Web Tool for Estimating Risk of Five Major Diseases

A few clicks of the mouse tell visitors to the "Your Disease Risk" Web site their risk for cancer, heart disease, diabetes, stroke and osteoporosis. The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis recently launched this easy-to-use tool, which offers a wealth of information about risk factors and prevention strategies for five prominent diseases affecting millions of Americans.

On the Web site (http://www.yourdiseaserisk.wustl.edu), users can answer a series of simple questionnaires about their medical history, eating habits, exercise and other behaviors and then get a personalized estimate of their risk for 12 different cancers plus heart disease, diabetes, stroke and osteoporosis. Users will also find tips on how to lower their disease risk and convenient Web links to fact sheets that describe the origins and symptoms of each disease.

"The key message is that we already have information to prevent much of the chronic disease that affects the population," says Graham Colditz, M.D., Dr.P.H., the Niess-Gain Professor and associate director of Prevention and Control at the Siteman Cancer Center. "If we can spread the word about prevention strategies, people can start early in life to prevent disease later. We know that it can be hard to decide among all the health claims in the media, and we established this site to make it easy for people to find reliable recommendations for better health and to identify strategies that are best for them."

It is estimated that healthy lifestyles could prevent over half of cancers, 70 percent of strokes and 80 percent of heart disease and diabetes. In addition to detailing the impact of well-known risk factors like smoking, lack of exercise and being overweight, "Your Disease Risk" offers many other important health tips, such as the benefits of calcium and vitamin D for both colon and bone health, the increased risk of diabetes from eating too many refined grains and the increased risk of stroke in apple-shaped people who carry extra fat around the waist.

The site's developers tested its usability with focus groups to make sure all the components are streamlined and understandable. Visitors to the site can choose to investigate just one of the diseases, but answers given in one area carry over to all other areas to avoid the need to repeat answers when learning about more than one disease. A Spanish language version will soon be available on the site's home page.

"We think the site is very accessible and attractive," Colditz says. "We sincerely hope that people make good use of it and feel they come away with a practical, personalized list of what they can do to improve their health."

"Your Disease Risk" reflects recent evidence from the medical community to assure that users are up to date. "We have a system of review that looks at published scientific research on disease risk and makes additions or changes when significant new data become available," Colditz says. "As we go forward, the prevention and control team at the Siteman Cancer Center will continue to ensure the accuracy and relevancy of the site."

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Moderate Drinkers Report Better Health

Moderate drinkers are more likely to report above-average health than lifetime abstainers, light drinkers and heavy drinkers, a new study reveals.

“Our results suggest that a moderate amount of drinking is not necessarily dangerous for most people and may actually be health-enhancing,” said study coauthor Michael French, Ph.D.

However, it is unclear whether moderate drinking leads to better health or whether moderate drinkers simply lead healthier lifestyles, he said.

This finding confirmed much of the clinical evidence on this topic. However, previous research has focused on objective health indicators such as cardiovascular disease, injuries and mortality. “We wanted to see if moderate drinkers are actually feeling better by their own assessment,” said French, professor of health economics at the University of Miami.

The study appears in the July/August issue of the American Journal of Health Promotion.

The study used 2002 data from a representative survey of U.S. households, representing more than 31,000 adults. The U.S. Census Bureau conducts the survey for the Centers for Disease Control and Prevention.

Participants answered questions about alcohol consumption, health behaviors and chronic health conditions. Researchers defined moderate drinking as four to 14 drinks weekly for men and four to seven drinks weekly for women.

Compared with lifetime abstainers and former light drinkers, moderate-drinking men were 1.27 times more likely to report above-average health. Women who were moderate drinkers were more than twice as likely to report above-average health as abstainers were.

Arthur Klatsky, M.D., a researcher and cardiology consultant at the Kaiser Permanente Medical Care Program in Oakland, Calif., suggests that the study’s results for moderate drinkers probably have something to do with healthy lifestyles. “By and large, the same people that work out and eat healthy are probably more likely to be moderate drinkers instead of heavier drinkers,” he said.

One major health benefit of moderate drinking is the ability to ward off cardiovascular disease, particularly hardening of the arteries and stroke caused by blockages in blood vessels, Klatsky added.

Both French and Klatsky warn that heavy drinking contributes to poor health. “Heavy drinking by everybody’s reckoning is bad business for health and social outcomes,” Klatsky said.

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Secondhand smoke = potent carcinogen absorbed

New research on secondhand smoke discovers nonsmoking workers immediately absorb potent carcinogen

Offering alarming new evidence on the dangers of permitting smoking in the workplace, scientists have found that nonsmoking restaurant and bar employees absorb a potent carcinogen—not considered safe at any level—while working in places where they had to breathe tobacco smoke from customers and co-workers. The carcinogen, NNK, is found in the body only as a result of using tobacco or breathing secondhand smoke.

In a study to be published in the August 2007 edition of the American Journal of Public Health, investigators at the Multnomah County Health Department and Oregon Department of Human Services report that elevated levels of NNK showed up in the urine of nonsmoking employees shortly after they encountered secondhand smoke during their shifts. Moreover, levels of NNK, which is known to cause lung cancer, increased by 6 percent for each hour of work.

“This is the first study to show increases in NNK as a result of a brief workplace exposure, and that levels of this powerful carcinogen continue to increase the longer the person works in a place where smoking is permitted. NNK is a major cancer causing agent from tobacco products—and workers should not have to be exposed to any dose of this very dangerous chemical,” said Michael Stark, PhD, of the Multnomah County Health Department and the study’s lead author. “The science shows that the threat of disease from secondhand smoke is no longer a distant threat. The amount of this carcinogen increases even within a single work shift.”

In a related study in the same issue of the Journal, experts in public health law note that across the country employers already are being held legally liable for exposing workers to secondhand smoke, even if state or local laws permit workplace smoking. They warn that as scientists continue to provide evidence of harm, employers could soon face a clear choice: either voluntarily ban smoking in their workplace or face an increasing wave of costly legal actions.

“When employers who allow smoking have scientists telling them that as soon as workers get on the job, they’re breathing in some of the most dangerous carcinogens around, it’s time to think about whether they want to deal with that kind of liability,” said Marice Ashe with the Public Health Law Program at the Public Health Institute in Oakland, CA. and the lead author of the legal analysis. “The science is making it easier and easier to persuade courts to sanction employers who continue to allow smoking.”

The Stark study on the effects of workplace smoking, “The Impact of Clean Indoor Air Exemptions and Preemption on the Prevalence of a Tobacco-Specific Lung Carcinogen Among Nonsmoking Bar and Restaurant Workers,” was funded by the Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program (SAPRP).

It followed 52 nonsmoking employees of bars and restaurants in Oregon communities where smoking is still permitted in such establishments and compared them to 32 nonsmoking bar and restaurant employees from other Oregon municipalities where smoking is prohibited by local ordinance. Researchers collected urine samples from both groups before and after their work-shifts and tested them for the tobacco produced lung carcinogen NNK.

What they found is that three out of four employees who worked in an establishment where smoking was permitted had detectable levels of NNK compared to fewer than half of the unexposed workers. In addition, exposure to tobacco smoke was associated with a three-fold increase in levels of the carcinogen. The study also notes that the amount of NNK in employees exposed to tobacco smoke went up in direct relationship to the number of hours worked—by 6 percent an hour on average—giving the researchers “confidence that the levels (of NNK) reported in this study do, indeed, reflect workplace exposure.”

The investigators also note that their research supports the notion that the risks of secondhand tobacco smoke in the workplace are borne disproportionately by an already vulnerable group. Employees who participated in their study are typical of foodservice workers nationwide in that the majority were women, under age 30, had relatively low household incomes, and more than one third of them lacked health insurance.

“This is already a population that tends to have fewer resources to deal with health problems than many other groups so the least we can do is protect them from harmful cigarette smoke,” Stark said. “For young women in particular, secondhand smoke can increase the risk of having breast cancer and of giving birth prematurely or having low-birth weight babies.”

In their analysis of the legal and liability issues raised by workplace smoking hazards—“Legal Risks to Employers Allowing Smoking in the Workplace”—Ashe and her colleagues said employees harmed by secondhand smoke already are using worker compensation laws, state and federal disability laws and an employer’s legal responsibility to “provide a safe workplace” to take action against secondhand smoke. While in the past such cases have not always met with success, the study notes that as the scientific evidence mounts, employers will increasingly be on the losing end.

“Employers are always talking about high costs of insurance and the need to reduce their potential liabilities,” Ashe said. “Voluntarily banning smoking and supporting state and local legislation mandating smoke-free workplaces is a relatively cheap and easy way of removing a cumbersome and costly liability.”

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Exercise stimulates formation of new brain cells

Exercise has a similar effect to antidepressants on depression. This has been shown by previous research. Now Astrid Bjørnebekk at Karolinska Institutet has explained how this can happen: exercise stimulates the production of new brain cells.

In a series of scientific reports, she has searched for the underlying biological mechanisms that explain why exercise can be a form of therapy for depression and has also compared it with pharmacological treatment with an SSRI drug.

The experiment studies were conducted on rats. The results show that both exercise and antidepressants increase the formation of new cells in an area of the brain that is important to memory and learning. Astrid Bjørnebekk’s studies confirm previous research results, and she proposes a model to explain how exercise can have an antidepressant effect in mild to moderately severe depression. Her study also shows that exercise is a very good complement to medicines.

“What is interesting is that the effect of antidepressant therapy can be greatly strengthened by external environmental factors,” she says.

Previous studies have shown that drug abusers have lowered levels of the dopamine D2 receptor in the brain's reward system. It has been speculated that this may be of significance to the depressive symptoms drug abusers often suffer from. These rat studies show that genetic factors may influence how external environmental factors can regulate levels of the dopamine D2 receptor in the brain.

“Different individuals may have differing sensitivity to how stress lowers dopamine D2 receptor levels, for example. This might be significant in explaining why certain individuals develop depression more readily than others,” she says.

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Therapeutic value of meditation unproven

Therapeutic value of meditation unproven, says study

While it's not likely to do you any harm, there is also no compelling evidence that meditation has therapeutic value

“There is an enormous amount of interest in using meditation as a form of therapy to cope with a variety of modern-day health problems, especially hypertension, stress and chronic pain, but the majority of evidence that seems to support this notion is anecdotal, or it comes from poor quality studies,” say Maria Ospina and Kenneth Bond, researchers at the University of Alberta/Capital Health Evidence-based Practice Center in Edmonton, Canada.

In compiling their report, Ospina, Bond and their fellow researchers analyzed a mountain of medical and psychological literature—813 studies in all—looking at the impact of meditation on conditions such as hypertension, cardiovascular diseases and substance abuse.

They found some evidence that certain types of meditation reduce blood pressure and stress in clinical populations. Among healthy individuals, practices such as Yoga seemed to increase verbal creativity and reduce heart rate, blood pressure and cholesterol. However, Ospina says no firm conclusions on the effects of meditation practices in health care can be drawn based on the available evidence because the existing scientific research is characterized by poor methodological quality and does not appear to have a common theoretical perspective.

“Future research on meditation practices must be more rigorous in the design and execution of studies and in the analysis and reporting of results,” Ospina explains.

But the researchers caution against dismissing the therapeutic value of meditation outright. “This report’s conclusions shouldn’t be taken as a sign that meditation doesn’t work,” Bond says. “Many uncertainties surround the practice of meditation. For medical practitioners who are seeking to make evidence-based decisions regarding the therapeutic value of meditation, the report shows that the evidence is inconclusive regarding its effectiveness.” For the general public, adds Ospina, “this research highlights that choosing to practice a particular meditation technique continues to rely solely on individual experiences and personal preferences, until more conclusive scientific evidence is produced.”

The report, published June 2007 and titled Meditation Practices for Health: State of the Research, identified five broad categories of meditation practices: mantra meditation, mindfulness meditation, Yoga, Tai Chi and Qi Gong. Transcendental Meditation and relaxation response (both of which are forms of mantra meditation) were the most commonly studied types of meditation. Studies involving Yoga and mindfulness meditation were also common.

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Emotions Can Affect Recovery from Hip Surgery

A patient's emotional state plays a significant role in his or her recovery from hip surgery, suggests Saint Louis University research published this month.

Orthopaedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function given by the doctor, and the second is a questionnaire patients answer that considers a wide variety of factors in determining the overall success of the surgical procedure.

"We started out simply looking to see if the results of the two tests were correlated; the one doctors give has been used for decades to evaluate hip function, and the other that the patient answers is much newer," says Berton Moed, M.D., chair of the department of orthopaedic surgery at Saint Louis University School of Medicine. "What we found was surprising - the clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery."
The disparity, says Moed, can be explained by a section of questions on the self-test not addressed by the clinical test: those dealing with emotional well-being. A patient's emotional status was the second-most important factor in determining how well he or she thought recovery was going, Moed found. (Mobility was the first.)

"Patients come in for check-ups after their hip surgery and the doctor says, 'Looks like you're doing fabulously,' and they respond, 'No, I'm not. I ache,'" Moed says. "They're not doing well, but why? It appears to have a lot to do with their emotional state. It's the elephant in the exam room - that is, something doctors need to acknowledge is a real issue."

Rather than retool the established clinical test to include an emotional component, Moed says orthopaedic surgeons should make efforts to use both exams for a more comprehensive measure of the patient's recovery.

"Do we need to look at other interventions besides fixing their hip? I think we might have to," he says. "That could include bringing in social workers and psychologists to work with the patients in the areas that surgeons, who often are super subspecialists, may not be able to deal with."

Moed says both underlying depression and new depression brought on by the injury and/or surgery could be to blame for slowing a patient's recovery.

"When an active person is suddenly confined to the bed or to limited activity, it can take a toll," Moed says. "Not being able to do the things one used - and feeling powerless over it - may play a larger role than we thought in how well the patient feels they're recovering."

While Moed says some patients may be taken aback by the suggestion that they see a psychologist after surgery, he thinks developing better and more customized treatment plans has the potential to help patients recover more fully - and not just after hip surgery.

"The number one issue is recognition - we need to acknowledge that there's more going on with patients than what current clinical tests tell us," he says.

Moed and fellow researchers studied 46 patients who had been followed for at least two years after elementary posterior wall fracture surgery. The research is published in the June issue of the Journal of Bone and Joint Surgery.

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Brain stimulation reduces risk of Alzheimer's

Frequent brain stimulation in old age reduces risk of Alzheimer's disease

How often old people read a newspaper, play chess, or engage in other mentally stimulating activities is related to risk of developing Alzheimer’s disease, according to a study published June 27, 2007, in the online edition of Neurology®, the medical journal of the American Academy of Neurology.

For the study, more than 700 people in Chicago, IL, with an average age of 80 underwent yearly cognitive testing for up to five years. Participants were part of the Rush Memory and Aging Project, a longitudinal study of more than 1,200 older people. Of the participants, 90 developed Alzheimer’s disease. Researchers also performed a brain autopsy on the 102 participants who died.

The study found a cognitively active person in old age was 2.6 times less likely to develop dementia and Alzheimer’s disease than a cognitively inactive person in old age. This association remained after controlling for past cognitive activity, lifetime socioeconomic status, and current social and physical activity.

Researchers say the findings may be used to help prevent Alzheimer’s disease.

“Alzheimer’s disease is among the most feared consequences of old age,” said study author Robert S. Wilson, PhD, with the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago. “The enormous public health problems posed by the disease are expected to increase during the coming decades as the proportion of old people in the United States increases. This underscores the urgent need for strategies to prevent the disease or delay its onset.”

Wilson says the study also found frequent cognitive activity during old age, such as visiting a library or attending a play, was associated with reduced risk of mild cognitive impairment, a transitional stage between normal aging and dementia, and less rapid decline in cognitive function.

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