Clinical Services / Educational Services / Organizations / E-Mail  

• Older Americans who want to quit smoking can receive counseling through Medicare to help them kick their tobacco habit, but only if they suffer from certain diseases or health problems. Those who stop smoking can still improve their health even if they smoked for years. To receive the counseling, Medicare patients must suffer from heart or lung disease, weak bones, cataracts or other diseases caused or worsened by tobacco use.
  It would also cover patients taking insulin or other medicines that can be less effective with smoking, including drugs to treat high blood pressure, depression and blood clots. The American Medical Association (AMA) said most seniors would probably be able to claim the benefit because there are so many health problems among smokers. About 9 percent of Americans age 65 and older smoke, according to the Centers for Disease Control and Prevention (CDC). A 2001 CDC report found about 38 percent of smokers age 65 to 74 and 30 percent of those 75 and older had tried to quit during a one-year period.

• A literature review suggests that there is, as might be imagined, an association between sexually transmitted diseases and alcohol consumption although the connection may appear obvious, few studies have examined the relationship. Eight of these studies found a significant association between alcohol consumption and at least 1 STD. The relationship did not appear to differ according to gender or to the pattern of alcohol consumption.Therefore, "clinicians seeing patients for STD-related concerns should directly address alcohol problems and make appropriate recommendations and referrals," he said. "Similarly, clinicians seeing patients with alcohol problems should directly address sexual health risks, including risk of HIV infection." Sex Transm Dis 2005;32:156-164.

• Less than 50% of participants in a recent study received treatment appropriate for the psychopathology associated with Alzheimer's disease. The findings "suggest there are patients out there with significant complications of Alzheimer's disease who are not getting the treatment that we would all expect." The study aim was to identify the most effective treatments for these symptoms, and to improve the quality of life of people with Alzheimer's disease, their families, and caregivers. What was clear was the impact of demanding nature of the patients' condition on the caregivers. For the most part, the patients, who ranged from 51 to 103 years old, were being cared for at home, a situation that resulted in depression, sleep disturbances, fatigue and irritability for the great majority of caregivers.

• Deep brain stimulation of the cingulate gyrus can reverse the symptoms of depression that are unresponsive to conventional treatments. Neuroimaging studies have demonstrated that the subgenual cingulate gyrus (Cg25) is metabolically overactive in patients with treatment-resistant depression. After 2 months of continuous electrical stimulation, five of the six patients exhibited decreases in Hamilton Depression Rating Scale-17 scores of at least 50%. At 6 months, four continued to exhibit an antidepressant response. Other improvements included increased energy, interest, and psychomotor speed, decreased apathy and improved ability to initiate and complete tasks. PET scanning showed that in responders, cerebral blood flow decreased in Cg25 and hypothalamus while increasing in prefrontal and brainstem areas.
  Neuron 2005;45:651-660.

• About 1 in 10 people visiting an urban primary care clinic screened positively for bipolar disorder, yet only about 10% received a formal diagnosis. At a single primary care visit, bipolar disorder can be misdiagnosed as major depression if the clinician does not screen for past manic or hypomanic episodes, say the investigators. Failing to recognize the disease as bipolar disorder can lead clinicians to prescribe antidepressant monotherapy, which can precipitate a manic episode. In about half of the patients in one study with a positive screening, the clinician recorded evidence of depression in the charts, but made no mention of bipolar disorder. The findings also suggest that screening positively for bipolar disorder, even without receiving a diagnosis, negatively affected quality of life, including social and family life. JAMA 2005;293:956-963.

• Conventional wisdom about physician expertise generally holds that the longer a physician has been in practice, the better honed his or her clinical skills become. But a new study turns that adage on its head with its conclusion that physicians who have been in practice longer may, in fact, provide lower quality of care. Overall, more than half (52%) of the 62 evaluations captured in the studies showed a negative association between increasing experience and performance for all outcomes assessed, and an additional 21% showed a negative association for some outcomes and none for others. In the area of assessing the knowledge of practicing physicians, for example, all of the 12 studies used reported a negative association between knowledge and increased experience, the study found. For example, after adjusting for specialty and other variables, physicians younger than 40 years were more likely to believe in the value of established therapies that improve survival rates for acute myocardial infarction (AMI), such as thrombolytic agents, aspirin, and beta-blockers, and less likely to believe in the value of therapies that have been disproved, such as prophylactic lidocaine. The study results call into question the benefit of relying exclusively on continuing medical activities, such as attending lectures or reading journal articles, as a way to remain current in knowledge and practice. Practice does not make perfect, but it must be accompanied by an ongoing effort to maintain competence and quality of care. Ann Intern Med. 2005:142:260-273, 302-303

• High intake of vitamin E from food (tocopherol), but not from supplements (which usually contain a-tocopherol), is inversely associated with Alzheimer disease. Vitamin E is composed of four different tocopherol forms (a-, ?, d, and ß-tocopherols) and four corresponding tocotrienols, and because vitamin E supplements usually consist of a-tocopherol only, one possible explanation for the seeming inconsistency is that the effect is not due to a-tocopherol alone but to another tocopherol form or to a combination of tocopherol forms. The results suggest that various tocopherol forms rather than a-tocopherol alone may be important in the vitamin E protective association with Alzheimer disease. This may explain the absence of association reported in some studies between Alzheimer disease and use of vitamin E supplements, which have traditionally contained only a-tocopherol. Am J Clin Nutr. 2005;81:508-514

• For adolescents who attempt suicide, suicidal ideation is reduced and mood improves when outpatient psychotherapy is maintained over 6 months (using) a skills-based, cognitive-behavioral treatment designed to teach problem solving and affect-management skills (SBT), and a nondirective, supportive relationship treatment (SRT).
  In both types of treatment, patients attended six individual sessions during the first 3 months, followed by three monthly sessions. Those receiving SBT were also given homework assignments to assist in skill acquisition and generalization. Although they expected the patients to benefit more from SBT, they found that both groups benefited to a similar extent, and that "most participants also showed significant improvements in depressed mood, suicidal ideation, and problem solving at 3- and 6-month assessments. Specifically, three fourths of adolescents showed clinically significant decreased suicidal ideation and two thirds exhibited less depressed mood over time. J Am Acad Child Adolesc Psychiatry 2005;44:113-120.

• Poor performance on intelligence tests in early adulthood is inversely associated with subsequent suicide. The four intelligence tests covered logic, language, spatial and technical skills. A total of 2811 suicides occurred during follow-up. The authors found that the risk of suicide was two to three times higher in those with lowest compared with the highest test scores. They observed the strongest association with the logic test, where for each unit increase in test score the risk of suicide decreased by 12%. The greatest risk was seen among subjects with low test scores and highly educated parents, which could represent a mismatch between parents' expectations and the offspring's ability. Also, cognitive ability may affect an individual's capacity to solve problems during times of crisis. Another possibility is that maladjustment in childhood, which may lead to poor school performance and poor results on intelligence testing, may also increase the risk of suicide. BMJ 2005;330:167-170.

• In 2002, three of the ten leading causes of death differed between blacks and whites in the US, according to findings in the Morbidity and Mortality Weekly Report for January 14th. Homicide, HIV infection, and septicemia were the 6th, 8th, and 10th leading causes of death, respectively, for blacks, whereas influenza/pneumonia, Alzheimer's disease, and suicide were the 6th, 7th, and 10th leading causes, respectively, for whites. In both ethnic groups, the top cause of death was heart disease, followed by cancer and stroke. Moreover, the groups also shared diabetes, chronic lower respiratory disease, unintentional injury, and nephritis as leading causes. The prevalence of hypertension for blacks was 40.5%, while rates for whites and Mexican Americans hovered around 26%. Although blacks were more likely to be aware of their condition than whites, the percentage with controlled hypertension was the same, at 29.8%. MMWR 2005;54:1-8.

• A genetic mutation that confers a risk for major depression has been identified by researchers. The mutation, G1463A, results in an 80% loss of function in serotonin production when expressed in cultured cells. Of the nine carriers with unipolar depression, seven had family histories of mental illness or drug and alcohol abuse, and six had exhibited suicidal behavior or made a suicide attempt.Furthermore, seven of the carriers with unipolar disorder were unresponsive to treatment with selective serotonin reuptake inhibitors, and the other two responded only to the highest doses of these medications. This finding, the researchers say, suggests that serotonin synthesis in the brain plays a role in the efficacy of this class of drugs. It may even be the case, they speculate, that this and similar genetic variants might be associated with the paradoxical adverse reactions that occur in some patients who take SSRIs, including suicidal behavior, mania, and psychosis. Their discovery "suggests that a defect in brain serotonin synthesis may represent an important risk factor for unipolar major depression." Neuron,2004.

• Acute stress appears to alter gut-specific efferent autonomic innervation in patients with irritable bowel syndrome (IBS) and in healthy controls. However, only IBS patients show heightened visceral sensation. Stress is an important causative factor in IBS. However, it remains unknown whether stress-related changes in gut function are mediated by altered autonomic efferent gut-specific innervation. The researchers examined the effect of acute physical and psychological stress on autonomic innervation and visceral sensitivity in 24 patients with constipation-predominant IBS and 12 healthy controls. Baseline perception of stress was higher among patients with IBS. During physical stress, rectal mucosal blood flow, a measure of gut-specific innervation, decreased by 29.6% in IBS patients and 28.7% in controls. During psychological stress, the corresponding decreases were 24.4% and 23.5%. During physical stress, patients with IBS experienced decreased rectal perception thresholds compared to controls (23.2% versus 0.6%) as well as decreased and rectal pain thresholds (27.0% versus 1.3%). During psychological stress, patients with IBS had reduced thresholds for rectal perception (19.4% versus 8%) and rectal pain (28.4% versus 3.4%). They also had increased anal perception thresholds during physical and psychological stress. Visceral sensitivity but not somatic sensitivity is heightened in patients with IBS in response to stress. This, they add suggests involvement of a different regulator mechanism, either central or peripheral. Gastroenterology 2004;127:1695-1703.