Sunday, March 31, 2013

From Jorge Sepulveda and Donald Young: The Ideal Laboratory Information System

The Ideal Laboratory Information System

Jorge L. SepulvedaMD, PhDDonald S. YoungMD, PhD
From the Department of Pathology & Cell Biology, Columbia University, New York, New York (Dr Sepulveda) and the Department of Pathology & Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Young).
Context.—Laboratory information systems (LIS) are critical components of the operation of clinical laboratories. However, the functionalities of LIS have lagged significantly behind the capacities of current hardware and software technologies, while the complexity of the information produced by clinical laboratories has been increasing over time and will soon undergo rapid expansion with the use of new, high-throughput and high-dimensionality laboratory tests. In the broadest sense, LIS are essential to manage the flow of information between health care providers, patients, and laboratories and should be designed to optimize not only laboratory operations but also personalized clinical care.
Objective.—To list suggestions for designing LIS with the goal of optimizing the operation of clinical laboratories while improving clinical care by intelligent management of laboratory information.
Data Sources.—Literature review, interviews with laboratory users, and personal experience and opinion.
Conclusions.—Laboratory information systems can improve laboratory operations and improve patient care. Specific suggestions for improving the function of LIS are listed under the following sections: (1) Information Security, (2) Test Ordering, (3) Specimen Collection, Accessioning, and Processing, (4) Analytic Phase, (5) Result Entry and Validation, (6) Result Reporting, (7) Notification Management, (8) Data Mining and Cross-sectional Reports, (9) Method Validation, (10) Quality Management, (11) Administrative and Financial Issues, and (12) Other Operational Issues.

Understanding the costs of care for cystic fibrosis: an analysis by age and health state

 2013 Mar-Apr;16(2):345-55. doi: 10.1016/j.jval.2012.12.003.

Understanding the costs of care for cystic fibrosis: an analysis by age and health state.


Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia. Electronic address:



Cystic fibrosis (CF) is an inherited disease that requires more intensive treatments as the disease progresses. Recent medical advancements have improved survival but have also increased costs. Our lack of understanding on the relationship between disease severity and lifetime health care costs is a major impediment to the timely economic assessment of new treatments.


Using data from three waves of the Australian Cystic Fibrosis Australia Data Registry, we estimate the annual costs of CF care by age and health state. We define health states on the basis of annual lung-function scores and patient's organ transplant status. We exploit the longitudinal nature of the data to model disease progression, and we use this to estimate lifetime health care costs.


The mean annual health care cost for treating CF is US $15,571. Costs for patients with mild, moderate, and severe disease are US $10,151, US $25,647, and US $33,691, respectively. Lifetime health care costs are approximately US $306,332 (3.5% discount rate). The majority of costs are accounted for by hospital inpatients (58%), followed by pharmaceuticals (29%), medical services (10%), complications (2%), and diagnostic tests (1%).


Our study is the first of its kind using the Australian Cystic Fibrosis Data Registry, and demonstrates the utility of longitudinal registry data for the purpose of economic analysis. Our results can be used as an input to future economic evaluations by providing analysts with a better understanding of the long-term cost impact when new treatments are developed.

From U South Carolina: The Relationship between Executive Function and Obesity in Children and Adolescents

 2013;2013:820956. doi: 10.1155/2013/820956. Epub 2013 Feb 21.

The Relationship between Executive Function and Obesity in Children and Adolescents: A Systematic Literature Review.


Medical Student at the Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29403, USA.


The objective of this paper is to examine the relationship between the development of executive function (EF) and obesity in children and adolescents. We reviewed 1,065 unique abstracts: 31 from PubMed, 87 from Google Scholar, 16 from Science Direct, and 931 from PsycINFO. Of those abstracts, 28 met inclusion criteria and were reviewed. From the articles reviewed, an additional 3 articles were added from article references (N = 31). Twenty-three studies pertained to EF (2 also studied the prefrontal and orbitofrontal cortices (OFCs); 6 also studied cognitive function), five studied the relationship between obesity and prefrontal and orbitofrontal cortices, and three evaluated cognitive function and obesity. Inhibitory control was most often studied in both childhood (76.9%) and adolescent (72.7%) studies, and obese children performed significantly worse (P < 0.05) than healthy weight controls on various tasks measuring this EF domain. Although 27.3% of adolescent studies measured mental flexibility, no childhood studies examined this EF domain. Adolescents with higher BMI had a strong association with neurostructural deficits evident in the OFC. Future research should be longitudinal and use a uniform method of EF measurement to better establish causality between EF and obesity and consequently direct future intervention strategies.

From Nature: Global health: Persuasive evidence on HIV policy

 2013 Mar 28;495(7442):452-3. doi: 10.1038/495452a.

Global health: Persuasive evidence on HIV policy.

Antiretroviral therapy has revolutionized the fight against the HIV/AIDS pandemic. Surveillance analyses of a large population in rural South Africa make a compelling case that sustained support for this therapy is essential.

Chronic Obstructive Pulmonary Disease and Vascular Disease Delay Timeliness of Early Stage Lung Cancer Resectional Surgery

 2013 Mar 28. [Epub ahead of print]

Chronic Obstructive Pulmonary Disease and Vascular Disease Delay Timeliness of Early Stage Lung Cancer Resectional Surgery.


Department of Pulmonary Medicine, Naval Medical Center San Diego , San Diego, California , USA.


Abstract Introduction: Lung cancer remains the leading cause of cancer death in the United States and worldwide. Timeliness to diagnosis and referral for resectional surgey is key to successful management for early stage disease. Methods: We investigated the contribution of medical co-morbidities in the timeliness to resectional surgery for non-small cell lung cancer (NSCLC). A retrospective record review of NSCLC surgery cases at Naval Medical Center San Diego (NMCSD) from 2004 to 2009 from the tumor registry was conducted. Results: More than 75% of NSCLC patients exhibited at least one co-morbidity. Of the 84 patients, 26% of patients had diabetes, patients with different vascular co-morbidities accounted for 39%, whereas 33% of subjects had COPD. Patients with sleep apnea or liver disease each accounted for 6%. Vascular disease co-morbidity and COPD in NSCLC patients significantly delayed time from initial cardiothoracic surgery evaluation to thoracotomy (p = 0.01-0.02 and p < 0.05 respectively). Conclusion: Although significances of different co-morbities in the development NSCLC cannot be extrapolated, theses data show that COPD and vascular diseases are significant risk factors that delay surgical treatment of early stage lung cancer.

From SUNY: Effects of assessing the productivity of faculty in academic medical centers

 2012 Aug 7;184(11):E602-12. doi: 10.1503/cmaj.111123. Epub 2012 May 28.

Effects of assessing the productivity of faculty in academic medical centres: a systematic review.


Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA.



Many academic medical centres have introduced strategies to assess the productivity of faculty as part of compensation schemes. We conducted a systematic review of the effects of such strategies on faculty productivity.


We searched the MEDLINE, Healthstar, Embase and PsycInfo databases from their date of inception up to October 2011. We included studies that assessed academic productivity in clinical, research, teaching and administrative activities, as well as compensation, promotion processes and satisfaction.


Of 531 full-text articles assessed for eligibility, we included 9 articles reporting on eight studies. The introduction of strategies for assessing academic productivity as part of compensation schemes resulted in increases in clinical productivity (in six of six studies) in terms of clinical revenue, the work component of relative-value units (these units are nonmonetary standard units of measure used to indicate the value of services provided), patient satisfaction and other departmentally used standards. Increases in research productivity were noted (in five of six studies) in terms of funding and publications. There was no change in teaching productivity (in two of five studies) in terms of educational output. Such strategies also resulted in increases in compensation at both individual and group levels (in three studies), with two studies reporting a change in distribution of compensation in favour of junior faculty. None of the studies assessed effects on administrative productivity or promotion processes. The overall quality of evidence was low.


Strategies introduced to assess productivity as part of a compensation scheme appeared to improve productivity in research activities and possibly improved clinical productivity, but they had no effect in the area of teaching. Compensation increased at both group and individual levels, particularly among junior faculty. Higher quality evidence about the benefits and harms of such assessment strategies is needed.

From Yale: Comprehensive quality of discharge summaries at an academic medical center

 2013 Mar 22. doi: 10.1002/jhm.2021. [Epub ahead of print]

Comprehensive quality of discharge summaries at an academic medical center.


Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.



Discharge summaries are essential for safe transitions from hospital to home.


To conduct a comprehensive quality assessment of discharge summaries.


Prospective cohort study.


Three hundred seventy-seven patients discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.


Discharge summaries were assessed for timeliness of dictation, transmission of the summary to appropriate outpatient clinicians, and presence of key content including elements required by The Joint Commission and elements endorsed by 6 medical societies in the Transitions of Care Consensus Conference (TOCCC).


A total of 376 of 377 patients had completed discharge summaries. A total of 174 (46.3%) summaries were dictated on the day of discharge; 93 (24.7%) were completed more than a week after discharge. A total of 144 (38.3%) discharge summaries were not sent to any outpatient physician. On average, summaries included 5.6 of 6 The Joint Commission elements and 4.0 of 7 TOCCC elements. Summaries dictated by hospitalists were more likely to be timely and to include key content than summaries dictated by housestaff or advanced practice nurses. Summaries dictated on the day of discharge were more likely to be sent to outside physicians and to include key content. No summary met all 3 quality criteria of timeliness, transmission, and content.


Discharge summary quality is inadequate in many domains. This may explain why individual aspects of summary quality such as timeliness or content have not been associated with improved patient outcomes. However, improving discharge summary timeliness may also improve content and transmission.

Erdheim-Chester Disease With Prominent Pericardial Effusion: Cytologic Findings and Review of the Literature

 2013 Feb 28. doi: 10.1002/dc.22957. [Epub ahead of print]

Erdheim-Chester Disease With Prominent Pericardial Effusion: Cytologic Findings and Review of the Literature.


Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland.


Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown origin with distinct clinicopathologic and radiographic features. Reports detailing the cytology of ECD are rare. We describe a case of ECD with pericardial effusion. Cytologic examination revealed a hypercellular specimen composed of clusters and singly dispersed foamy macrophages with round nuclei and inconspicuous nucleoli, admixed with lymphocytes, eosinophils, and Touton-type multinucleated giant cells. Immunostains for CD68 were strongly positive in the foamy macrophages while S100 and CD1a were negative. The presence of foamy histiocytes, multinucleated giant cells, lymphocytes and eosinophils are also features of other systemic histiocytic disorders, including Langerhans cell histiocytosis (LCH), Rosai-Dorfman disease (RDD) and sarcoidosis. To the best of out knowledge, this is the first report describing the cytological features of ECD in a pericardial effusion. 

Antibiotics and antibiotic resistance: A bitter fight against evolution

 2013 Mar 18. pii: S1438-4221(13)00019-2. doi: 10.1016/j.ijmm.2013.02.004. [Epub ahead of print]

Antibiotics and antibiotic resistance: A bitter fight against evolution.


Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Darwin 3, Campus de la Universidad Autónoma, Cantoblanco-Madrid 28049, Spain.


One of the most terrible consequences of Darwinian evolution is arguably the emergence and spread of antibiotic resistance, which is becoming a serious menace to modern societies. While spontaneous mutation, recombination and horizontal gene transfer are recognized as the main causes of this notorious phenomenon; recent research has raised awareness that sub-lethal concentrations of antibiotics can also foster resistance as an undesirable side-effect. They can produce genetic changes by different ways, including a raise of free radicals within the cell, induction of error-prone DNA-polymerases mediated by SOS response, imbalanced nucleotide metabolism or affect directly DNA. In addition to certain environmental conditions, subinhibitory concentrations of antimicrobials may increase, even more, the mutagenic effect of antibiotics. Here, we review the state of knowledge on antibiotics as promoters of antibiotic resistance.

From JAMA: The cover. Easter Sunday.

 2013 Mar 27;309(12):1205. doi: 10.1001/jama.2012.176795.

The cover. Easter sunday.

The intoxicating scent of soon-approaching spring and sunny daffodils bobbing above the desiccating snow are all part of the exhilaration of the Easter season. Children excitedly race around Grandma's house in search of hidden Easter eggs, and gardeners ponder the preternaturally perfect veggies seen in seed catalogs. For others, there may be a quieter inward sense of renewal.
New beginnings often require new clothes, as is perhaps illustrated by the blossom-bedecked bonnets adorning women in Easter Sunday (cover) by Gari Melchers (1860-1932), an example of his skill in portraying the beauty of ordinary life and keenly conveying the subtlety of human emotion.

Saturday, March 30, 2013

Applying lean methods to improve quality and safety in surgical sterile instrument processing

 2013 Mar;39(3):99-105.

Applying lean methods to improve quality and safety in surgical sterile instrument processing.


Center for Health Services Research, Virginia Mason Medical Center, Seattle, USA.



Surgical instrument processing is critical to safe, high-quality surgical care but has received little attention in the medical literature. Typical hospitals have inventories in the tens of thousands of surgical instruments organized into thousands of instrument sets. The use of these instruments for multiple procedures per day leads to millions of instrument sets being reprocessed yearly in a single hospital. Errors in the processing of sterile instruments may lead to increased operative times and costs, as well as potentially contributing to surgical infections and perioperative morbidity.


At Virginia Mason Medical Center (Seattle), a quality monitoring approach was developed to identify and categorize errors in sterile instrument processing, through use of a daily defect sheet. Lean methods were used to improve the quality of surgical instrument processing through redefining operator roles, alteration of the workspace, mistake-proofing, quality monitoring, staff training, and continuous feedback. To study the effectiveness of the quality improvement project, a before/after comparison of prospectively collected sterile processing error rates during a 37-month time frame was performed.


Before the intervention, instrument processing errors occurred in 3.0% of surgical cases, decreasing to 1.5% at the final follow-up (p < .001). Improvements were observed in multiple categories of error types, particularly the assembly errors of packaging (from 0.66 to 0.24 errors per hundred cases, p = .004), and foreign objects (0.17 to 0.02 errors per hundred cases, p = .025).


Surgical instrument processing errors are a barrier to the highest quality and safety in surgical care but are amenable to substantial improvement using Lean techniques.

“It will be all right. New York Review Classics is careful.” Then I thought, “Maybe I’d better proofread it.”




There is also constant misuse of words with an aura of the intellectual. Annabel Davis-Goff pointed out, years ago, the idiotic misuse of “irony,” or “ironical,” for work that has no element of irony whatever. “Isn’t it ironic: for breakfast he had an egg. And the irony is, he had already had bacon.” What? Coincidence, humor, sarcasm, deadpan, any relation or none: it was ironic. It was a perfectly good word. Now it’s nearly always hack non-think, and coming from some of the most highly respected writers of our time.
BLVR: What was the thing you were most scared to write?
RA: It has always been more the fear of publication. The content was never frightening. I never attacked anyone weak—that I knew about. Only bullies, secure in their courts, bureaucracies, fiefdoms. Fear didn’t come into it. Maybe it should have.
BLVR: Is there anything that you regret writing?
RA: No. I mean, sort of. There are things that I would have done a little bit differently, a little bit sharper. I almost never reread anything I’ve published.
BLVR: Really? So these two novels that are coming out, you didn’t reread them?
RA: I thought, “It will be all right. New York Review Classics is careful.” Then I thought, “Maybe I’d better proofread it.” 

Comparing the effects of food restriction and overeating on brain reward systems

 2013 Mar 24. pii: S0531-5565(13)00083-1. doi: 10.1016/j.exger.2013.03.006. [Epub ahead of print]

Comparing the effects of food restriction and overeating on brain reward systems.


University of Florida, Department of Psychiatry, Gainesville, FL 32610; Princeton University, Department of Psychology, Princeton, NJ 08540. Electronic address:


Both caloric restriction and overeating have been shown to affect neural processes associated with reinforcement. Both preclinical and some clinical studies have provided evidence that food restriction may increase reward sensitivity, and while there are mixed findings regarding the effects of overeating on reward sensitivity, there is strong evidence linking this behavior with changes in reward-related brain regions. Evidence of these changes comes in part from findings that show that such eating patterns are associated with increased drug use. The data discussed here regarding the differential effects of various eating patterns on reward systems may be particularly relevant to the aging population, as this population has been shown to exhibit altered reward sensitivity and decreased caloric consumption. Moreover, members of this population appear to be increasingly affected by the current obesity epidemic. Food, like alcohol or drugs, can stimulate its own consumption and produce similar neurochemical changes in the brain. Age-related loss of appetite, decreased eating, and caloric restriction are hypothesized to be associated with changes in the prevalence of substance misuse, abuse, and dependence seen in this cohort.

Learn some Economics! Hayek vs. Keynes: Rounds 1 and 2



6 Fitness and Weight Loss Tips We Should Borrow from French Women

6 Fitness and Weight Loss Tips We Should Borrow from French Women

Survey: Only 1/3 of parents follow pediatrician advice all the time

1/3 of parents follow pediatrician advice

ANN ARBOR, Mich., March 30 (UPI) -- Parents disregard a lot of medical advice regularly dispensed by pediatricians during well-child visits, U.S. researchers say.

Sarah J. Clark of the University of Michigan -- associate director of the National Poll on Children's Health -- and colleagues polled 907 U.S. parents of children age 8 and younger, and found 56 percent of parents said they followed their child's doctor's advice most of the time, while 13 percent said they follow the provider's advice only occasionally.

The survey found only 31 percent said they followed advice from their child's healthcare provider all the time. Seventeen percent of parents from lower-income households -- less than $60,000 annually -- followed advice occasionally, compared to 8 percent of parents from higher-income households who followed advice occasionally.

Read more:

The Illusion of Argument Justification

 2013 Mar 18. [Epub ahead of print]

The Illusion of Argument Justification.


Argumentation is an important way to reach a new understanding. Strongly caring about an issue, which is often evident when dealing with controversial issues, has been shown to lead to biases in argumentation. We suggest that people are not well calibrated in assessing their ability to justify a position through argumentation, an effect we call the illusion of argument justification. Furthermore, we find that caring about the issue further clouds this introspection. We first show this illusion by measuring the difference between ratings before and after producing an argument for one's own position. The strength of the illusion is predicted by the strength of care for a given issue (Study 1). The tacit influences of framing and priming do not override the effects of emotional investment in a topic (Study 2). However, explicitly considering counterarguments removes the effect of care when initially assessing the ability to justify a position (Study 3). Finally, we consider our findings in light of other recent research and discuss the potential benefits of group reasoning. 

The history of the Greek Anti-Malaria League and the influence of the Italian School of Malariology

 2013 Mar 1;21(1):56-71.

The history of the Greek Anti-Malaria League and the influence of the Italian School of Malariology.


Department of Microbiology, Medical School, University of Athens, Greece.


In 1905, a group of eminent Greek physicians led by Professor of Hygiene and Microbiology Constantinos Savvas and the pediatrician Dr. Ioannis Kardamatis founded the Greek Anti-Malaria League. The League assumed a role that the State would not, and for the next 25 years organized the country's anti-malaria campaign. During its first steps, the Greek Anti-Malaria League adopted the principles of Professor Angelo Celli's Italian Anti-Malaria League. The League's accomplishments include a decrease in malarial prevalence, due to mass treatment with quinine, new legislation ensuring the provision of quinine, State monopoly and the collection of epidemiologic data. However, defeat in the Greek-Turkish War (1922) and the massive influx of one million Greek refugees that ensued, led to a change in malarial epidemiology. In 1928, following a visit to Italy, the Greek League adopted the organization and knowledge of the Italian Malaria Schools in Rome and in Nettuno, and this experience served as the basis of their proposal to the State for the development of the anti-malaria services infrastructure. The State adopted many of Professor Savvas' proposals and modified his plan according to Greek needs. The League's experience, accumulated during its 25 years of struggle against malaria, was its legacy to the campaigns that eventually accomplished the eradication of malaria from Greece after World War II.

From Harvard: Feast or Famine: The Host-Pathogen Battle Over Amino Acids

 2013 Mar 22. doi: 10.1111/cmi.12140. [Epub ahead of print]

Feast or Famine: The Host-Pathogen Battle Over Amino Acids.


Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, US.


Intracellular bacterial pathogens often rely on their hosts for essential nutrients. Host cells, in turn, attempt to limit nutrient availability, usingstarvation as a mechanism of innate immunity. Here we discuss both host mechanisms of amino acid starvation and the diverse adaptations of pathogens to their nutrient-deprived environments. These processes provide both key insights into immune subversion and new targets for drug development.

Elegent: Getting away with murder: how does the BCL-2 family of proteins kill with immunity?

 2013 Mar 25. doi: 10.1111/nyas.12045. [Epub ahead of print]

Getting away with murder: how does the BCL-2 family of proteins kill with immunity?


Department of Oncological Sciences Department of Dermatology The Tisch Cancer Institute The Graduate School of Biological Sciences, Mount Sinai School of Medicine, New York, New York.


The adult human body produces approximately one million white blood cells every second. However, only a small fraction of the cells will survive because the majority is eliminated through a genetically controlled form of cell death known as apoptosis. This review places into perspective recent studies pertaining to the BCL-2 family of proteins as critical regulators of the development and function of the immune system, with particular attention on B cell and T cell biology. Here we discuss how elegant murine model systems have revealed the major contributions of the BCL-2 family in establishing an effective immune system. Moreover, we highlight some key regulatory pathways that influence the expression, function, and stability of individual BCL-2 family members, and discuss their role in immunity. From lethal mechanisms to more gentle ones, the final portion of the review discusses the nonapoptotic functions of the BCL-2 family and how they pertain to the control of immunity.

Which doctor for primary health care? Quality of care and non-physician clinicians in India

 2013 May;84:30-4. doi: 10.1016/j.socscimed.2013.02.018. Epub 2013 Feb 19.

Which doctor for primary health care? Quality of care and non-physician clinicians in India.


Public Health Foundation of India, ISID Campus, India; Department of International Health, Health Systems Program, Johns Hopkins University, USA. Electronic address:


The scarcity of rural physicians in India has resulted in non-physician clinicians (NPC) serving at Primary Health Centers (PHC). This study examines the clinical competence of NPCs and physicians serving at PHCs to treat a range of medical conditions. The study is set in Chhattisgarh state, where physicians (Medical Officers) and NPCs: Rural Medical Assistants (RMA), and Indian system of medicine physicians (AYUSH Medical Officers) serve at PHCs. Where no clinician is available, Paramedics (pharmacists and nurses) usually provide care. In 2009, PHCs in Chhattisgarh were stratified by type of clinical care provider present. From each stratum a representative sample of PHCs was randomly selected. Clinical vignettes were used to measure provider competency in managing diarrhea, pneumonia, malaria, TB, preeclampsia and diabetes. Prescriptions were analyzed. Overall, the quality of medical care was low. Medical Officers and RMAs had similar average competence scores. AYUSH Medical Officers and Paramedicals had significantly lower average scores compared to Medical Officers. Paramedicals had the lowest competence scores. While 61% of Medical Officer and RMA prescriptions were appropriate for treating the health condition, only 51% of the AYUSH Medical Officer and 33% of the prescriptions met this standard. RMAs are as competent as physicians in primary care settings. This supports the use of RMA-type clinicians for primary care in areas where posting Medical Officers is difficult. AYUSH Medical Officers are less competent and need further clinical training. Overall, the quality of medical care at PHCs needs improvement.

From Qazvin U-Iran: Risk-Taking Behaviors and Subgrouping of College Students (participating in the political process curiously absent)

 2013 Mar 28. [Epub ahead of print]

Risk-Taking Behaviors and Subgrouping of College Students: A Latent Class Analysis.


1Qazvin University of Medical Sciences, Qazvin, Iran.


Risk-taking behaviors have negative consequences on adolescent and young adult's health. The aim of this study was to identify the subgroups of college students on the basis of risk-taking behaviors and to assess the role of demographic characteristics, religious beliefs, and parental support on membership of specific subgroup. The cross-sectional study took place in Tabriz (northwest of Iran) in April and May of 2011. The randomly selected sample consisted of 1,837 college students. A survey questionnaire was used to collect data. Latent class analysis was performed to achieve the study's objectives. Four latent classes were identified: (a) low risk, (b) cigarette and hookah smoker, (c) sexual and drinking risk-takers (for males)/sexual risk takers (for females), and (d) high risk. Notably, 13.3% of the males and 4.3% of the females were in the high-risk class. The results identified evidence of protective influence of familial support and religiosity on risky behaviors. A fair number of college students, males in particular, were identified as high risk-takers. Design and implementation of preventive interventions for this segment of the population are necessary. Higher level of familial support and religiosity may serve as preventive factors in risk-taking behaviors.

From Sandefjord High School-Norway: Aflatoxins, hepatocellular carcinoma, and public health

 2013 Mar 14;19(10):1508-12. doi: 10.3748/wjg.v19.i10.1508.

Aflatoxins, hepatocellular carcinoma and public health.


Arvin Magnussen, Sandefjord High School, 3228 Sandefjord, Norway.


Hepatocellular carcinoma (HCC) is one of the leading causes of cancer deaths worldwide, primarily affecting populations in the developing countries. Aflatoxin, a food contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus, is a known human carcinogen that has been shown to be a causative agent in the pathogenesis of HCC. Aflatoxin can affect a wide range of food commodities including corns, oilseeds, spices, and tree nuts as well as milk, meat, and dried fruit. Many factors affect the growth of Aspergillus fungi and the level of aflatoxin contamination in food. Drought stress is one of the factors that increase susceptibility of plants to Aspergillus and thus aflatoxin contamination. A recent drought is thought to be responsible for finding of trace amounts of aflatoxin in some of the corn harvested in the United States. Although it's too soon to know whether aflatoxin will be a significant problem, since United States is the world's largest corn producer and exporter, this has raised alarm bells. Strict regulations and testing of finished foods and feeds in the United States should prevent a major health scare, and prevent human exposure to deleterious levels of aflatoxin. Unfortunately, such regulations and testing are not in place in many countries. The purpose of this editorial is to summarize the current knowledge on association of aflatoxin and HCC, encourage future research and draw attention to this global public health issue.

From Berklee College of Music-Boston: Music Therapy in Cardiac Healthcare

 2013 Mar 27. [Epub ahead of print]

Music Therapy in Cardiac Healthcare: Current Issues in Research.


Music Therapy Department Berklee College of Music, Boston, Ma.


Music therapy is a service that has become more prevalent as an adjunct to medical practice, as its evidence base expands and music therapists begin to join the cardiology team in every phase of care, from the most serious cases to those maintaining good heart health. While applications ofmusic medicine, primarily listening to short segments of music, are capable of stabilizing vital signs and managing symptoms in the short-term,music therapy interventions by a qualified practitioner are showing promise in establishing deeper and more lasting impact. Based on mind-body approaches, stress/coping models, the neuromatrix theory of pain, and entrainment, music therapy capitalizes on the ability of music to affect the autonomic nervous system. Although only a limited number of randomized controlled trials pinpoint the efficacy of specific music therapy interventions, qualitative research reveals some profound outcomes in certain individuals. A depth of understanding related to the experience of living with a cardiovascular disease can be gained through such music therapy approaches as nonverbal music psychotherapy, and guided imagery andmusic. The multifaceted nature of musical responsiveness contributes to strong individual variability, and must be taken into account in the development of research protocols for future music therapy and music medicine interventions. The extant research provides a foundation for exploring the many potential psychosocial, physiological, and spiritual outcomes of a music therapy service for cardiology patients.

From Cukurova U-Turkey: Social support and hopelessness in patients with breast cancer


Social support and hopelessness in patients with breast cancer.


Nursing Department, Cukurova University Adana Health High School, Adana, Turkey E-mail :


Background: Patients with breast cancer can experience a feeling of hopelessness very deeply in the adjustment process, and the social support provided during this period can be effective in increasing the level of hope. The present study aimed to identify breast cancer patients' social support and hopelessness level. 
Materials and Methods: The target population of this analytical study was all breast cancer patients (total of 85) who had treatment in the oncology department of a university hospital located in Adana/Turkey and who met the inclusion criteria. Data were collected through "Personal Information Form", "Beck Hopelessness Scale (BHS) " and "Multidimensional Scale of Perceived Social Support" (MSPSS). Analysis was performed using Shapiro Wilk, One Way ANOVA Welch, Student t-test, Mann Whitney U, and Kruskall Wallis tests. Homogeneity of variance was tested with the Levene, Bonferroni and Games Howell tests. Mean scores and standard deviation values are given as descriptive statistics. 
Results: Average age of the participants with breast cancer is 48.6∓10.6. Of all the participants, 84.7% are married, 49.4% graduated from primary school, 81.2% are housewives, and 82.4% had children. The participants' multidimensional perceived social support total scores were found to be high (57.41∓13.97) and hopelessness scale scores low (5.49∓3.80). There was a reverse, linear relationship between hopelessness scale scores and social support total scores (r=-0.259, p=0.017). A statistically significant relationship was found between hopelessness scores and education level and having children, occupation, income status, and education level of spouses (p<0.05). 
Conclusions: The present study indicates thathopelessness of the patients with breast cancer decreased with the increase in their social support. Therefore, activating patient social support systems is of importance in increasing their level of hope.

Screen viewing and diabetes risk factors in overweight and obese adolescents

 2013 Apr;44(4 Suppl 4):S364-70. doi: 10.1016/j.amepre.2012.11.040.

Screen viewing and diabetes risk factors in overweight and obese adolescents.


Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario; School of Human Kinetics, University of Ottawa, Ottawa, Ontario; Department of Pediatrics, University of Ottawa, Ottawa, Ontario; Department of Psychology, University of Ottawa, Ottawa, Ontario. Electronic address:



Sedentary behavior has been associated with deleterious cardiometabolic health indicators in adults, but very little research has examined this relationship in youth.


To examine the association between the duration and type of sedentary screen behavior with diabetes risk factors (fasting glucose, insulin, homeostasis model-insulin resistance [HOMA-IR], 2-hour postload glucose, hemoglobin A1c) in a sample of overweight and obese adolescents.


A cross-sectional study of 307 overweight or obese adolescents aged 14-18 years (90 boys, 217 girls) assessed at baseline of a lifestyle intervention for weight control conducted from 2005 to 2010. Sedentary screen behaviors, defined as hours per day spent watching TV, playing seatedvideo games, recreational computer use, and total screen time were measured by self-report. Data were analyzed using linear regression analyses in 2012.


TV viewing was the only type of sedentary screen behavior associated with elevated diabetes risk factors before and after adjustment for confounders. Specifically, TV viewing remained positively associated with fasting insulin (adjusted r=0.11, β=0.10, p=0.048) and HOMA-IR (adjusted r=0.11, β=0.10, p=0.05) after adjustment for age, gender, waist-to-hip ratio, caloric intake, percentage of intake in carbohydrates, physical activity duration, and physical activity intensity.


TV watching may be independently associated with an increase in diabetes risk factors in a high-risk sample of overweight and obese adolescents. These findings provide support for interventions designed to reduce time spent watching TV as a possible means to attenuating diabetes risk factors in this high-risk population.

The genetics of eating disorders

 2013 Mar 28;9:589-620. doi: 10.1146/annurev-clinpsy-050212-185546.

The genetics of eating disorders.


Department of Psychiatry.


Over the past decade, considerable advances have been made in understanding genetic influences on eating pathology. Eating disorders aggregate in families, and twin studies reveal that additive genetic factors account for approximately 40% to 60% of liability to anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Molecular genetics studies have been undertaken to identify alterations in deoxyribonucleic acid sequence and/or gene expression that may be involved in the pathogenesis of disordered eating behaviors, symptoms, and related disorders and to uncover potential genetic variants that may contribute to variability of treatment response. This article provides an in-depth review of the scientific literature on the genetics of AN, BN, and BED including extant studies, emerging hypotheses, future directions, and clinical implications.