Good and Bad Health Habits in U.S.: drinkers outnumber exercisers

The CDC study shows that six in 10 American adults were regular drinkers in 2005-2007, but only about three in 10 regularly exercised.

Since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged.

Men were more likely than women to be drinkers (68% vs. 55%).

The more educated people were, the more likely they were to drink. 74% of people who have a graduate degree were drinkers, compared with 44% of people with a high school diploma.

Adults with higher levels of education were less likely to be smokers, be physically inactive, and be obese and to sleep six hours or less per night.

Twitter comments:

@kcb704: "The more educated people were, the more likely they were to drink." http://goo.gl/JDv1 // work hard, play hard..

@BrettLinda: Hold on... good or bad? RT @DrVes Good and Bad Health Habits in U.S.: drinkers outnumber exercisers http://goo.gl/JDv1

References:
Good and Bad Health Habits in U.S. WebMD.

Images source: Wikipedia, Free Documentation License.

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Occupation may be a key factor in lung cancer

While cigarettes are by far the most important cause of lung cancer, chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

References:

Occupation a key factor in men's lung cancer risk. Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E53920100215

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FDA: High-dose simvastatin increases risk of muscle injury – caution with lower doses plus Amiodarone, Verapamil, Diltiazem

Based on review of data from a large clinical trial and data from other sources, the U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg, compared to patients taking lower doses of simvastatin and possibly other drugs in the "statin" class.

The muscle injury, also called myopathy, is a known side effect with all statin medications. The most serious form of myopathy is called rhabdomyolysis. Patients with myopathy generally have muscle pain, tenderness or weakness, and an elevation of a muscle enzyme in the blood (creatine kinase). The higher the dose of statin used, the greater the risk of developing myopathy. The risk of myopathy is also increased when simvastatin, especially at the higher doses, is used with certain drugs (see Simvastatin Dose Limitations below).

The data come from the SEARCH study, in which myopathy was seen in nearly 1% of patients taking the 80 milligram dose of Zocor but in only 0.02% of patients taking the 20 milligram dose of Zocor.

Rhabdomyolysis was rare in the SEARCH study. It happened in only 11 of 6,031 patients (0.02%) in group taking the 80 milligram dose of Zocor, but was not seen in patients taking the 20 milligram dose.

New data also suggest that people of Chinese descent should not take Zocor at the 80 milligram dose -- and should be careful even when taking lower doses -- if they also take niacin-containing products.

Simvastatin Dose Limitations

These limitations apply to ALL patients taking simvastatin.

Do not use simvastatin with these medications:

Itraconazole
Ketoconazole
Erythromycin
Clarithromycin
Telithromycin
HIV protease inhibitors
Nefazodone

Do not use more than 10mg of simvastatin with these medications:

Gemfibrozil
Cyclosporine
Danazol

Do not use more than 20mg of simvastatin with these medications:

Amiodarone
Verapamil

Do not use more than 40mg of simvastatin with this medication:

Diltiazem

References:

Image source: Simvastatin. Wikipedia, public domain.

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500 repetitions of 4 cardiac murmurs improved auscultatory proficiency of medical students

According to a 2004 study in Chest, the ability of medical students to recognize heart murmurs is poor (20%), and does not improve with subsequent years of training.

Five hundred repetitions of four basic cardiac murmurs significantly improved auscultatory proficiency in recognizing basic cardiac murmurs by medical students. These results suggest that cardiac auscultation is, in part, a technical skill.

Related resources
The Heart Sounds Tutorial by Blaufuss.org is a fancy flash-based simulator with animations. The McGill University Virtual Stethoscope is another useful website. Click here for more web-based teaching resources for hearts sounds from UCLA and breath sounds from Loyola University.
References:
Mastering cardiac murmurs: the power of repetition. Barrett MJ, Lacey CS, Sekara AE, Linden EA, Gracely EJ. Chest. 2004 Aug;126(2):470-5.

http://www.ncbi.nlm.nih.gov/pubmed/15302733

Image source: Modern stethoscope. Wikipedia, public domain.

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Rock legend Ronnie James Dio is fighting stomach cancer

On 25 November 2009, Dio's wife and manager announced that he was diagnosed with stomach cancer:

"Ronnie has been diagnosed with the early stages of stomach cancer. We are starting treatment immediately at the Mayo Clinic. After he kills this dragon, Ronnie will be back on stage, where he belongs, doing what he loves best, performing for his fans. Long live rock and roll, long live Ronnie James Dio. Thanks to all the friends and fans from all over the world that have sent well wishes. This has really helped to keep his spirit up." -- "He has had a few hiccups between Christmas and New Year's," she said in a statement to fans. "He has had a blood clot, a trip to the emergency room, and a three-day stay at the hospital."

ArtisanNewsService — April 13, 2010 — "One of heavy metal's premiere vocalists Ronnie James Dio shares his thoughts on his battle with stomach cancer at the Revolver Golden Gods awards."

On 14 March 2010, Dio's wife and manager Wendy posted an online update on his condition:

"It has been Ronnie's 7th chemo, another cat scan and another endoscopy, and the results are good - the main tumour has shrunk considerably, and our visits to Houston (MD Anderson Cancer Center in Texas) are now every three weeks instead of every two weeks."

References:
Ronnie James Dio. Wikipedia.
http://www.nme.com/news/black-sabbath/49346
Black Sabbath, Dio singer Ronnie James Dio gives cancer update. NME.com.

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Hockey-puck-on-a-rod test checks for concussion after head trauma

From NPR:

The hockey-puck-on-a-rod test was invented by a Michigan high school student.

It works like this: Tester suspends the device while injured athlete sits with forearm on table, fingers loosely circling the stick. Without warning, tester drops stick. Athlete grabs stick as fast as possible. Place where athlete grabs gives an instant readout of reaction time.

It all happens in milliseconds - too fast to measure with a stopwatch. Athletes with concussions had reaction times that were 15% slower.

References:
Comments:

Nicholas Genes - Neat idea. I like how it's free of stopwatches and all the variability they introduce. But it seems that athletes would need to have a baseline measurement pre-trauma to really compare (maybe they can do it when they're signing waivers at the start of the season...)

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AskaPatient.com – Medication Ratings and Health Care Opinions

This website "reports patient ratings and rankings of pharmaceuticals and prescription drug side effects. Database includes FDA-approved pharmaceuticals."

http://www.askapatient.com

You can Search by Drug Name:

http://www.askapatient.com/rateyourmedicine.htm

You can add ratings for the medications you take or look at ratings and comments from other patients.

For example:

cetirizine
http://www.askapatient.com/viewrating.asp?drug=19835&name=ZYRTEC

simvastatin (scores rather low)
http://www.askapatient.com/viewrating.asp?drug=19766&name=ZOCOR

Please note that I am not sure how useful the site is, and obviously, this post is not an endorsement or recommendation.
Image source: AskaPatient.com.

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Standardized patient: Over the course of three days, I had 23 head-to-toe physicals from 23 medical students

From Slate:

"I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy.

A "standardized patient" is a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people.

Now there are standardized patients trained for genital duty (they're called GUTAs, for genitourinary teaching associates).

Dr. N wasted the first eight minutes of the exam trying repeatedly to get a blood pressure reading. The panic in his eyes seemed to say, "She appears to be alive, yet she has no vital signs."

Comments:
Lakshman Swamy - Don't forget that some of them were capable! I have to say, in my experience as an MS2 at Wright State, our standardized patients are amazing teachers. It is much easier to learn physical exam skills and even interviewing when the patient can give you precise feedback. The author is right on with the characters that patients can portray... it is shocking when they break character to give feedback! Just recently I learned how to do the male exam with two standardized patients ("GUTA" -- never heard of that term before). I was definitely feeling a little ... awkward before the session began-- this was by far the most invasive thing I had ever done to another person. But the standardized patients were amazing about the whole process, even acting out the different hesitations that we might encounter in patients, emphasizing the importance of the exam, etc. Without being too graphic, I can't emphasize how much I learned about how to do those exams and what I was actually supposed to be finding. It was a totally different experience than I expected, and after it, I feel really confident about the whole process.

I can't even IMAGINE what it would be like to do that with my classmates-- and how much less I would have understood. Wow.

References:
Oh, no! I'm the first patient these 23 medical students have ever examined. Slate, 2010.
Image source: OpenClipArt.org, public domain.

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Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points

From Science Life Blog at the University of Chicago:

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information.

OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

References:

Better Sleep, Better Learning? « Science Life Blog « University of Chicago.
http://sciencelife.uchospitals.edu/2010/02/15/better-sleep-better-learning

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Mobile Medicine via iPod/iPhone/iPad Apps

NatureVideoChannel — March 31, 2010 — "You might not realize it, but with an iPhone, you also have a stethoscope and a CPR trainer within reach. These are just a few of the more than 2,000 medical applications available on the iPhone, and here we've rounded up ten for you to check out. Whether you're a researcher, doctor, or patient, get ready for your medicine to go mobile."

Smartphones and portable devices for medical education
I use an iPhone Touch to listen to lectures and watch presentations (PDF and video). Amazon Kindle works for the same purpose (PDF only, no video).
However, the external speaker of the iPhone Touch leaves much to be desired in terms of sound quality and volume, and recently, I started downloading the lectures directly to my cell phone (HTC Touch Pro2). The HTC Touch Pro interface is not as polished as the one on the iPod Touch but the device itself is not tied to iTunes and I can easily download audio files from the mobile sites of Google Reader, Bloglines and Google Docs.
Related:

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Vitamin D deficiency occurs frequently in COPD and correlates with severity

Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV1).

Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels lower than 20 ng/ml.

25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk allele.

76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 allele exhibited 25-OHD levels lower than 20 ng/ml.

Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

References:
Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65:215-220 doi:10.1136/thx.2009.120659.
Image source: Lungs, Wikipedia, public domain.

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The College of American Pathologists unveils a new patient website MyBiopsy.org

The site is easy to navigate, well-organized and it looks helpful. Check the navigation menu in the left sidebar.

MyBiopsy.org redirects to:
http://www.cap.org/apps/docs/reference/myBiopsy/index2.html

RSS feed is also available: http://feeds2.feedburner.com/MybiopsyFeeds

This is the "fan page" on Facebook: http://www.facebook.com/MyBiopsy.org

(link via @Berci)

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Taking charge of your toddler’s vaccination record is the best way to ensure they don’t miss any shots

From Reuters:

"In our country, we think the doctor should have all the medical records," said Dr. James McElligott, a pediatrician at the Medical University of South Carolina who worked on the study. "I like the idea of putting the ownership back in Mom's hands and empowering her a little bit."

When parents kept a so-called shot card, their child's odds of being up-to-date on vaccinations rose by more than half.

40 percent of the toddlers had a shot card, and 84 percent of these had up-to-date vaccinations. By contrast, only 79 percent of the children without a card had all their shots.

Use the card: it doesn't have a downside and it's cheap."

References:

Want kids' vaccinations up to date? Keep the record | Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E37I20100215

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How to use Google Docs Drawings for medical mind maps

Google Drawings is a new collaborative drawing editor - part of the updated Google Docs. It is free to use, just like the rest of Google Docs. The new standalone drawings editor lets you collaborate in real time on flow charts, designs, diagrams and other fun or business graphics. You can copy these drawings into documents, spreadsheets and presentations using the web clipboard, or share and publish drawings just like other Google Docs.

Until now, my service of choice for medical mind maps was Bubbl.us and I have made more than 100 diagrams with it for AllergyCases.org:

Mind Map Diagrams in Allergy and Immunology

Bubbl.us works very well but I was concerned about embedding the mind maps in case the service goes down temporarily or if the company closes down in the future (mind maps can be exported in XML format for backup). None of these should be a problem with Google Docs. Drawings is obviously behind Bubbl.us in terms of features but it works for basic mind maps and I am planning to use it frequently in the future.

You can embed the minds maps as images, just like you do with YouTube videos, or provide a link to the original mind map and share it for collaboration:

Example: Accidental Injection of Epinephrine Into Finger

Every time you update the mind map in Google Docs/Drawings, the image updates too.

See a few mind maps created with Drawings below:

In order to publish the mind map diagram on the web, you have to click the "Share" button in the top right corner of the Google Docs menu. After the diagram is published, you will see the options to embed the image with different sizes and the link to share the original drawing with options to be edited by collaborators.

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Australian grandmother beats off attacking shark – BBC

From BBC:

"An Australian grandmother has survived a shark attack by repeatedly punching and kicking the animal after it "ripped off" part of her body.

Surgeon Mark Flanagan said: "We can estimate that she lost about 40 per cent of her blood volume from the degree of shock that she had when she came in, and the fact that we required to give her several units of blood."

Mrs Trumbull said she was happy to be alive."

Shark Tunnel and Aquarium at Omaha Zoo, Nebraska.

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Start metformin early when diabetes type II is first diagnosed

Initiating metformin soon after diabetes diagnosis and while A1C is low might preserve ?-cell function, prolong the effectiveness of metformin, reduce lifetime glycemic burden, and prevent diabetes complications.

These findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.

Video: How the Body Works - The Pancreas.

References:

Secondary Failure of Metformin Monotherapy in Clinical Practice. Diabetes Care March 2010 vol. 33 no. 3 501-506.

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Increasing Diet Polyunsaturated Fat in Place of Saturated Fat Reduces Risk of Coronary Heart Disease

Reduced saturated fat (SFA) consumption is recommended to decrease coronary heart disease (CHD), but there is an absence of strong supporting evidence from randomized controlled trials (RCTs) of clinical CHD events and few guidelines focus on any specific replacement nutrient. Additionally, some public health groups recommend lowering or limiting polyunsaturated fat (PUFA) consumption, a major potential replacement for SFA.

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

References:
Image source: Varieties of meat, Wikipedia, public domain.

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Preventing diabetes, biological passport for athletes and more from the Lancet

Low-dose combination therapy with rosiglitazone and metformin was highly effective in prevention of type 2 diabetes in patients with impaired glucose tolerance, with little effect on the clinically relevant adverse events of these two drugs.

Preventing type 2 diabetes with low-dose combinations: Lifestyle interventions aimed at reducing bodyweight, and use of metformin, thiazolidinediones, acarbose, and orlistat, reduce the risk of diabetes by 25—60% over 3—6 years

The biological passport and doping in athletics: A biological passport monitors an athlete's blood and body chemistry values over time to assess whether there has been a deviation from an established baseline, thus indirectly detecting illegal manipulation.

A long look at obesity: Even with their primitive understanding of nutrition, our neolithic forebears somehow made the “right choices”, thriving on a wholesome diet of nuts, seeds, and fruits with the occasional piece of meat. And what is more, their rare intake of animal protein could only have been obtained through vigorous exercise, which they would, of course, indulge in every day.

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Contact lenses change color when blood glucose increases in diabetics

In the future, diabetics may be able to wear contact lenses that continuously alert them to variations in their glucose levels by changing colors - potentially replacing the need to routinely draw blood throughout the day.

The non-invasive technology, developed by Chemical and Biochemical Engineering professor Jin Zhang at The University of Western Ontario, uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes their color.

References:
Nanocomposites could change diabetes treatment. The University of Western Ontario, 2010.

Image source: OpenClipArt.org.

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