Wednesday, September 14, 2005

Study :Fast Food Clusters Near Schools

Researchers say pattern likely contributes to obesity

http://www.cnn.com/2005/HEALTH/diet.fitness/08/26/fast.food.schools.ap/index.html

CHICAGO, Illinois (AP) -- The big Burger King sign across the street from a high school campus advertises this temptation: "2 Whoppers for $3."
The scene is repeated throughout Chicago, where fast-food restaurants are clustered within easy walking distance of elementary and high schools, according to a study by Harvard's School of Public Health. The researchers say the pattern probably exists in urban areas nationwide and is likely contributing to the nation's obesity epidemic.
"It can be very hard for children and teens to eat in healthy ways when they're inundated with this," said lead author Bryn Austin, a researcher at Harvard and Children's Hospital Boston.
Nearly 80 percent of Chicago schools studied had at least one fast-food restaurant within a half mile. Statistical mapping techniques showed there were at least three times more fast-food restaurants located less than a mile from schools than would be expected if the restaurants had been more randomly distributed, the researchers said.
Austin said Chicago was chosen because some of the researchers had previous expertise in the city, and she noted that Chicago has a diverse population that likely reflects what is happening in other urban areas.
Previous studies have shown that on a typical day, almost one-third of U.S. youngsters eat fast food, and that when they do, they consume more calories, fats and sugars and fewer fruits and vegetables than on days when they don't eat fast food, the researchers said.
The findings beg the question of whether fast-food companies intentionally locate their restaurants near schools to make them easily accessible to young people, some of their key customers, Austin said.
"We know that a great deal of thought and planning goes into fast-food restaurant site location," and that children "are very important to the market," Austin said.
McDonald's Corp. spokesman Walt Riker said the fast-food giant locates its restaurants "in high-traffic areas like every other business, to serve customers. It has nothing to do with schools." He called the study assumptions speculative since the researchers didn't assess whether proximity of fast food affected students' eating habits.
Burger King did not return several phone messages seeking comment.
If students were to take advantage of the Whopper special outside the Chicago campus, it would lead to a sizable calorie and fat intake.
Two "Original" Whoppers have 1,400 calories -- over half of them from fat, according to Burger King's Web site. Government nutrition guidelines for children aged 4 to 18 recommend a daily total of between 1,400 and 3,200 calories, depending on age, gender and activity level, and that no more than 35 percent of calories come from fat.
The study was released in the September issue of the American Journal of Public Health.
The researchers compiled 2002 data on 613 fast food restaurants and 1,292 public and private schools in Chicago. Sources included Technomic Inc., a food industry market research company that publishes a list of leading fast-food chains. Restaurants and schools for which addresses could not be found were excluded, but the researchers said the report includes at least 90 percent of both.
An estimated 16 percent or more than 9 million U.S. children aged 6 to 19 are seriously overweight or obese, numbers that have tripled since 1980.
Children in Chicago are more than twice as likely to be overweight when they enter kindergarten than children elsewhere, so the study is especially troubling, said Dr. Matt Longjohn, executive director of the Consortium to Lower Obesity in Chicago Children.
One solution is to "change demand" and make healthy food choices more accessible, Longjohn said.
Chicago's public schools are among districts that have eliminated junk-food and soft drinks from campus vending machines in an effort to tackle the problem, but the researchers said the clustering of fast-food restaurants near schools may be undermining those efforts.
"We can't really tell our students not to go to fast-food restaurants; all we can do is to educate them about what healthy food choices are," said Mike Vaughn, a spokesman for Chicago's public schools.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

COPD Deaths Skyrocket While Heart, Stroke, and Cancer Mortality Decline

COPD Deaths Skyrocket While Heart, Stroke, and Cancer Mortality Decline
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/tb/1721
Review
Byron Thomashow, MD NY Presbyterian ATLANTA, Sept 13-

The age-adjusted mortality rates attributed to four of the six leading causes of death in the U.S. declined during the past three decades while one stands out by its extraordinary rise -- chronic obstructive pulmonary disease (COPD).
The overall age-standardized death rate fell by 32%. For stroke, it dropped by 63%. The heart disease rate fell by 52% and the accident rate was down by 41%. Cancer squeezed onto the improvement list, although by only 2.7%.
Then there was cigarette-fueled COPD, which rose by 102.8% from 1970 to 2002, according to Ahmedin Jemal, D.V.M., Ph.D., and colleagues of the department of epidemiology and surveillance research at the American Cancer Society here.
In 1970 the COPD age-standardized death rate (per 100,000 per year) was 21.4 deaths, while in 2002 it was 43.4 deaths, according to the death-trend data published in the Sept 14 issue of the Journal of the American Medical Association.
The age-standardized death rate from diabetes, one of the six leading causes of death analyzed, also increased during the study from a rate of 24.6 deaths (per 100,000 per year) in 1970 to 25.4 deaths (per 100,000 per year) in 2002.
The increases in COPD and diabetes age-standardized death rates are grim evidence of the impact of two major public health concerns: tobacco and obesity.
The increase in COPD age-standardized death rates results largely from the long-term effects of tobacco smoking in an aging population, said the investigators. The increase in diabetes deaths, they wrote, "reflects dramatic increases in obesity."
Causes of death vary by age and in 2002 the leading cause of death in persons age 75 or older was heart disease, while cancer was the leading cause of death for people ages 40 to 74, and accidents were the leading cause of deaths in those younger than 40.
The researchers analyzed death certificate data and classified causes of death by ICD-8, ICD-9, and ICD-10 coding.
Between 1970 and 2002 the age-adjusted standardized death rate from all causes combined decreased 32% from 1242.2 to 844.6 based on the year 2000 age standard.
The age-adjusted standardized rate per cause of death is as follows:
1970 heart disease 502.6 (per 100,000 per year) versus 2002 240.6 (per 100,000 per year)
1970 cancer 198.8 (per 100,000 per year) versus 2002 193.5 (per 100,000 per year)
1970 stroke 151.9 (per 100,000 per year) versus 2002 56.1 (per 100,000 per year)
1970 21.4 (per 100,000 per year) versus 2002 43.4 (per 100,000 per year)
1970 accidents 62.5 (per 100,000 per year) versus 2002 36.9 (per 100,00 per year)
1970 diabetes mellitus 24.6 (per 100,000 per year) versus 2002 25.4 (per 100,000 per year).
The decrease in age-standardized death rates in four of the six leading causes of death represents "progress toward one of the fundamental goals of disease prevention by extending the number of years of potentially healthy life," the researchers wrote. That progress, they wrote, has been greater in heart disease than in cancer, but even the cancer death rate has been "decreasing by 1.1% per year since 1993."
The researchers cautioned, however, that the rate of decline in the death rate for stroke and accidents has slowed since the 1990s, suggesting that this decline may be approaching a plateau.
At the same time, the "biphasic trend in cancer mortality rates reflects both the impact of the tobacco epidemic on tobacco-related cancers through 1990, followed by reduction in cancer mortality through tobacco control and advances in early detection, in treatment, or in both," they wrote.
Finally, they pointed out that the flip side of declining death rates is an increase in the number of aging Americans who survive disease but require chronic treatment, which is likely to play out in ever-increasing demands on Medicare.

Primary source: Journal of the American Medical AssociationSource reference: Jemal A et al "Trends in the Leading Causes of Death in the United States, 1970-2002" JAMA 2005;294:1255-1259View this abstract.

Soy Protein May Reduce Bone Fractures

Soy Protein May Reduce Bone Fractures
By Michael Lemonick Permalink
TIME Magazine Online
One of the arguments used by doctors in support of hormone-replacement therapy for menopausal women is that it helps prevent osteoporosis, and thus reduces the chances of the all-too-easy breaking of bones in the female elderly. But in light of the proven danger of hormones increasing the risk of heart problems and cancer, the FDA has been urging women to strengthen their bones in other ways, including calcium supplements and weight-bearing exercise. Now, a new study suggets that soy protein, such as the Asian vegetarian staple tofu, may offer an effective alternative hedge against bone loss.
The current issue of Archives of Internal Medicine reports on the Shanghai Women’s Health Study in China, in which more than 24.000 women with an average age of 60, participated. Dr. Xianglan Zhang and colleagues divided the women into five groups, based on their intake of soy, a significant part of the Chinese diet. When he looked at their relative risk of bone fracture after 4.5 years, the group that ate the most soy protein - more than 13 grams per day - had a 35% lower risk of fracture than those who ate the least (just under 5 grams). The likely explanation for soy's protective power is a set of natural estrogen-like compounds called soy isoflavones, and indeed, when the scientists looked directly at isoflavone consumption (it isn't precisely the same as soy consumption because levels of the chemicals vary in different batches of soy), the group consuming the most isoflavones had a 37% lower risk of fracture.

More Evidence on Benefits of Exercise

More Evidence on Benefits of Exercise
By Sora Song Permalink
TIME Magazine Online

New research from Duke University Medical Center offers further proof - if you needed any - that exercise is imperative to good health, and that even moderate amounts of activity can melt away fat in places you never knew you had it.
An inactive lifestyle not only pads the gut, but also increases the body's hidden "visceral" fat, which accumulates around organs deep inside the belly. In past studies, visceral fat has been associated with an elevated risk for insulin resistance, diabetes and hypertension. And, unlike subcutaneous fat - the jiggly body fat that lies just under the skin - it can't be sucked away with surgery.
The best way to get rid of it, say authors of a new study published in the Journal of Applied Physiology, is with good old-fashioned exercise. In their six-month study, researchers assigned 175 overweight, sedentary adults to one of four exercise groups, ranging from a control group that did no exercise at all to a high-intensity group who jogged 20 miles per week. At end of six months, the sedentary group showed an 8.6% increase in visceral fat. Meanwhile, those in the high-intensity group lost 6.9% of their visceral fat, and dropped another 7% of their subcutaneous fat.
If jogging 20 miles a week sounds daunting, don't worry. Smaller amounts of exercise result in significant health benefits too. Participants in the study who either walked or jogged 12 miles a week showed no major changes in levels of visceral fat, suggesting that a moderate amount of physical activity, regardless of intensity, can successfully keep visceral fat at bay.

Do You Know Your Calcium Score?

Do You Know Your Calcium Score?
The Newest Risk FactorBy ALICE PARK

Posted Sunday, Aug. 28, 2005

First it was blood cholesterol that could give you an early warning that a heart attack might be around the corner. Then came c-reactive protein. And now that doctors can get a better look at what's inside your heart arteries, they are taking a new interest in something they have always known was present in problem vessels: calcium. Hospitals, clinics and even gyms are touting quick and easy scans that can measure the amount of calcium in your coronary arteries in minutes. But while calcium scores can be helpful, doctors caution that using them to predict who is at risk of heart disease isn't always straightforward.
Ever since the 1700s, when doctors discovered bony material in heart vessels, physicians have known that some blood-vessel cells can morph into bony tissue. Now we know that excess cholesterol tends to trigger this process in the arteries that feed the heart. Calcium can then build up in the vessels and stiffen them, laying the foundation for heart disease. Getting one's calcium score is as simple as getting a quick injection of a contrast agent in the arm and a zap from an ultrafast X ray, either by electron beam computed tomography (EBCT) or by multidetector CT. Studies show that in every age group people with higher calcium levels have a greater risk of heart attack than do people of the same age with lower scores.
But that doesn't mean everyone with a high calcium score is headed for a heart attack. For one thing, as we age, we tend to build up more plaque, and therefore more fat and calcium, in our arteries. Thus higher calcium numbers in young people are a more significant indicator of potential problems than they would be in the elderly. It also turns out that even two people of the same age with the same calcium scores don't necessarily have the same heart-disease risk. Like cholesterol, coronary calcium is only one of many risk factors that determine how vulnerable you are to heart abnormalities. The latest research, for example, shows that in some people, the calcium is spread thinly throughout the coronary arteries, while in others it is clumped in larger lesions. Which is worse?
Doctors still aren't sure, but they are developing some interesting theories. Dr. Linda Demer, a cardiologist at UCLA who has been studying coronary calcium for 15 years, believes that having many small calcium deposits may be worse than having fewer larger ones. Her work suggests that it is not the total amount of calcium that makes vessels vulnerable but rather the way the deposits are anchored to the blood vessels. Since the vessels are flexible and the calcium is hard, the arteries are weakest wherever the calcium adheres; the more deposits, the more tension points where the vessel can tear.
So who should get their hearts scanned for a calcium score, and who should be worried if the number is high? So far, studies show that scans are best at predicting heart problems in those with several risk factors: high cholesterol, elevated blood pressure, a family history of heart disease. "The question for these people is, How aggressive should their treatment be?" says Dr. Matthew Budoff, a cardiologist at UCLA. "Do we put them on a statin for the rest of their lives or tell them to just watch their diet? Knowing how much calcium they have could help inform this decision." --By Alice Park

Heart Attack Patients Do As Well With Drugs As With Invasive Steps

Heart-Attack Patients Do as Well With Drugs As With Invasive Steps
By SYLVIA PAGÁN WESTPHAL Staff Reporter of THE WALL STREET JOURNALSeptember 15, 2005; Page D1

For patients who are having a mild heart attack, medication and monitoring may work as well as the standard, more-invasive approach now used by hospitals, a new study says.
The study, published in today's New England Journal of Medicine, adds fuel to an already heated debate over how to treat the more than one million patients admitted into U.S. hospitals each year complaining of chest pain, and whose electrocardiogram shows they are likely suffering a form of mild heart attack. These attacks stem from a narrowing, rather than a complete blockage, of an artery feeding the heart. About two-thirds of patients complaining of heart-attack symptoms or chest pain fall into this category, says the American Heart Association.
The standard approach for these patients is to take a blood test to see if an enzyme known as troponin T is elevated, which doctors consider to be an indicator of high risk that the patient is having a heart attack. Current U.S. and European guidelines recommend an invasive procedure immediately, which involves threading catheters through the patient's arteries to help get an image of the vessels near the heart.
If narrowed vessels are found, doctors usually open up the artery with a balloon and place a stent -- a metal mesh tube -- in the artery to keep it open. If the blockage is very serious doctors may turn to bypass surgery.
Until a few years ago this wasn't the standard approach. A more-conservative tactic was also commonly done, giving patients a cocktail of drugs in hopes their cardiac symptoms would go away, says Robbert J. de Winter, a cardiologist at the Academic Medical Center in Amsterdam, who wrote the New England Journal study. If the symptoms didn't subside, more-invasive imaging often followed, along with balloon treatment, stenting or bypass surgery.
But in recent years, a number of large clinical trials came out favoring the catheter-based invasive strategy from the outset, showing this approach yielded lower rates of chest pain and fewer heart-attack recurrences. Guidelines from the American College of Cardiology and the American Heart Association, as well as European authorities, were amended to recommend the invasive strategy.
But newer anticlotting, cholesterol-lowering and other state-of-the-art drugs have become more widely used since the earlier studies. Moreover, the previous studies mixed lower-risk with higher-risk patients. So Dr. de Winter and his collaborators ran a new study using a cocktail of these medicines in combination with careful monitoring, against the more-aggressive approach in high-risk patients.
The researchers were still expecting to find the invasive therapy to be better, but to their surprise, their study of 1,200 men and women ages 29 to 83 found that the conservative approach appeared at least as effective as the invasive approach.
A year after the initial hospital visit, an equal percentage of patients, 2.5%, had died in each group, researchers found. In that time, subsequent heart attacks occurred in 15% of patients undergoing the catheterization, versus 10% of those on the conservative strategy. Visits to the hospital for symptoms were slightly more frequent -- 10.9% versus 7.4% -- among patients assigned to the conservative approach.
By being more conservative, Dr. de Winter's team spared dozens of patients surgery or stenting. One year after the initial visit, 54% of patients in the conservative-treatment group had received stents or undergone bypass surgery, compared with 79% of patients in the invasive group.
The study was conducted at 42 hospitals in the Netherlands, and was supported in part by grants from several pharmaceutical and medical-device companies. Some of the investigators in the trial reported receiving grants and consulting fees from the pharmaceutical companies making some of the drugs given to the patients.
William E. Boden, a cardiologist at the University of Connecticut, who wrote an accompanying editorial in the journal and wasn't involved in the study, believes the likely explanation for the new results was better drugs. "I think that leveled the playing field," he says.
He thinks the results should serve as a wake-up call to physicians. The main point of the study, he says, is not to discourage doctors from intervening with an invasive procedure, but to make them realize they might not have to do it right away. The study shows "you are not putting the patient in harm's way by deferring intervention for a few days," Dr. Boden says.
This message may be especially important to smaller hospitals that don't have the in-house capability to implant stents or do bypass surgery, Dr. de Winter adds. Currently those hospitals transfer their high-risk patients to a larger center within 48 hours. But Dr. de Winter says doctors at these facilities might now feel reassured to keep some of those patients longer.
Cardiologist Gregg W. Stone, of the Columbia University Medical Center, cautioned that most clinical trials still suggest early intervention is better. Dr. Stone, who has conducted research for stent maker Boston Scientific, says, "The totality of the evidence certainly suggests that the aggressive approach ... is appropriate."

Write to Sylvia Pagán Westphal at sylvia.westphal@wsj.com

ADHD Drug Use Among Adults Double in 4 Years

ADHD Drug Use Among Adults Doubles in 4 Years
Associated PressSeptember 15, 2005; Page D2
Wall Street Journal

Use of prescription drugs for attention deficit hyperactivity disorder is rising at a faster rate among adults than children for the first time, research shows.
Between 2000 and 2004, use of drugs that help keep ADHD patients focused doubled among adults ages 20 to 44, but rose only 56% among children, according to data compiled by Medco Health Solutions Inc., a Franklin Lakes, N.J., pharmacy-benefit manager.
Medco's study, to be released today, shows use rose 113% among women 20 years old to 44 years old and 104% among women 45 to 64, both far more than among men. Meanwhile, spending on the medicines quadrupled.
Experts say such reasons for the surge include better drugs and advertising to parents of children diagnosed with ADHD realizing they have the same symptoms.
Awareness of the disorder is increasing. ADHD symptoms include impulsivity, trouble concentrating, disorganization, procrastination and hyperactivity, although fewer females are hyperactive. People with ADHD tend to be creative, tenacious, energetic and sensitive, said Dr. Edward Hallowell, author of a book about ADHD, "Delivered from Distraction."
"We're seeing about 1% of adults being treated," but four times as many are estimated to have ADHD, said Dr. Robert Epstein, Medco's chief medical officer.
Eight percent of children ages 4 to 17, or about 4.4 million, are diagnosed with ADHD, and just above half take medication, according to the Centers for Disease Control and Prevention. Nearly 1.5 million people in the U.S. 20 years and older are using the drugs, Medco said.
Those figures dispel earlier beliefs that children "grow out of the disorder," said Dr. Patricia Quinn, a developmental pediatrician at the National Center for Gender Issues and ADHD, and an adviser to Children and Adults with Attention-Deficit/Hyperactivity Disorder, an advocacy group.
Spending on ADHD medicines has surged with the increasing popularity of brand-name versions that last all day, limiting ups and downs of symptoms.
Revenue skyrocketed to $3.1 billion in 2004 from $759 million in 2000, according to health-care data provider IMS Health Inc.

Copyright © 2005 Associated Press

Employer Health- Care Costs Rise 9.2%

Employer Health-Care Costs Rise 9.2%
By VANESSA FUHRMANS Staff Reporter of THE WALL STREET JOURNALSeptember 15, 2005; Page D2

Employers are facing a 9.2% increase in the cost of providing health care to employees this year, pushing the premium for an average family health plan above the annual salary for a minimum-wage worker, a nationwide survey shows.
The 2,995-employer survey, conducted by the Kaiser Family Foundation and Health Research and Educational Trust, is considered an authoritative barometer of U.S. company health-care costs. It contains one glimmer of good news: After four years of double-digit increases in health-insurance premiums, the average increase has fallen below 10%.
But this year's jump is still three times bigger than the average increase in workers' income and nearly triple the inflation rate. Since 2000, employers' premiums have climbed 73%, bringing the average annual premium for family coverage to $10,880.
That makes a family premium more expensive than the $10,712 a full-time minimum-wage worker earns in a year. Given that the average worker pays 26% of those annual premiums, or $2,713, the cumulative rise in health-care costs have made it all but impossible for many low-income workers to afford company-sponsored coverage. Indeed, the share of workers covered by health insurance through their own employer fell to 60% in 2005, compared with 63% in 2000, the study's authors said.
"It is the low-wage workers who are being hurt the most by the steady drip, drip, drip of coverage draining out of the employer-based health-insurance system," said Drew Altman, president of the Kaiser Family Foundation, a nonprofit health-policy research group based in Menlo Park, Calif. The foundation surveys employers every year between January and May, asking how their current premiums compare to a year earlier.
More businesses, mostly smaller ones, are dropping health benefits altogether. The percentage of firms offering health insurance to their workers dropped to 60%, down from the 66% in 2003 and 69% in 2000, the study said.
Few employers with more than 200 workers have dropped health coverage, the Kaiser study reports, but they do continue to reduce benefits or shift more of the costs to employees. Another employer survey published this week, by employee-benefits firm Mercer Human Resource Consulting, found that companies are becoming more determined to hold down cost increases.
"Many are saying they've set a target of mid- to high-single digits as their threshold of pain," said Blaine Bos, a senior Mercer consultant and one of the study's authors. The 1,883 employers Mercer surveyed said they expect to bring next year's average health-care cost increase down to 6.4%, but only by raising employees' premiums and deductibles and introducing measures such as programs that manage costly diseases such as diabetes, hypertension and other chronic illnesses.

Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com

Friday, September 09, 2005

Healthcare Articles

Articles Pertaining to the Changing Dynamics of Healthcare . . .