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Tobacco Use Cigarette Smoking and Invasive Pneumococcal Disease. J.P. Nuorti, et al. New England Journal of Medicine, 342(March 2000) 681-689. Lowering the prevalence of cigarette smoking from 25 to 15 percent could prevent annually about 4,000 cases of invasive pneumococcal disease in adults aged 18 to 64. In 1995, 47 million adult Americans aged 18 and older smoked cigarettes. This study examined the risk of invasive pneumococcal disease for smokers and for those exposed to passive smoke. Study participants included 228 patients with pneumococcal infection between 18 and 64 years who had no other conditions (such as organ transplantation or HIV infection) that might have contributed to their illness. These subjects were compared with 301 healthy control subjects with the same general characteristics. Researchers interviewed the study participants by telephone from January 1995 to May 1996 to determine smoking history, smoking behavior in the past month, and exposure to passive smoke. Subjects were divided into four categories: current smokers, former smokers with no passive exposure to smoke, people with passive exposure to smoke, and people who had never smoked and had no passive exposure to smoke. Results showed that current smoking was strongly associated with pneumococcal disease; passive smoke exposure was associated to a lesser degree. About half of otherwise healthy patients with invasive pneumococcal disease were smokers. Other characteristics associated with the disease included chronic illness, living with children under 6 years old who attended day care centers, low educational level, low income, and lack of health insurance. The risk of contracting pneumococcal disease increased steadily with the number of cigarettes smoked per day and with the number of years of smoking. Risk of pneumococcal infection decreased by 14 percent per year after subjects quit smoking; in approximately 13 years, researchers predicted it would reach the same level as that of nonsmokers. There was a direct relationship between the number of years a person was exposed to passive smoke and their risk of infection. |
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Heart Olive Oil and Reduced Need for Antihypertensive Medications. L.A. Ferrara, et al. Archives of Internal Medicine 160 (March 27, 2000): 837-842. Use of extra-virgin olive oil can reduce the daily dosage requirement for antihypertensive drugs in people with high blood pressure. High blood pressure is a major risk factor for cardiovascular disease. Controlling high blood pressure through various methods, including diet and antihypertensive medications reduces the risk of heart attacks and strokes, two of the leading killers in the United States. This double-blind, randomized crossover study examined 23 hypertensive patients randomly assigned to a monounsaturated fatty acids (MUFA)—extra-virgin olive oil—diet or polyunsaturated fatty acids (PUFA)—sunflower oil—diet for 6 months. After 6 months, patients were switched to the other diet for 6 more months. Blood pressure was measured at baseline, 6 months, and 12 months. Patients were all put on a well-balanced diet, with the only difference being the source of added fat. Resting blood pressure was significantly lower (P = .05 for systolic; P = .01 for diastolic) on the MUFA diet compared with the PUFA diet. Daily drug dosage among patients on the MUFA diet was reduced by 48 percent, more than 10 times the reduction in patients on the PUFA diet. All patients on the PUFA diet required antihypertensive treatment. Of those patients who received the MUFA diet, eight did not require daily dosage of antihypertensive drugs. |
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Mental Health and Mental Disorders Adolescent Patients—Healthy or Hurting? Missed Opportunities to Screen for Suicide Risk in the Primary Care Setting. D.L. Frankenfield, et al. Archives of Pediatrics & Adolescent Medicine, 154 (February 2000) 162-168. Training in suicide risk factors and appropriate interventions, together with improved screening tools, can help primary care providers identify and prevent potential suicides among their adolescent patients. Suicide rates among adolescents have increased to the point where suicide is now the third leading cause of death among 10- to 19-year-olds in the United States. This mail survey collected information on the knowledge and attitudes of pediatricians and family physicians regarding adolescent suicide and their screening practices for suicide risk factors. Completed surveys were received from 693 respondents in Maryland and the Washington, DC, area (two-thirds response rate). Almost half of the respondents (328) reported having an adolescent patient attempt suicide within the preceding year, and 74 percent reported having one or two patients attempt suicide. Five percent of the respondents reported a completed suicide among their adolescent patients. Although 75 percent of respondents always or frequently screened their adolescent patients for alcohol use and abuse, only 23 percent reported frequently or always screening patients for suicide risk. Physicians’ knowledge of risk factors for suicide was found to be incomplete, however, based on the results of this survey. Most recognized depression as a suicide risk, but most did not recognize disruptive behavior or concerns about sexual orientation as risk factors. More than 70 percent of the respondents expressed the need and desire for more training in suicide prevention, and many also mentioned the need for a short, reliable screening tool for psychosocial and mental health problems in adolescent patients.
The Potential Role of an Adult Mentor in Influencing High-Risk Behaviors in Adolescents. S.R. Beier, et al. Archives of Pediatric Medicine, 154 (April 2000) 327-331. Adolescents who had an adult mentor were less likely to engage in high-risk behaviors such as carrying weapons, using illicit drugs, smoking five or more cigarettes per day, and having more than one sex partner in 6 months. These findings were obtained from anonymous self-administered questionnaires that asked about five specific high-risk behaviors within the past 30 days, past 6 months, or ever in the respondent’s life. Participating in this study were 294 adolescents and young adults, ranging in age from 12 to 23 years old. The study population was 68 percent female, but otherwise was racially, ethnically, and socioeconomically diverse. All were receiving outpatient medical care at an adolescent health service in a suburban New Jersey teaching hospital.
Among the 99 questions in the survey was one that asked, “Is there an adult in your life you can usually turn to for help and advice?” Sixty-eight percent responded affirmatively. Results showed that participants who had mentors were less likely than their counterparts to engage in four of the five high-risk behaviors included in the study. The exception was alcohol use.
Food Safety Fluoride and Bacterial Content of Bottled Water vs Tap Water. J.A. Lalumandier, et al. Archives of Family Medicine 9 (March 2000): 246-250. Some bottled water lacks fluoride and may be less pure than tap water. People of all ages in the United States are choosing to drink bottled water instead of tap water. Bottled water is one of the fastest growing domestic industries, with annual sales of nearly 4 billion gallons, or about 14 gallons for every person in the United States. Perceived purity is one reason for the trend. This comparative study evaluated tap water and bottled water in Cleveland, Ohio, to determine differences in effective tooth decay prevention and purity. The 1.5 million residents of Greater Cleveland get water from Lake Erie and are served by four water processing plants. Fifty-seven samples of bottled water were purchased from local stores. Samples of tap water were collected from each of the four local water processing plants. Only three samples of bottled water had fluoride levels within the range recommended by the Ohio Environmental Protection Agency (0.80 to 1.30 mg/L). Fluoride levels of these three samples were just short of the optimal fluoride level of 1.00 mg/L. All tap water samples had a fluoride level within 0.04mg/L of the optimal fluoride level of 1.00 mg/L. Bacterial colony forming units (CFUs) among the 57 samples of bottled water ranged from less than 0.01 CFUs/mL to 4,900 CFUs/mL. All tap water samples were purer than 15 of the 57 bottled water samples; 3 bottled water samples were as pure as tap water, and 39 bottled water samples were purer than tap water. The 15 samples of bottled water that were not as pure as tap water had bacterial counts more than twice that of the most contaminated tap water and almost 2,000 times that of tap water samples with the lowest bacterial levels.
Physical Activity Physical Activity and Osteoporotic Hip Fracture Risk in Men. U.M. Kujala, et al. Archives of Internal Medicine 160 (March 13, 2000): 705-708. Vigorous to moderate levels of physical activity protect men from future hip fractures. Hip fractures are a significant cause of disability among the over-50 population and are a major health risk among those over age 85. Mortality rates among men who experience hip fracture are higher than the rates among women. Preventing hip fractures can reduce their related health, economic, and social costs. This prospective cohort study conducted in Finland examined the role of physical activity in preventing hip fractures in men, with a focus on vigorous activity. More than 3,000 male twins, 44 years or older in 1975 and not restricted in their ability to exercise, completed a questionnaire about their physical activity, occupation, body weight, height, alcohol use, smoking, and physician-diagnosed diseases at baseline. In 1981, the men were given a followup questionnaire of identical questions, which showed that physical activity had remained stable. Hip fractures were followed from January 1, 1976 to December 31, 1996. After adjusting for age, the risk of hip fractures in men participating in vigorous physical activity decreased, as the participants’ physical activity level increased in intensity and volume. Analysis also showed that men with moderate levels of physical activity had a lower risk of hip fractures compared with men who were sedentary. |
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