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Respiratory Care

Smoking ban reduces cardiac hospitalizations

Pell J, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med. 2008;359:482-491.


Brandt A. FDA regulation of tobacco-pitfalls and possibilities. N Engl J Med. 2008;359:445-448.


Recent Scottish research has found that hospitalizations due to acute coronary syndrome have dropped significantly since cigarette smoking has been banned in indoor public places. These findings are published in the July 31 issue of The New England Journal of Medicine.

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The research indicates that the drop in hospitalizations is attributed to reduced exposure to second-hand smoke. The smoking ban in Scotland was issued on April 1, 2006. The investigation found 3,235 hospital admissions from June 2005 to March 2006, compared with 2,684 admissions in the same months from 2006 to 2007.


The investigation found that in current smokers, the rate of admissions fell by 14% after the ban. However, the rate of admissions of lifelong nonsmokers dropped by 21% and that of former smokers declined by 19%. Therefore, these findings strongly support the theory that second-hand smoke is of foremost danger to public health.


In the United States, 21 states and Washington, D.C., in addition to over 150 cities and counties in other states have put such smoking bans into practice.


Psychiatric Care

Exercise does not reduce anxiety and depression

De Moor MHM, Boomsma DI, Stubbe JH, et al. Testing causality in the association between regular exercise and symptoms of anxiety and depression. Arch Gen Psychiatry. 2008;65:897-905.


An innovative study of identical twins suggests that regular exercise does not improve mood in the general population, although previous research has linked exercise to less stress and anxiety. The current study, published in the August issue of Archives of General Psychiatry, indicates that this link may instead be genetic.

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The link was tested by examining data from 5,952 twins in the Netherlands Twin Register, 1,357 of their other siblings, and 1,249 parents; all of whom were 18 to 50 years of age.


During the study, one twin exercised rigorously more than the other twin. The twin who exercised more was not less depressed than the twin who exercised less. Individual environmental factors, such as level of exercise and other nongenetic factors were not significant.


The researchers could not identify which specific genes are responsible for the relationship between exercise behavior and risk of anxiety and depression. However, they suspect that they might be located in the dopaminergenic, opioidergic, norepinephrenergic, or serotonergic areas of the brain.


Antidepressant-related sexual dysfunction in women can be treated with sildenafil

Nurnberg HG, Hensley PL, Heiman JR, et al. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA. 2008;300:395-404.


Women who experience sexual dysfunction associated with taking antidepressant medications may now get relief from sildenafil (Viagra). A study published in the July 23/30 issue of TheJournal of the American Medical Association, suggests that sildenafil may improve sexual function in women who develop sexual dysfunction due to the use of selective or nonselective serotonin reuptake inhibitors.


This study included 98 premeno pausal women with a mean age of 36.7 years who reported decreased libido, lack of lubrication, delayed orgasm, and pain during intercourse as a result of taking antidepressants. After 8 weeks of this parallel-group, randomized, double-blind, placebo-controlled trial, the sildenafil group experienced a significant reduction in symptoms than the placebo group.


The only symptom not affected by the sildenafil was libido--there was no significant improvement in the women's sexual desire with use of the drug.


Pediatric Care

Lack of sleep increases obesity risk in children

Liu X, Forbes EE, Ryan ND, et al. Rapid eye movement sleep in relation to overweight in children and adolescents. Arch Gen Psychiatry. 2008;65:924-932.


Researchers suggest that children who do not get enough sleep, particularly rapid eye movement (REM) sleep, are at an increased risk of obesity. A study, found in the August issue of Archives of General Psychiatry, investigated 335 children aged 7 to 17 years. In this group, 241 of the children were at normal weight, 49 had higher body mass index (BMI) and were at risk for overweight, and 45 were in fact overweight. Each participant's height and weight were noted, as well as BMI. Each child participated in standard polysomnography testing for three consecutive nights.

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The test results found that the overweight children slept 22 minutes less than the normal-weight children and had reduced sleep efficiency, shorter REM cycles, lower REM activity and density, and longer latency to the first REM period. Hence, the research shows that the relationship between short sleep duration and overweight is sleep stage dependent.


The source of this relationship, however, remains unclear. Previous studies have suggested that sleep loss contributes to weight gain and obesity by endocrine changes.


Dermatologic Care

Cats may cause eczema in infants

Bisgaard H, Simpson A, Palmer CNA, et al. Gene-environment interaction in the onset of eczema in infancy: filaggrin loss-of-function mutations enhanced by neonatal cat exposure. PLoS Med. 2008;5:e131.


Infants who have a specific genetic mutation-a filaggrin mutation-and who have a cat in the house are more likely to develop eczema in their first year of life than those who don't have the mutation. In fact, infants who have the filaggrin deficiency and have cats in the house are more than twice as likely to develop eczema.

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Filaggrin genetic mutation weakens the skin's protective barrier, and children who have it should not be exposed to cats for at least the first few months of life. Two studies published in the June issue of PLoS Medicine describe this research.


In both studies, cat exposure was the only allergen that increased eczema risk, and it did so only in children with the filaggrin mutation. Cat exposure increased the risk from a hazard ratio of 2.26 with filaggrin mutation alone to 11.11 if a cat was in the home. Dog exposure seemed to have the opposite effect. Neither study demonstrated a significant interaction of the filaggrin mutation with the dust mite allergen.


Women's Health Care

Treatment may not be the best option for infertility

Bhattacharya S, Harrild K, Mollison J, et al. Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomized controlled trial. BMJ. 2008;337:a716.


When a couple is presumed infertile for no apparent reason, common courses of action are the oral drug clomiphene (Clomid, Serophene) and unstimulated intrauterine insemination. These treatments can be expensive and potentially hazardous. New research, however, suggests that these measures are not necessary; continued unassisted attempts to conceive is said to yield the same results.

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The trial conducted in Scotland, included couples who had been infertile for at least 2 years despite bilateral tubal patency and normal ovulation and sperm motility. The 580 women enrolled in the study were randomized to 3 groups for 6 months, including:


* Expectant management with no clinic visits, medical interventions, basal temperature charts, or luteinizing hormone detecting kits.


* Administration of oral clomiphene at 50 mg between days 2 and 6 with intercourse suggested on days 12 to 18 of each menstrual cycle.


* One intrauterine insemination 20 to 30 hours after an endogenous surge in self-monitored urinary luteinizing hormone concentrations.



The results showed no differences among the groups in the time it took to achieve pregnancy that led to a live birth. Therefore, the researchers suggest that expectant management for 6 to 12 months may be the best option for otherwise healthy women under age 36 who have not been able to conceive after less than 3 years of trying.


Emergency Care

Rapid HIV tests in the ED may not be accurate

Walensky RP, Arbelaez C, Reichmann WM, et al. Revising expectations from rapid HIV tests in the emergency department. Ann Intern Med. 2008;149:153-160.


Pilcher CD, Hare CB. The deadliest catch: fishing for HIV in new waters. Ann Intern Med. 2008;149:204-205.


The CDC recommends offering HIV testing to all adults and teens in all healthcare settings, including EDs. However, research shows that the FDA-approved oral antibody test (OraQuick) yields more false positives than reported by the manufacturer.

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The report, published in the August 5 issue of Annals of Internal Medicine, states that OraQuick test results in one hospital had a false positive rate higher than expected from the test specificity reported by the manufacturer.


Eight hundred fifty-four consenting ED patients participated in this investigation. Oral samples were obtained from each patient and then were run at the onsite ED lab within a 20 to 40 minute window recommended by the manufacturer. Thirty-nine of these patients had a positive rapid HIV test result. Of these patients, 31 agreed to further testing, and 5 were confirmed as HIV-infected.


Despite this high-false-positive rate, the researchers in this study stress the importance of the rapid HIV test in EDs. It is still better than many other screening tests commonly used in clinical practice.


Geriatric Care

Mild cognitive impairment is another complication of diabetes

Roberts RO, Geda YE, Knopman DS, et al. Association of duration and severity of diabetes mellitus with mild cognitive impairment. Arch Neurol. 2008;65:1066-1073.


The latest research indicates that mild cognitive impairment may be another complication of long-standing diabetes. A new investigation, published in the August issue of Archives of Neurology, examined 1,969 patients with diabetes and at least 70 years old. Information was gathered via face-to-face interviews with the patients, and demonstrated that 329 of them had mild cognitive impairment. These patients all had:

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* diabetes onset before age 65


* diabetes duration of at least 10 years


* insulin treatment


* diabetic complications.



Although this study only examined patients at a single time point, the researchers concluded that the findings suggest an association between mild cognitive impairment and early onset diabetes, diabetes of long-standing duration and the presence of diabetic complications.


Healthcare providers are urged towork with their patients on reducing obesity, exercising, and maintaining a healthy lifestyle to prevent complications.


Alternative Care

Medicinal marijuana reduces HIV-related pain

Ellis RJ, Toperoff W, Vaida F, et al. Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, cross-over clinical trial. Neuropsychopharmacology. August 6, 2008.


Recent research has found that smoking marijuana can be as effective as other currently used treatments for HIV- related neuropathic pain. Although federal law currently prohibits the use of marijuana for medical purposes, some states do allow it.

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While there are other treatments for HIV-related neuropathic pain, none of them substantially improves the pain. Nucleoside-analogue HIV reverse transcriptase inhibitors such as didanosine (Videx) and stavudine (Zerit) can actually worsen the pain.


The findings from this research indicate that there is a place for medical marijuana in treatment of HIV-related neuropathic pain, although it is unsure whether they should be first-line drugs or adjuncts.


This double-blind study included 28 patients with HIV who had distal, sensory predominant polyneuropathy refractory to at least two prior analgesics. They were split randomly to two groups--cannabis and placebo. Either the drug or placebo was administered four times a day by a study nurse at an onsite facility.


Over a 7-week duration, 46% of patients reported a significant reduction in pain, whereas only 18% of patients in the placebo group reported pain reduction.


Primary Care

Running leads to longer life and fewer disabilities

Chakravarty E, Hubert HB, Lingala VB, Fries JF. Reduced disability and mortality among aging runners: a 21 year longitudinal study. Arch Intern Med. 2008;168:1638-1646.


New information from a 21-year-long study indicates that people who run regularly in middle age and beyond are less likely to develop disabilities in later life, and may also lengthen their lifespan.

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The analysis began in 1984, with 538 members of a national running club aged 50 and older and 423 healthy controls. Each participant completed annual questionnaires.


After 21 years, 284 runners and 156 controls remained. Both groups had increased disability scores, but the scores were significantly lower for the runners. The runners also took longer to reach various levels of disability than the controls. At the end of the study, 15% of the runners had died, compared with 34% of the controls.


The researchers cited several reasons for these results, and encouraged middle age and older adults to participate regularly in moderate to vigorous physical activity.