methylation targets. No global methylation differences were observed between the two subject groups with 80% genetic overlap, but extreme methylation was observed in both groups at specific loci corresponding with known methylated genes (e.g., H19) and potentially other genes of unknown methylation status. Methylation density patterns targeting CpG islands visually correlated with recognized chromosome banding. Our study provides insight into global epigenetic regulation in the human brain in relationship to controls and potentially novel targets for hypothesis generation and follow-up studies of alcoholism.

From Indiana U: The biological actions of alcohol


Curr Top Behav Neurosci. 2012 Feb 16. [Epub ahead of print]
What is in that Drink: The Biological Actions of Ethanol, Acetaldehyde, and Salsolinol.
Deehan GA Jr, Brodie MS, Rodd ZA.
Institute of Psychiatric Research, Indiana University School of Medicine, 791 Union Drive, Indianapolis, IN, 46202-4887, USA, gdeehan@iupui.edu.

Alcohol abuse and alcoholism represent substantial problems that affect a large portion of individuals throughout the world. Extensive research continues to be conducted in an effort to identify the biological basis of the reinforcing properties of alcohol in order to develop effective pharmacotherapeutic and behavioral interventions. One theory that has developed within the alcohol field over the past four decades postulates that the reinforcing properties of alcohol are due to the action of the metabolites/products of alcohol within the central nervous system (CNS). The most extreme version of this theory suggests that the biologically active metabolites/products of alcohol, created from the breakdown from alcohol, are the ultimate source of the reinforcing properties of alcohol. The contrary theory proposes that the reinforcing properties of alcohol are mediated completely through the interaction of the ethanol molecule with several neurochemical systems within the CNS. While there are scientific findings that offer support for both of these stances, the reinforcing properties of alcohol are most likely generated through a complex series of peripheral and central effects of both alcohol and its metabolites. Nonetheless, the development of a greater understanding for how the metabolites/products of alcohol contribute to the reinforcing properties of alcohol is an important factor in the development of efficacious pharmacotherapies for alcohol abuse and alcoholism. This chapter is intended to provide a historical perspective of the role of acetaldehyde (the first metabolite of alcohol) in alcohol reinforcement as well as review the basic research literature on the effects of acetaldehyde (and acetaldehyde metabolites/products) within the CNS and how these function with regard to alcohol reward.

The genetic basis of alcoholism


Genome Biol. 2012 Feb 20;13(2):239. [Epub ahead of print]
The genetic basis of alcoholism: multiple phenotypes, many genes, complex networks.
Morozova TV, Goldman D, Mackay TF, Anholt RR.
Department of Biology, Box 7617, North Carolina State University, Raleigh, NC 27695, USA. anholt@ncsu.edu

Alcoholism is a significant public health problem. A picture of the genetic architecture underlying alcohol-related phenotypes is emerging from genome-wide association studies and work on genetically tractable model organisms.

Monday, February 27, 2012

Eating disorders and obesity


Int J Neuropsychopharmacol. 2012 Mar;15(2):147.
Eating disorders and obesity.
Frazer A.

Unfortunately, no abstact.

Food security and dietary intake among Mexican-origin children


BMC Pediatr. 2012 Feb 20;12(1):16. [Epub ahead of print]
Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias.
Sharkey JR, Nalty C, Johnson CM, Dean WR.

Food insecurity among Mexican-origin and Hispanic households is a critical nutritional health issue of national importance. At the same time, nutrition-related health conditions, such as obesity and type 2 diabetes, are increasing in Mexican-origin youth. Risk factors for obesity and type 2 diabetes are more common in Mexican-origin children and include increased intakes of energy-dense and nutrient-poor foods. This study assessed the relationship between children's experience of food insecurity and nutrient intake from food and beverages among Mexican-origin children (age 6-11 y) who resided in Texas border colonias.

Baseline data from 50 Mexican-origin children were collected in the home by trained promotora-researchers. All survey (demographics and nine-item child food security measure) and 24-hour dietary recall data were collected in Spanish. Dietary data were collected in person on three occasions using a multiple-pass approach; nutrient intakes were calculated with NDS-R software. Separate multiple regression models were individually fitted for total energy, protein, dietary fiber, calcium, vitamin D, potassium, sodium, Vitamin C, and percentage of calories from fat and added sugars.

Thirty-two children (64%) reported low or very low food security. Few children met the recommendations for calcium, dietary fiber, and sodium; and none for potassium or vitamin D. Weekend intake was lower than weekday for calcium, vitamin D, potassium, and vitamin C; and higher for percent of calories from fat. Three-day average dietary intakes of total calories, protein, and percent of calories from added sugars increased with declining food security status. Very low food security was associated with greater intakes of total energy, calcium, and percentage of calories from fat and added sugar.

This paper not only emphasizes the alarming rates of food insecurity for this Hispanic subgroup, but describes the associations for food insecurity and diet among this sample of Mexican-origin children. Child-reported food insecurity situations could serve as a screen for nutrition problems in children. Further, the National School Lunch and School Breakfast Programs, which play a major beneficial role in children's weekday intakes, may not be enough to keep pace with the nutritional needs of low and very low food secure Mexican-origin children.

From U Western Sydney: Of SNP arrays and the metabolic syndrome


Med Hypotheses. 2012 Feb 18. [Epub ahead of print]
Genetic selection of embryos that later develop the metabolic syndrome.
Edwards MJ.
Department of Paediatrics, School of Medicine, University of Western Sydney, Australia.

THE BARKER HYPOTHESIS: Is an excellent explanation of the process where human and animal foetuses exposed to malnutrition, either by maternal malnutrition or placental insufficiency, are metabolically programmed, with selective stunting of cell differentiation and organ growth. With the postnatal excess of nutrition observed in developed countries, this irreversible programming causes metabolic syndrome, including obesity, type 2 diabetes, and hypertension. Metabolic programming involves epigenetic changes including imprinting which might be transmitted through more than one generation rather than being completely re-set or erased during reproduction. The Barker hypothesis was supported by epidemiological data that recognised no excess fetal or postnatal mortality when pregnant women were starved during the Dutch famine in World War II. This argued against the "thrifty genotype" theory introduced in 1962, which proposed that starvation selected against members of the population with less "thrifty" genes, but the survivors who had "thrifty" genes developed metabolic syndrome if they were subsequently over-nourished. EMBRYONIC/FETAL SELECTION: Embryos or early foetuses could be selected very early in pregnancy on the basis of their genotype, by maternal malnutrition, hypertension, obesity or other causes of placental insufficiency. The genotype that allows embryos, or cells within them, to survive a less hospitable environment in the decidua after implantation might contribute to the later development of metabolic syndrome. This article hypothesises that an adverse intrauterine environment, caused by maternal malnutrition or placental insufficiency, kills a proportion of embryos and selects a surviving population of early embryos whose growth in utero is retarded by their genotype, their environment or a combination of both. The metabolic syndrome follows if the offspring is over-nourished later in life. The embryonic selection hypothesis presented here could be tested by using single nucleotide polymorphism (SNP) microarrays to study adults who had a history of intrauterine growth retardation (IUGR) and subsequent metabolic syndrome. Their SNP array could be compared with their parents and unaffected unrelated or related controls. If there were no selection based on a "thrifty genotype", all parental sequences would be expected to appear in their surviving children, whether or not they had IUGR or developed metabolic syndrome. SNP sequences present in parents or controls but missing from adult offspring with metabolic syndrome who had IUGR, could be associated with or linked to genes that influence susceptibility to metabolic syndrome. This hypothesis proposes that missing genotypes would be lost if the embryos that inherited them died very early in pregnancy.

From Albert Einstein Coll of Med: Housing as an obesity-mediating environment

Int J Public Health. 2012 Feb 21. [Epub ahead of print]
Housing as an obesity-mediating environment.
Chambers EC, Fuster D.
Albert Einstein College of Medicine, 1300 Morris Park Ave., Mazer 408, Bronx, NY, 10461, USA, earle.chambers@einstein.yu.edu.

"Understanding as to whether the structural layout of the home influences the potential to increase physical activity both inside and outside the home can be an important part of identifying those at most risk for physical inactivity, and help inform housing policy and housing development to better influence healthy behaviors."

"Increased body weight is independently associated with severe school absenteeism in children but not adolescents"

Int J Obes (Lond). 2012 Feb 21. doi: 10.1038/ijo.2012.15. [Epub ahead of print]
Association between increased BMI and severe school absenteeism among US children and adolescents: findings from a national survey, 2005-2008.
Li Y, Raychowdhury S, Tedders SH, Lyn R, Lòpez-De Fede A, Zhang J.
Northrop Grumman Information Systems, Atlanta, GA, USA.

School absenteeism may be an underlying cause of poor school performance among overweight and obese children. We examined the associations between school absenteeism and body mass index (BMI) in a nationally representative sample.

Design and Subjects:
We analyzed the data of 1387 children (6-11 years) and 2185 adolescents (12-18 years), who completed an interview and anthropometric measurement as a part of the National Health and Nutrition Examination Survey, 2005-2008. The CDC 2000 growth chart was used to categorize BMI status, and the number of school days missed during the past 12 months was assessed by asking the proxies or interviewees.

The prevalence of obesity and overweight were 18.96±1.44% (s.e.) and 16.41±0.78%, respectively, among study populations. The means of school days missed in the last 12 months were not statistically different between the normal-weight, overweight and obese groups, 3.79±0.56, 3.86±0.38 and 4.31±0.01 days, respectively. However, when >2 days missed per school month was defined as severe absence, the prevalence of severe absence were 1.57%, 2.99% and 4.94% respectively, among 6-11-year-old children with normal, overweight and obese. The adjusted odds of severe school absence were 2.27 (95% confidence interval=0.64-8.03) and 3.93 (1.55-9.95), respectively, among overweight and obese children compared with normal-weight peers (P for trend test <0.01). No significant association was found among adolescents.

Increased body weight is independently associated with severe school absenteeism in children but not adolescents. Future research is needed to determine the nature, and academic and social significance of this association.

Loose sleep, gain weight?


Int J Obes (Lond). 2012 Feb 21. doi: 10.1038/ijo.2012.17. [Epub ahead of print]
Short sleep duration in association with CT-scanned abdominal fat areas: the Hitachi Health Study.
Yi S, Nakagawa T, Yamamoto S, Mizoue T, Takahashi Y, Noda M, Matsushita Y.
1] Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan [2] Asia Health Policy Program, Walter H. Shorenstein Asia-Pacific Research Center, Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA.

To examine the relationship between short sleep duration and body mass index (BMI), waist circumference (WC), visceral fat area (VFA) and subcutaneous fat area (SFA) among a working population in Japan.

Health-center-based, cross-sectional study.

The study subjects included 5400 men and 642 women aged 30 to 75 years who underwent an abdominal computed tomography (CT) scanning examination in a comprehensive health checkup.

Height and weight were measured, and BMI was calculated. WC, VFA and SFA were measured using a CT scanner. Sleep duration was self-reported. Analysis of covariance was used to estimate adjusted means of BMI, WC, VFA and SFA across categories of sleep duration with adjustments for potential confounders. Trend of the association was assessed using multiple linear regression analysis.

In men, the mean values of BMI, WC and SFA decreased with increasing sleep duration after adjustment for age, physical activity, smoking and drinking (P-value for trend <0.001). Additional adjustment for physical illnesses did not attenuate the explanatory power of the models (P-value for trend <0.001). In addition, the association between sleep duration and SFA did not change after controlling for VFA (P-value for trend <0.001). The mean values of SFA for subjects sleeping '<5 h', '5 to <6 h', '6 to <7 h' and '7 h' per day were 145.8±67.4 cm(2), 138.7±61.5 cm(2), 134.7±60.4 cm(2) and 132.5±49.2 cm(2), respectively. Sleep duration was not appreciably associated with VFA. In women, no significant association was detected in any models.

Shorter sleep duration is associated with higher BMI, WC and SFA in men. Further research is needed to explicate the biological mechanisms behind these relationships and to see whether interventions addressing inadequate sleep could treat or prevent obesity by taking gender differences into consideration.

From Children's Hospital Boston: Associations between maternal behaviors and obese children


Obesity (Silver Spring). 2012 Feb 21. doi: 10.1038/oby.2012.43. [Epub ahead of print]
Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial.
Sonneville KR, Rifas-Shiman SL, Kleinman K, Gortmaker S, Gillman MW, Taveras EM.
Division of Adolescent Medicine, Children's Hospital Boston, Boston, MA.

Relatively little research has assessed the association between obesogenic behaviors in parents and their children. The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing, sugar-sweetened beverage intake, and fast food intake between mothers and their pre-school aged children. We studied baseline data among 428 participants in High Five for Kids, a randomized controlled trial of behavior change among overweight and obese children ages 2-6.9 years. The main exposures were whether mothers viewed TV/videos <1 hour/day, drank <1 serving/day of sugar-sweetened beverages, and ate fast food <1 time/week. The main outcomes were whether children met these goals for the same behaviors. Using multivariate logistic regression adjusted for maternal and child characteristics, we estimated odds ratios of children meeting the behavioral goals. The majority of mothers ate fast food <1 time/week (73%) and drank <1 serving/day of sugar-sweetened beverages (73%), while few mothers viewed <1 hour/day of TV/videos (31%). Most children met the fast food goal (68%), but not the goals for sugar-sweetened beverages (31%) or TV/video viewing (13%). In adjusted models, the odds ratios for a child meeting the goal were 3.2 (95% CI 1.7, 6.2) for TV/video viewing, 5.8 (95% CI 2.8, 12.0) for sugar-sweetened beverage intake, and 17.5 (95% CI 9.8, 31.2) for fast food intake if their mothers met the goal for the same behavior. Obesogenic behaviors of mothers and pre-school aged children were strongly associated. Our findings lend support to obesity prevention strategies that target parental behavior and the family environment.

From U Copenhagen: Psychosocial risk factors for obesity


Eur J Epidemiol. 2012 Feb 19. [Epub ahead of print]
Psychosocial risk factors, weight changes and risk of obesity: the Copenhagen City Heart Study.
Iversen LB, Strandberg-Larsen K, Prescott E, Schnohr P, Rod NH.
Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014, Copenhagen K, Denmark.

The aim of the study was to establish the effects of a range of psychosocial factors on weight changes and risk of obesity. The study population consisted of the 4,753 participants in the third (1991-1994) and fourth wave (2001-2003) of the Copenhagen City Heart Study, Denmark. At baseline the participants were asked comprehensive questions on major life events, work stress, vital exhaustion, social network, economic hardship, and intake of sleep medication. Weight and height were measured by health professionals. Weight changes and incident obesity was used as outcome measures. The participants on average gained 2 kg of weight and 8% became obese during follow-up. The experience of major life events in childhood, work life and adult life was associated with weight gain and obesity in women, but not in men. Vital exhaustion was associated with weight gain in a dose-response manner in men (P = 0.002) and younger women (P = 0.02). Persons with high vital exhaustion gained approximately 2 kg more during follow-up compared to those with no vital exhaustion. Women with high vital exhaustion were also more likely to become obese during follow-up (OR = 2.39; 95% CI: 1.14-5.03). There were no clear patterns in the associations between social network, economic hardship and weight gain or obesity. The number of psychosocial risk factors, as an indicator for clustering, was not associated with weight gain or obesity. In conclusion, major life events and vital exhaustion seem to play a role for weight gain and risk of obesity, especially in women.

From Tokyo Women's Medical U: Obesity accelerates IgA nephropathy progression


Clin Exp Nephrol. 2012 Feb 17. [Epub ahead of print]
Overweight and obesity accelerate the progression of IgA nephropathy: prognostic utility of a combination of BMI and histopathological parameters.
Kataoka H, Ohara M, Shibui K, Sato M, Suzuki T, Amemiya N, Watanabe Y, Honda K, Mochizuki T, Nitta K.
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.

Although more than 40 years have passed since IgA nephropathy (IgAN) was first reported, predicting the renal outcome of individual IgAN patients remains difficult. Emerging epidemiologic evidence indicates that overweight and obesity are risk factors for end-stage renal disease. We aimed to elucidate the outcome of overweight IgAN patients and improve our ability to predict the progression of IgAN based on a combination of body mass index (BMI) and histopathological parameters, including maximal glomerular area (Max GA).

Forty-three adult IgAN patients whose estimated glomerular filtration rate was ≥50 ml/min/1.73 m(2) were enrolled in this study. Renal biopsy specimens were evaluated according to the Oxford classification of IgAN. A Kaplan-Meier analysis and the multivariate Cox proportional hazards method were used to evaluate 10-year kidney survival and the impact of covariates. The ability of factors to predict the progression of IgAN was evaluated by their diagnostic odds ratio (DOR).

A BMI ≥25 kg/m(2) was found to be an independent predictor of a ≥1.5-fold increase in serum creatinine value (DOR 7.4). The combination of BMI ≥25 kg/m(2), Max GA ≥42,900 μm(2), and presence of mesangial hypercellularity (Oxford M1) optimally raised predictive power for disease progression of IgAN (DOR 26.0).

A combination of BMI ≥25 kg/m(2), the Oxford classification M1, and a Max GA ≥42,900 μm(2) can serve as a predictor of long-term renal outcome of IgAN.

Nanny state: "although most postings were legally compliant, they did not demonstrate utility"


J Urban Health. 2012 Feb 16. [Epub ahead of print]
Calorie Postings in Chain Restaurants in a Low-Income Urban Neighborhood: Measuring Practical Utility and Policy Compliance.
Cohn EG, Larson EL, Araujo C, Sawyer V, Williams O.
School of Nursing, New York, NY, USA, ec2341@columbia.edu.

Current strategies for combating obesity include recent federal legislation mandating calorie count postings in chain restaurants. This study describes the current practice of menu board calorie postings in a low-income urban neighborhood, identifies the extent to which current practice complies with existing policy, and evaluates the practical utility of menu boards to consumers. We conclude that although most postings were legally compliant, they did not demonstrate utility. Menu postings for individual servings are easily understood, but complex math skills are needed to interpret meals designed to serve more than one person. In some items, calories doubled depending on flavor and the calorie posting did not give enough information to make healthier selections. We identified specific strategies to improve practical utility and provide recommendations for policy implementation.

From Ohio State U: Impact of prepregnancy obesity on children's cognitive test scores


Matern Child Health J. 2012 Feb 17. [Epub ahead of print]
The Impact of Prepregnancy Obesity on Children's Cognitive Test Scores.
Tanda R, Salsberry PJ, Reagan PB, Fang MZ.
The College of Nursing, The Ohio State University, Columbus, OH, USA, tanda.3@buckeyemail.osu.edu.

To examine the association between maternal prepregnancy obesity and cognitive test scores of children at early primary school age. A descriptive observational design was used. Study subjects consist of 3,412 US children aged 60-83 months from the National Longitudinal Survey of Youth 1979 Mother and Child Survey. Cognitive test scores using the Peabody Individual Achievement Test reading recognition and mathematics tests were used as the outcomes of interest. Association with maternal prepregnancy obesity was examined using the ordinary least square regression controlling for intrauterine, family background, maternal and child factors. Children of obese women had 3 points (0.23 SD units) lower peabody individual achievement test (PIAT) reading recognition score (p = 0.007), and 2 points (0.16 SD units) lower PIAT mathematics scores (p < 0.0001), holding all other factors constant. As expected, cognitive test score was associated with stimulating home environment (reading: β = 0.15, p < 0.0001, and math: β = 0.15, p < 0.0001), household income (reading: β = 0.03, p = 0.02 and math: β = 0.04, p = 0.004), maternal education (reading: β = 0.42, p = 0.0005, and math: β = 0.32, p = 0.008), and maternal cognitive skills (reading: β = 0.11, p < 0.0001, and math: β = 0.09, p < 0.0001). There was a significant association between maternal prepregnancy obesity and child cognitive test scores that could not be explained by other intrauterine, family background, maternal, and child factors. Children who live in disadvantaged postnatal environments may be most affected by the effects of maternal prepregnancy obesity. Replications of the current study using different cohorts are warranted to confirm the association between maternal prepregnancy obesity and child cognitive test scores.

From UT-Soutwestern: obesity and postgastrectomy outcomes


Gastric Cancer. 2012 Feb 21. [Epub ahead of print]
Obesity and postgastrectomy outcomes: large risks, fat chances, or no big deal?
Schwarz RE.
Division of Surgical Oncology, Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8548, USA, Roderich.Schwarz@utsouthwestern.edu.

"Many Western and Asian societies face an increasing prevalence of obesity and related metabolic disorders [1]. Aside from the related issues that affect health care systems in general, surgeons specifically are faced with an increasing challenge to maintain high-quality care with good outcomes in an ever-increasing number of obese patients. Overweight patients are at greater risk for comorbidity and disability, particularly at body mass indices (BMI) of greater than 35 kg/m2 [2]. It is thus clear that operative care of obese patients requires greater health care resources, and frequently leads to increased length of hospital stay [3]. Associations between obesity and postoperative morbidity are less clear-cut, although many reports suggest that this is indeed so [4]. Some recent reports suggest a link between obesity and surgical site infection risk [5], while others indicate increased risks for minor complications after major cancer operations, but not major complications or death [6]."

Super-super obese patients: 66.5 ± 3.4 kg/m(2)


Obes Surg. 2012 Feb 16. [Epub ahead of print]
Preoperative Weight Loss with Intragastric Balloon Decreases the Risk of Significant Adverse Outcomes of Laparoscopic Gastric Bypass in Super-Super Obese Patients.
Zerrweck C, Maunoury V, Caiazzo R, Branche J, Dezfoulian G, Bulois P, Verkindt H, Pigeyre M, Arnalsteen L, Pattou F.
Department of Digestive and Endocrine Surgery, Lille University Hospital, Lille, France.

Extreme obesity increases morbi-mortality in bariatric surgery. We previously showed that significant weight loss can be obtained within 3 months in super-super obese patients (BMI > 60 kg/m(2)) with an intragastric balloon (IGB). Here, we explored the potential benefit of preoperative IGB on the outcome of laparoscopic gastric bypass (LGBP) in super-super obese patients.

In this case-control study, we compared the records of 60 consecutive super-super obese patients (66.5 ± 3.4 kg/m(2)) submitted to a LGBP between 2004 and 2009, with preoperative IGB (n = 23, cases) or without (n = 37, controls). We analyzed the clinical outcome of surgery and a composite end point of significant adverse events defined as the presence of at least one of the following conditions: conversion to laparotomy, intensive care unit stay for more than 2 days, and overall hospital stay superior to 2 weeks.

All baseline clinical and biological characteristics were homogenous between both groups. IGB was maintained during 155 ± 62 days and induced a loss of 5.5 ± 1.3 kg/m(2) (11.2 ± 3.2% of excess body mass index) at the time of LGBP, associated with a decrease in systolic blood pressure and gamma-glutamyl transpeptidase level (p < 0.05 vs. baseline). Operative time was lower in the IGB group (146 ± 47 vs. 201 ± 81 min in controls; p < 0.01). Significant adverse events occurred less frequently after LGBP in the IGB group (2 vs. 13 in controls; p < 0.05). All patients were alive at 1 year and overall weight loss was similar in both groups (52.4 ± 17.3 vs. 50.3 ± 12.7 percent of excess BMI loss in controls; NS).

IGB prior to LGBP in super-super obese patients significantly reduced excess BMI. It was associated with a shorter operative time and a lower overall risk of significant adverse outcomes.

Relationships between sedentary behavior, physical activity, and body composition after bariatric surgery


Obes Surg. 2012 Feb 19. [Epub ahead of print]
Dynamic Relations Between Sedentary Behavior, Physical Activity, and Body Composition After Bariatric Surgery.
Vatier C, Henegar C, Ciangura C, Poitou-Bernert C, Bouillot JL, Basdevant A, Oppert JM.
Service de Nutrition, Groupe Hospitalier Pitié-Salpêtrière (AP-HP), Université Pierre et Marie Curie-Paris6, 83, boulevard de l'Hôpital, 75013, Paris, France.

Physical activity has been shown to increase following obesity surgery; however, changes in sedentary behavior in this setting are not known. Our aim was to describe changes in both physical activity and sedentary behavior of obese patients after gastric bypass (GBP) and their relationships with changes in body composition.

Physical activity, time spent watching TV as typical sedentary behavior (self-report), and body composition (DXA) were assessed before and 6 and 12 months after GBP in 86 obese patients (67 women, 24-66 years old, BMI 41.3-53.5 kg/m(2)).

One year after GBP (mean loss of weight -37.1 kg, fat mass -25.7 kg, lean body mass -9.4 kg), leisure-time physical activity (LTPA) significantly increased from 2.0 (SD 3.7) to 3.8 (5.4) h/week and from 7.2 (12.5) to 14.1 (20.1) MET-h/week (MET: metabolic equivalent task), the number of LTPA performed increased from 1.3 (1.3) to 1.8 (1.4), and TV time decreased from 3.0 (1.6) to 2.4 (1.4) h/day (all p < 0.05). The ranking of the most frequently performed LTPA did not change. Positive associations were observed between the increase in lean body mass and (1) the increase in LTPA and (2) the decrease in TV watching. Inverse relationships were found for changes in fat mass.

Together with increased LTPA, this study shows a decrease in sedentary behavior after GBP, which appears related to favorable changes in body composition. These observations are important to design future intervention studies, including physical activity and sedentary occupations aiming to optimize the care of patients after bariatric surgery.

From Harvard U: Toxicity of weight loss agents


J Med Toxicol. 2012 Feb 14. [Epub ahead of print]
Toxicity of Weight Loss Agents.
Yen M, Ewald MB.
Children's Hospital Boston, Harvard Medical Toxicology Fellowship, 300 Longwood Ave, Ida C. Smith Building, Boston, MA, 02115, USA, May.Yen@childrens.harvard.edu.

With the rise of the obesity epidemic in the United States over the last several decades and the medical complications seen with it, weight loss and dieting have become a national public health concern.

Because of their increased use and availability through internet sales, several different dieting agents were reviewed for potential toxicity. These included: syrup of ipecac, cathartics, human chorionic gonadotropin hormone, 2,4 Dinitrophenol, guar gum, phenylpropanolamine, ma huang/ ephedra, caffeine, clenbuterol, fenfluramine, sibutramine, thyroid hormone, orlistat and cannabinoid antagonists.

With the internet making even banned products readily accessible, healthcare providers need to be aware of the potential toxicities of a wide range of weight loss agents. Our review covered topics we thought to be most historically significant as well as pertinent to the practice of medical toxicology today.

From U Oregon: Obesity and adipokines


J Physiol. 2012 Feb 20. [Epub ahead of print]
Obesity and Adipokines: Effects on Sympathetic Overactivity.
Smith MM, Minson CT.
University of Oregon.

Excess body weight is a major risk factor for cardiovascular disease, increasing the risk of hypertension, hyperglycemia and dyslipidemia, recognized as the metabolic syndrome. Adipose tissue acts as an endocrine organ by producing various signaling cytokines called adipokines (including leptin, free fatty acids, tumor necrosis factor-alpha, interleukin-6, C-reactive protein, angiotensinogen and adiponectin). A chronic dysregulation of certain adipokines can can have deleterious effects on insulin signaling. Chronic sympathetic overactivity is also known to be present in central obesity, and recent findings demonstrate the consequence of an elevated sympathetic outflow to organs such as the heart, kidneys, and blood vessels. Chronic sympathetic nervous system overactivity can also contribute to a further decline of insulin sensitivity, creating a vicious cycle that may contribute to the development of the metabolic syndrome and hypertension. The cause of this overactivity is not clear, but may be driven by certain adipokines. The purpose of this review is to summarize how obesity, notably central or visceral as observed in the metabolic syndrome, leads to adipokine expression contributing to changes in insulin sensitivity and overactivity of the sympathetic nervous system.

Early life programming of obesity


Curr Diabetes Rev. 2012 Jan 25. [Epub ahead of print]
Early Life Programming of Obesity: The Impact of the Perinatal Environment on the Development of Obesity and Metabolic Dysfunction in the Offspring.
Spencer SJ.
Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria 3800, Australia. sarah.spencer@monash.edu.

It is now well accepted that early life events can contribute substantially to the likelihood of an individual becoming obese, although many of the mechanisms for this are not well understood. Maternal over- and under-nutrition as well as the postnatal nutritional environment can contribute significantly to obesity throughout life. This review will provide an overview of early life events associated with neuroendocrine programming of obesity and metabolic dysfunction. In particular this review will focus on the long-term impact of perinatal nutrition, as well as the perinatal role of leptin, insulin, and glucocorticoids in programming the hypothalamic circuitry responsible for appropriate regulation of feeding and metabolism throughout life.

From U Kentucky: Childhood obesity and cavities


Pediatr Dent. 2012 Jan-Feb;34(1):23-7.
Association between Childhood Obesity and Dental Caries.
Werner SL, Phillips C, Koroluk LD.
Division of Pediatric Dentistry, College of Dentistry, University of Kentucky, Lexington, KY.

The purpose of this study was to investigate dental caries and body mass index (BMI percentile) in pediatric dental patients.

A 3-year retrospective review of patient records included all 6- to 9-year-olds seen for a new patient examination who had at least 1 recall examination. Decayed permanent teeth (DT) and primary teeth (dt), plaque score, gingival score, height, and weight were recorded at the initial examination and each recall visit. BMI percentile was categorized into underweight/healthy weight (UH), overweight (OW), and obese (OB).

A total of 230 subjects were seen for the initial examination: approximately 13% were OB, 15% were OW, and 72% were UH, while approximately 12% had permanent caries and 46% had primary caries. The presence of caries in permanent teeth at the initial exam was not significantly different between BMI groups (P=.41). OW and OB children had less primary tooth caries than UH children. (P=.04) The presence of new carious lesions at recall exams in primary teeth (P=.35) and permanent teeth (P=.96) was not significantly different between BMI groups.

A smaller proportion of obese and overweight children initially presented with primary tooth caries than underweight/healthy weight children.

From Wake Forest U: Rural pediatric obesity clinics


Telemed J E Health. 2012 Feb 22. [Epub ahead of print]
TeleFIT: Adapting a Multidisciplinary, Tertiary-Care Pediatric Obesity Clinic to Rural Populations.
Irby MB, Boles KA, Jordan C, Skelton JA.
1 Department of Pediatrics, Wake Forest University School of Medicine , Winston-Salem, North Carolina.

Pediatric obesity occurs most frequently in underserved communities where families have difficulty accessing healthcare. Disproportionate obesity rates in rural children denote significant disparities warranting innovative solutions. However, intensive, tertiary-care treatment options outlined in recent expert recommendations may not be available to families living in rural areas. Telemedicine may be useful for providing pediatric obesity treatment to rural families. The aim of this study was to assess the impact of a new outreach program (TeleFIT), which placed telemonitors in four rural satellite clinics to increase access to a pediatric obesity clinic (Brenner Families In Training [FIT]). Before TeleFIT began, of five patients from rural counties enrolled in treatment over a 1-year period, all dropped out by their third visit. Within the first year of TeleFIT, the number of rural patients increased nearly threefold (to 14) and increased again in the second year by an additional 16 new patients (n=35). Preliminary outcomes indicate comparable attrition rates and improvement in weight status compared with patients in conventional treatment. Telemedicine allows rural families to access intensive obesity treatment from local pediatric offices, eliminating geographic barriers. Systems delivering state-of-the-art care in rural areas have tremendous potential for reducing health disparities in rural populations. Further research is needed to test the efficacy of such interventions.

From U Miami: Skin color and medical student's attitudes toward obesity


Stud Health Technol Inform. 2012;173:23-9.
Medical Students' Attitudes toward Obese Patient Avatars of Different Skin Color.
Andrade AD, Ruiz JG, Mintzer MJ, Cifuentes P, Anam R, Diem J, Gómez-Marín O, Sun H, Roos BA.
Laboratory of E-Learning & Multimedia Research (LEMUR), Geriatric Research, Education, and Clinical Center, Bruce W. Carter VAMC, University of Miami.

Physicians' biases for skin color and obesity may negatively affect health-care outcomes. Identification of these biases is the first step to address the problem. We randomized 128 U.S medical students into one of four animated videos of avatar physician-patient counseling sessions, varying the weight and skin color of an elderly patient avatar: white-thin, black-thin, white-obese and black-obese. Medical students viewed white obese avatars as unattractive, ugly, noncompliant, lazy, and sloppy. Medical students' comments suggested a paternalistic attitude toward avatar patients. Avatar-mediated experiences can elicit medical students' bias potentially enabling medical educators to implement bias reduction interventions.

From U Colorado: Maternal obesity-Improving pregnancy outcomes


MCN Am J Matern Child Nurs. 2012 Mar;37(2):110-5.
Maternal obesity: improving pregnancy outcomes.
Nodine PM, Hastings-Tolsma M.
Priscilla M. Nodine is an Assistant Professor at School of Medicine, Department of Obstetrics and Gynecology, University of Colorado, Denver, Aurora, CO. She can be reached via e-mail at priscilla.nodine@ucdenver.edu Marie Hastings-Tolsma is an Associate Professor in the Division of Women, Children, and Family Nursing, College of Nursing, University of Colorado, Denver, Aurora, CO.

ABSTRACT: Approximately 30% of pregnant women are obese (body mass index [BMI] ≥ 30) and are at risk for adverse pregnancy outcomes. In this article, we review the literature on select obstetrical risks associated with maternal obesity and assess the recommended prevention and management strategies. The selected risks include infertility, fetal anomalies, gestational hypertensive diseases, gestational diabetes, intrauterine fetal death, cesarean birth, macrosomia, and long-term risks of adult disease for the fetus. The causes of these adverse outcomes include maternal body habitus, the proinflammatory state of obesity, and metabolic dysfunction. We also discuss how nurses, nurse practitioners, and nurse-midwives can make a difference in the prenatal care and immediate pregnancy outcomes of pregnant women with obesity and influence future health for these women and their children.

Nanny state: Just a spoonful of sugar makes the medicine go down...


Nature. 2012 Feb 1;482(7383):27-9. doi: 10.1038/482027a.
Public health: The toxic truth about sugar.
Lustig RH, Schmidt LA, Brindis CD.
Department of Pediatrics, University of California, San Francisco, California 94143, USA. rlustig@peds.ucsf.edu

"The possible dream
Government-imposed regulations on the marketing of alcohol to young people have been quite effective, but there is no such approach to sugar-laden products. Even so, the city of San Francisco, California, recently banned the inclusion of toys with unhealthy meals such as some types of fast food. A limit — or, ideally, ban — on television commercials for products with added sugars could further protect children's health.

Reduced fructose consumption could also be fostered through changes in subsidization. Promotion of healthy foods in US low-income programmes, such as the Special Supplemental Nutrition Program for Women, Infants and Children and the Supplemental Nutrition Assistance Program (also known as the food-stamps programme) is an obvious place to start. Unfortunately, the petition by New York City to remove soft drinks from the food-stamp programme was denied by the USDA.

Ultimately, food producers and distributors must reduce the amount of sugar added to foods. But sugar is cheap, sugar tastes good and sugar sells, so companies have little incentive to change. Although one institution alone can't turn this juggernaut around, the US Food and Drug Administration could “set the table” for change8. To start, it should consider removing fructose from the Generally Regarded as Safe (GRAS) list, which allows food manufacturers to add unlimited amounts to any food. Opponents will argue that other nutrients on the GRAS list, such as iron and vitamins A and D, can also be toxic when over-consumed. However, unlike sugar, these substances have no abuse potential. Removal from the GRAS list would send a powerful signal to the European Food Safety Authority and the rest of the world.

Regulating sugar will not be easy — particularly in the 'emerging markets' of developing countries where soft drinks are often cheaper than potable water or milk. We recognize that societal intervention to reduce the supply and demand for sugar faces an uphill political battle against a powerful sugar lobby, and will require active engagement from all stakeholders. Still, the food industry knows that it has a problem — even vigorous lobbying by fast-food companies couldn't defeat the toy ban in San Francisco. With enough clamour for change, tectonic shifts in policy become possible. Take, for instance, bans on smoking in public places and the use of designated drivers, not to mention airbags in cars and condom dispensers in public bathrooms. These simple measures — which have all been on the battleground of American politics — are now taken for granted as essential tools for our public health and well-being. It's time to turn our attention to sugar."

From Cornell: Rattlesnakes and cryptic sociality


Biol Lett. 2012 Feb 22. [Epub ahead of print]
Cryptic sociality in rattlesnakes (Crotalus horridus) detected by kinship analysis.
Clark RW, Brown WS, Stechert R, Greene HW.
Department of Ecology and Evolutionary Biology, Cornell University, , Ithaca, NY 14853, USA.

Research on social behaviour has largely concentrated on birds and mammals in visually active, cooperatively breeding groups (although such systems are relatively rare) and focused much less on species that rarely interact other than for mating and parental care. We used microsatellite markers to characterize relatedness among aggregations of timber rattlesnakes (Crotalus horridus), a putatively solitary reptile that relies heavily on chemical cues, and found that juveniles and pregnant females preferentially aggregate with kin under certain conditions. The ability to recognize kin and enhance indirect fitness thus might be far more widespread than implied by studies of animals whose behaviour is primarily visually and/or acoustically mediated, and we predict that molecular markers will reveal many additional examples of 'cryptic' sociality.

Friday, February 24, 2012

From Cancer: The increased risk of certain cancers in patients with HIV/AIDS


Cancer. 2012 Feb 22. doi: 10.1002/cncr.27454. [Epub ahead of print]
Increased risk of histologically defined cancer subtypes in human immunodeficiency virus-infected individuals: Clues for possible immunosuppression-related or infectious etiology.
Shiels MS, Engels EA.
Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland. shielsms@mail.nih.gov.

Malignancies that occur in excess among human immunodeficiency virus (HIV)-infected individuals may be caused by immunosuppression or infections. Because histologically defined cancer subtypes have not been systematically evaluated, their risk was assessed among people with acquired immunodeficiency syndrome (AIDS).

Analyses included 569,268 people with AIDS from the HIV/AIDS Cancer Match Study, a linkage of 15 US population-based HIV/AIDS and cancer registries during 1980 to 2007. Standardized incidence ratios (SIRs) were estimated to compare cancer risk in people with AIDS to the general population overall, and stratified by age, calendar period (a proxy of changing HIV therapies), and time since onset of AIDS (a proxy of immunosuppression).

Sixteen individual cancer histologies or histology groupings manifested significantly elevated SIRs. Risks were most elevated for adult T cell leukemia/lymphoma (SIR = 11.3), neoplasms of histiocytes and accessory lymphoid cells (SIR = 10.7), giant cell carcinoma (SIR = 7.51), and leukemia not otherwise specified (SIR = 6.69). SIRs ranged from 1.4 to 4.6 for spindle cell carcinoma, bronchioloalveolar adenocarcinoma, adnexal and skin appendage neoplasms, sarcoma not otherwise specified, spindle cell sarcoma, leiomyosarcoma, mesothelioma, germ cell tumors, plasma cell tumors, immunoproliferative diseases, acute lymphocytic leukemia, and myeloid leukemias. For several of these cancer subtypes, significant declines in SIRs were observed across calendar periods (consistent with decreasing risk with improved HIV therapies) or increase in SIRs with time since onset of AIDS (ie, prolonged immunosuppression).

The elevated risk of certain cancer subtypes in people with AIDS may point to an etiologic role of immunosuppression or infection. Future studies are needed to further investigate these associations and evaluate candidate infectious agents.

From Dept of Homeland Security: Military med mal and "the right to sue"


Clin Dermatol. 2012 Mar;30(2):181-7.
Military medical malpractice and "the right to sue".
Kels CG.
Office of the General Counsel, Office of Health Affairs, US Department of Homeland Security and The Judge Advocate General's Corps, US Air Force Reserve; Office of Health Affairs, Stop 0315, Department of Homeland Security, 245 Murray Lane, Washington, DC 20528.

The Feres doctrine bars tort claims against the government by military service members for injuries incident to their service. This prohibition extends to medical malpractice claims arising out of military health care. The latest legislative effort to overturn the Feres doctrine and allow military medical malpractice claims by service members was inspired by, and named for, a Marine whose death from melanoma may have been preventable through earlier diagnosis and referral. This article explores the genesis of the Feres rule, its 60-year history, and the arguments for and against its continued application. The article then assesses the military's experience under Feres in the context of the larger ethical debate over the social utility of malpractice liability as a tool for accountability and deterrence.

From Boston U: Improving health care delivery to aging adults with disabilities


J Gerontol Soc Work. 2012 Feb;55(2):191-207.
Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform.
Bachman SS, Gonyea JG.
a School of Social Work , Boston University , Boston , Massachusetts , USA.

Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.

Socioeconomic equity in health care


J Health Serv Res Policy. 2012 Jan;17 Suppl 1:55-63.
Effects of the Blair/Brown NHS reforms on socioeconomic equity in health care.
Cookson R, Laudicella M, Li Donni P, Dusheiko M.
Centre for Health Economics, University of York, York.

The central objectives of the 'Blair/Brown' reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the 'dose' of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients.

From Carnegie Mellon U: Can competition improve UK health care outcomes?


J Health Serv Res Policy. 2012 Jan;17 Suppl 1:49-54.
Can competition improve outcomes in UK health care? Lessons from the past two decades.
Gaynor M, Moreno-Serra R, Propper C.
Carnegie Mellon University, Pittsburgh, PA, USA.

UK governments of all political colours have sought to improve productivity in health care by introducing pro-competitive reforms in the National Health Service (NHS) during the last two decades. The first wave of reform operated from 1991 to 1997. The second wave was introduced in England only in the mid 2000s. In 2010, further reform in England, intended to increase the extent of competition, was proposed by the Coalition administration. But the effect of competition on productivity in health care and in particular on the quality of health care remains a contested issue. This paper reviews the evidence, focusing on robust and recent evidence, on the use of competition as a mechanism for improving quality. The consensus is that competition will increase quality in health care, but that institutional details matter. Given this, we end by discussing whether the current plans to make the buyers of care family doctors and other professionals and to allow some local price variation are likely to be beneficial in the UK context of full public funding for health care.

Pros and cons of the affordable care act


Clin Dermatol. 2012 Mar;30(2):151-5.
Ethical considerations in health care reform: Pros and cons of the affordable care act.
Pariser DM.

Legal and ethical issues regarding utilizing tissue for molecular research


Am J Clin Pathol. 2012 Mar;137(3):346-55.
Stuck between a scalpel and a rock, or molecular pathology and legal-ethical issues in use of tissues for clinical care and research: what must a pathologist know?
Dry S, Grody WW, Papagni P.
13-145 CHS, 10833 Le Conte Ave., Los Angeles, CA 90095.

Personalized medicine and health care reform offer the opportunity for pathologists to have a more central and visible role in patient care. Pathologists face new and more complicated requests for clinical and research testing on tissue specimens, including testing for somatic and inherited mutations. Pathologists must comprehend the applications and requirements for molecular testing and their legal and ethical responsibilities in handling tissue requests for clinical and research purposes to best serve the needs of patients and clinicians and to comply with federal and state laws. This article reviews these rapidly evolving and complex areas.

From Andy Churg and colleagues: Are animal models of cigarette smoke-induced COPD any use?


Am J Respir Cell Mol Biol. 2011 Dec;45(6):1111-5. Epub 2011 Jun 17.
Everything prevents emphysema: are animal models of cigarette smoke-induced chronic obstructive pulmonary disease any use?
Churg A, Sin DD, Wright JL.
Department of Pathology, University of British Columbia, Vancouver, Canada. achurg@interchange.ubc.ca

There is a very large number of experimental approaches that prevent cigarette smoke-induced emphysema in laboratory animals, but the few similar treatments that have been tried in humans have had minimal effects, leading to questions of whether animal models of chronic obstructive pulmonary disease (COPD) are of any use in developing treatments for human disease. We review possible reasons for this problem. First, humans usually get treated when they have severe (Global Initiative for Chronic Obstructive Lung Disease III/IV) COPD, but animal models only produce mild (Global Initiative for Chronic Obstructive Lung Disease I/II) disease that never progresses after smoking cessation, and never develops spontaneous exacerbations (i.e., animal models are not models of severe human disease, and probably can't be used to model treatment of severe disease). Second, animal models have concentrated on emphysema and largely ignored small airway remodeling, but small airway remodeling is an equally important cause of airflow obstruction. In addition, small airway remodeling and emphysema are independent responses to smoke, and some experimental animal treatments prevent both lesions, but many do not. Third, animal models are typically Day 1 of smoke exposure "prevention" models, but humans are always treated well along in the course of their disease; thus, any human treatment will be an intervention, and not a prevention. We propose that animal models should examine both emphysema and small airway remodeling, and that experiments should include a relatively late intervention arm. This approach, combined with the realization that human COPD probably needs early rather than late treatment, may make development of treatments based on animal models more relevant.