April 2006
Compiled by Brent R. Gibson, MD, MPH
Resident, Pfizer Practicum Rotation in Health Policy and
Preventive Medicine
Increased Odds of Cancer from Environmental Exposures in
People Who Have Never Smoked
Cost Effectiveness of Medical Interventions to Reduce
Risk of Coronary Heart Disease
Management of Trachoma with a Single Dose of
Azithromycin in Rural African Population
Emergency Preparedness and Managing the Crush Syndrome
A Prospective Study of Mesothelioma from Exposure to
Erionite in Turkey
Need for Development of Antiviral Therapy for Polio
Increasing Prevalence of Overweight and Obesity in the
United States
Continued Need for Research Demonstrating the
Effectiveness of Preventive Measures
Animal Model Narrows Search for Excessive Drinking Genes
Benign Skin Tumor Linked to
Cigarette Smoking
Increased Odds of Cancer from Environmental Exposures in
People Who Have Never Smoked
A recent article in the
International Journal of Cancer examined the incidence
of lung cancer among people who have never smoked—an
understudied group, according to the authors¾and
explored links with other factors to include
environmental tobacco smoke (ETS). Using a case control
study design with 280 cases and 242 controls, the
authors conclude that people who have never smoked and
who are exposed to either ETS or dusts have increased
odds of developing lung cancer. The odds were even
higher (over three times when compared to non-exposed)
for individuals exposed to both. In contrast, the odds
of developing lung cancer among those with a history of
hay fever were less.
Gorlova O, Zhang Y,
Schabth M, Lei L, Zhang Q, Amos C, and Spitz M. Never
Smokers and Lung Cancer Risk: A Case-Control Study of
Epidemiologic Factors. International Journal of
Cancer; 118: 1798-1804.
April 2006 Index
Cost Effectiveness of Medical Interventions to Reduce
Risk of Coronary Heart Disease
Pignone and colleagues
recently explored the cost effectiveness of using
aspirin, statins, or both drugs for preventing coronary
heart disease (CHD) events in men. Writing in the
Annals of Internal Medicine, researchers found that
cost effectiveness of the intervention depended on the
baseline risk of CHD. The outcome measure was cost per
Quality Adjusted Life Year (QALY) gained. Using a Markov
analysis (a statistical procedure used to determine
probabilities in a chain of dependent events) for
healthy men, the authors found that aspirin alone is
less costly and more effective in preventing CHD in
middle-aged men with a 10-year risk for CHD of 10% when
compared to no intervention. Addition of a statin added
cost per QALY gained, but this cost decreased with
increasing risk of CHD. The cost per QALY gained is
$56,200 for men with a 10-year risk of 7.5%, but drops
to $42,500 per QALY for men with a 10-year risk of 10%.
Pignone M, Earnshaw S,
Tice J, and Pletcher M. Aspirin, Statins, or Both Drugs
for the Prevention of Coronary Heart Disease Events in
Men: A Cost-Utility Analysis. Annals of Internal
Medicine; 144: 326-336.
April 2006 Index
Management of Trachoma with a Single Dose of
Azithromycin in Rural African Population
Writing in the Journal
of the American Medical Association, Chidambaram and
colleagues studied the efficacy of one time,
single-dose, mass administration of azithromycin to
reduce long-term prevalence of ocular Chlamydia
infection (trachoma) in children. A population of 500
Ethiopian, village-dwelling children was examined at
baseline for trachoma; the prevalence was 43.5 percent.
Eighty-three (83) percent of the children were available
for follow-up examination. Prevalence was reduced to
5.1 percent immediately post-treatment, but increased to
11.3% after 24 months. Control villages also showed a
decrease in prevalence during the later 12 months of
observation, implying a secular trend. The authors
conclude that a single mass treatment campaign is not
effective in controlling ocular Chlamydia in this
population.
Chidambaram J, Alemayehu
W, Melese M et al. Effect of a Single Mass Antibiotic
Distribution on the Prevalence of Infectious Trachoma.
Journal of the American Medical Association; 295:
1142-1146
April 2006 Index
Emergency Preparedness and Managing the Crush Syndrome
Emphasizing the importance
of disaster preparedness and consequence management,
Sever and colleagues recently outlined planning for,
identifying, and treating large numbers of casualties
suffering from the crush syndrome, a major cause of late
mortality in disaster-related trauma. Primarily a
result of rhabdomyolysis, crush syndrome results when
patients’ kidneys are overwhelmed with large amounts of
myoglobin and uric acid and are inadequately perfused.
It behooves emergency planners and providers in these
areas to have the training, facilities, supplies, and
logistical support to manage such a crisis. Researchers
discuss the importance of recognizing that many regions
of the world are both densely populated and prone to
natural disasters such as earthquakes and tropical
storms. Along these lines, Sever provides written and
graphical guidance to aid emergency personnel.
Sever M, Vanholder R, and
Lameire N. Management of Crush-Related Injuries after
Disasters. The New England Journal of Medicine;
354: 1052-6.
April 2006 Index
A Prospective Study of Mesothelioma from Exposure to
Erionite in Turkey
Mesothelioma is a
well-known consequence of exposure to asbestos fibers;
however, there are other, naturally occurring mineral
fibers know to cause this disease. Inhabitants of
certain villages in the Cappadocia area of Turkey have a
significantly higher incidence of mesothelioma than
controls. This is attributed to exposure to erionite, a
variety of the fibrous mineral group, zeolites. This
mineral is present in the volcanic rock of areas of
central Turkey and was previously used as building
material. Writing in the Journal of the National
Cancer Institute, Baris reports a prospective cohort
study that examined 891 villagers from the region of
interest. Two villages had known exposure to erionite
and one control village did not. When standardized to
the world population, the incidence of mesothelioma was
200-700 cases for 100,000 exposed residents compared to
10 per 100,000 control residents. The Standardized
Mortality Ratio was 486 (95% CI = 395-590) using Danish
data for comparison.
Baris Y, Grandjean P.
Prospective Study of Mesothelioma in Turkish Villages
with Exposure to Fibrous Zeolite. Journal of the
National Cancer Institute; 98: 414-417.
April 2006 Index
Need for Development of Antiviral Therapy for Polio
The journal Science
recently reported that an expert panel, appointed by the
National Research Council in Washington, D.C. and
requested by the World Health Organization (WHO) and the
U.S. Centers for Disease Control and Prevention is
recommending that an anti-polio drug be developed to
help mitigate the effects of a post-eradication polio
outbreak in an unvaccinated population. There was no
agreement about whether developing such a drug, which
would both prevent and treat the infection, was an
achievable objective. According to the article, the WHO
predicts that transmission of the virus will end on
about one year. Specific problems with this proposal
include the time needed to create the drug and the
likelihood that its development would not be a
profitable endeavor for the manufacturer.
Couzin J. Report
Concludes Polio Drugs Are needed--After Disease is
Eradicated. Science; 311: 1539.
April 2006 Index
Increasing Prevalence of Overweight and Obesity in the
United States
The problem of obesity in
the United States was recently underscored by Ogden and
colleagues in the Journal of the American Medical
Association. Using data from the National Health
and Nutrition Examination Survey (NHANES), the authors
concluded that the proportion of children and
adolescents who are overweight increased significantly
between the 1999-2000 survey and the 2003-2004 survey.
Specifically, the prevalence of overweight in male
children and adolescents increased from 14.0% to 18.2%
while the prevalence of overweight in female children
and adolescence increased from 13.8% to 16.0%.
Similarly, the proportion of men who are obese increased
during the same period from 27.5% to 31.1%. In
contrast, no significant trend was seen in women among
whom the prevalence of obesity was 33.4% in 1999-2000
and 33.2% in 2003-2004. Stratification by ethnicity
revealed a prevalence among non-Hispanic black adults of
45%, among Mexican-American adults of 36.8%, and among
non-Hispanic white adults of 30%
Ogden C, Carroll M, Curtin
L, McDowell M, Tabak C, and Flegal K. Prevalence of
Overweight and Obesity in the United States, 1999-2004.
Journal of the American Medical Association; 296:
1549-1555.
April 2006 Index
Continued Need for Research Demonstrating the
Effectiveness of Preventive Measures
The editors of the
Archives of Internal Medicine, Patrick O’Malley and
Phillip Greenland, have recently called for papers to
address an increasingly well recognized concern: the
lack of evidence supporting the efficacy and
effectiveness of preventive interventions. Citing the
abundance of descriptive, observational studies, and a
corresponding lack of studies demonstrating true
effectiveness, O’Malley concludes that there is
insufficient evidence for the efficacy, efficiency and
cost-effectiveness of preventive measures from all
practice environments including both communities and
hospitals. This editorial underscores the need for the
prevention community to aggressively research and
effectively market its work.
O’Malley P, Greenland P.
The Proof for Prevention. Archives of Internal
Medicine; 166: 486.
April 2006 Index
Animal Model Narrows
Search for Excessive Drinking Genes
NIH news reports this
month that researchers at the National Institute on
Alcohol Abuse and Alcoholism (NIAAA) have identified
genes in mice that have an innate preference for
alcohol. Microarray technology was used to study the
full complement of active genes in these animals.
Beginning with nearly 4.000 differently expressed genes
the search was narrowed to 75 likely candidates.
Interestingly, genes found to be expressed differently
are known to reside in the human genome in areas that
are already known to be associated with alcoholism.
According to Dr. Ting-Kai Li, NIAAA director, this was
the first micro array-based analysis of a behavior
trait.
Mulligan M, Ponomarev I,
Hitzemann R et al. Toward Understanding the Genetics of
alcohol Drinking Through Transciptome Meta-analysis.
Proceedings of the National Academy of Sciences;
103: 6368-6373.
April 2006 Index
Benign Skin Tumor
Linked to Cigarette Smoking
Solitary Keratoacanthoma
(KA) is a benign skin tumor that tends to spontaneously
regress. A recent case control study, featured in
Dermatology Online Journal, looked at 78 cases of KA and
199 controls from a related community, found a
significantly increased odds (OR 9.1; 95% CI 4.9-17.1)
that KA patients were smokers. This is an important
study because the link between smoking and skin
malignancies is not well understood. Proposed
mechanisms for causation include, tobacco smoke acting
as a direct skin carcinogen and systemic toxicity from
absorbed toxins. Immunosuppression by nicotine is
another possible mechanism. Shortfalls of this study
include that there was no evaluation of possible
confounders such as caffeine, alcohol analgesics or
hypnotics which are used more in smokers.
Miot H, Miot L, da Costa
A, Matsuo C, Stolf, H Marques M. Association Between
Solitary Keratoacanthoma and Cigarette Smoking: A Case
control Study. Dermatology Online Journal:
12(2).
April 2006 Index
