Podcast 2007 Show Notes
#0039—August 24, 2007
Schmalfeldt: Welcome to episode thirty-nine of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—I'll have a discussion about Cancer Prevention with the chair of the President's Cancer Panel, Dr. LaSalle Lefall. Lauren Waddell tells us how one institute at the NIH is reaching out to the Hispanic community. And Frances Sanchez has some good news about lower income kids who take part in early childhood education. But first, with the start of school right around the corner, a report from 2005 about how trained screeners can help identify vision problems in preschoolers. That's next on NIH Research Radio.
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Schmalfeldt: The opening of school is coming up very soon. It's already started in some locations. Wally Akinso has this report from August 2005 about how trained screeners can help identify vision problems in pre-schoolers.
Trained Screeners Identify Vision Problems In Pre-Schoolers
Akinso: A study funded by the National Eye Institute, has determined that trained screeners can identify preschoolers with vision disorders. Doctor Maryann Redford, group leader of the Collaborative Clinical Research, Division of Extramural Research says the vision in preschoolers study was designed to provide scientific evidence to address key questions .
Redford: "The number 1 question is it feasible to screen 3, 4, and 5-year-olds for vision disorders? And the number 2 question, are there specific tests that perform better than others? Finally who needs to administer the test. What kind of skill level or training, do the people, who administer the test need?"
Akinso: Among the trained screeners, nurses correctly identified up to 68 percent of children with vision disorders, compared to 62 percent of these children. Doctor Redford feels that the data is very encouraging.
Redford: "There's a lot of vision screening being proposed and conducted in the united states. And I think this data will inform the people in future vision screening programs how to design them bes, so that they can get the most effective use of their resources."
Akinso: This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Schmalfeldt: Now here's Lauren Waddell with a story about one institute's effort to reach out to the Hispanic Community.
NINDS Announces Effort To Promote Stroke Awareness In The Hispanic Community
Waddell: Increasing stroke awareness among the Hispanic community in America is the goal of a new education program sponsored by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. As part of the NINDS campaign known as Know Stroke. Know the Signs. Act in Time, the program will work towards raising awareness about the symptoms of stroke, according to Dr. Jose G. Merino, staff clinician in the Section of Stroke Diagnostics and Therapeutics at NINDS.
Merino: We are interested in getting the message about brain attack, or stroke, and knowledge of the symptoms and the importance of rapid response, to the Latin community. So, in order to do this, the NINDS put together a toolbox, which contains several educational materials that can be used by health educators out in the community. These materials are in Spanish, they include a tape; some visual prompts that will help get the conversation going about stroke warning signs and the importance of calling 911 and getting to the hospital as soon as possible.
Waddell: The toolkit mentioned by Dr. Merino will contain video testimonials from survivors of stroke, as well as brochures with helpful information. Dr. Merino said the campaign is fortunate to be supported not only by members of the NINDS, but by supporters of Hispanic health education as well.
Merino: We're partnering with very well known Hispanic organizations, like the National Council of La Raza and the National Alliance for Hispanic Health, to use their resources and their networks to help us get the message out, so that these organizations which already are working on health issues, and have a vast network of clinics and health educators, can then help us disseminate our message.
Waddell: According to Dr. Merino, the Latino community is ideal for this campaign because, overall, Hispanics have a higher rate of risk factors that act as contributors, and increase the likelihood, of stroke. These risk factors include smoking, diabetes, high blood pressure and excessive weight. Although this campaign focuses mainly on the Latino community, according to Dr. Merino, the slow response to stroke symptoms is a nation-wide concern. For more information about the new community education program, and other stroke information, call NINDS at 1-800-352-9424, or visit the Web site at www.ninds.nih.gov/stroke. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, MD.
Schmalfeldt: When we come back, I'll sit down for a chat with Dr. LaSalle Lefall, Chair of the President's Cancer Panel. That's next on NIH Research Radio.
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Interview With Dr. Lasalle Lefall—Chair Of The President's Cancer Panel
Schmalfeldt: Welcome back to NIH Research Radio, and our guest today is Dr. LaSalle Lefall. He's the Charles R. Drew Professor of Surgery at Howard University College of Medicine in Washington, DC; past Chair of the Board at the Susan G. Komen Breast Cancer Foundation—now known as Susan G. Komen for the Cure; a surgeon, oncologist, medical educator and leader in professional and civic organizations. And in May 2002, he was appointed by President George W. Bush as a member and Chair of the President's Cancer Panel. He was recently reappointed for a three year term ending in February 2010. Welcome to NIH Research Radio, sir.
Lefall: I'm pleased to be here.
Schmalfeldt: And quite a prestigious appointment, it sounds like. The President's Cancer Panel. You sit with Dr. Margaret Kripke and Tour de France champion Lance Armstrong. Why don't you tell us a little bit about the function of the President's Cancer Panel?
Lefall: Well, the role of the President's Cancer Panel is to monitor the development and execution of the National Cancer Program and to report directly to the President if we see any obstacles. Certainly, we would report it if we see any opportunities that are not being realized. We also want to really see if there are any obstacles to be sure that the National Cancer Program can be carried out to successful completion.
Schmalfeldt: Now, there's going to be a report issued here, "Promoting Healthy Lifestyles: Policy, Program and Personal Recommendations for Reducing Cancer Risk". Over the last year, you've looked at the links between physical activity, obesity, nutrition, tobacco use and environmental tobacco smoke exposure and cancer risk. And you've heard from over 40 experts from a variety of disciplines and organizations. Can you give us a little sneak peek at what this report is going to have to say? LEFALL: Yes. One thing the report wants to emphasize is prevention. We hear so much about diagnosis and treatment, and they are important also. But we want to emphasize prevention. If you eat in a healthy manner, if you avoid tobacco in any form, what you can do to improve your health and decrease the risk for developing cancer.
Schmalfeldt: And it makes sense. If you don't get cancer, you don't have to fight it.
Lefall: That is correct. And prevention is very important.
Schmalfeldt: That's going to be the main focus of the report?
Lefall: The main focus is going to emphasize that. And what we can do, what the government can do. For example, if we could have the Food and Drug Administration have the ability to regulate tobacco and what is going on with tobacco sales. If we could increase the tax on tobacco so we have more money to fight cancer. If we can emphasize the fact that eating in a healthy manner—being sure that healthy foods are available in all areas of our country, not just in certain areas and in affluent areas, but in low income areas so that everyone can get the benefit of eating a healthy diet. Avoiding obesity—very important. Increasing physical activity. All of these things, we think, will help decrease cancer.
Schmalfeldt: I saw a report not long ago. It seems like our lifestyles have contributed to the cancer rates in our country. Will this report try to modify some of those risks we take on a daily basis?
Lefall: Well, you certainly want to let people know—something we've talked about over and over again—to emphasize the risk of tobacco, smoked or smokeless tobacco and the harm that it can cause. Eating in a healthy manner. Decreasing obesity, because with obesity there's an increased risk of the development of the common cancers: colorectal cancer, breast cancer, prostate cancer. And we want to avoid that.
Schmalfeldt: Now you're working in collaboration with the National Cancer Institute here at the National Institutes of Health. What's your relationship with the NCI?
Lefall: Well, the President's Cancer Panel works closely with the National Cancer Institute. But we do not report to the National Cancer Institute. So that lets us have that "hands off" relationship, so we can look at it in a dispassionate way, and if we see something that isn't going quite right, we can report directly to the President. And that's important. We report directly to the President of the United States but work closely with the National Cancer Institute for the National Cancer Program.
Schmalfeldt: All right, now this report again is called "Promoting Healthy Lifestyles: Policy, Program and Personal Recommendations for Reducing Cancer Risk." And that represents the previous year's investigation. What's coming up next?
Lefall: Next year, we're going to talk about strategies to see if we can maximize the nation's investment in cancer. We spend a lot of money in cancer, cancer research with what we can do to decrease the risk of cancer, the incidence of cancer, to decrease mortality. So we want to find out what we can do to actually increase the return we're going to get on the money that we are spending on the fight against cancer.
Schmalfeldt: We're certainly thrilled to have you here with us today on NIH Research Radio. And as long as we've got you here, is there anything else you'd like our listeners to know?
Lefall: I'd just like to emphasize that if you prevent cancer, then you don't have to treat it. And there are things we can do. One-third of all human cancer, we believe, is caused by tobacco and tobacco products, one-third is related to nutritional factors and diet.
Schmalfeldt: Thank you so much, Dr. LaSalle Lefall. He's Chair of the President's Cancer Panel, joining us here today on NIH Research Radio.
Lefall: Thank you very much.
Schmalfeldt: When we come back, a story we first brought to you in August 2005 about a link between alcohol and cancer. That's next on NIH Research Radio.
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Finding May Explain Alcohol/Cancer Link
Schmalfeldt: Drinking alcohol has been linked to an increased risk of upper gastrointestinal cancer, as well as other types of cancers. But researchers don't yet understand the basic molecular reasons why. Now, a new study by scientists from the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Standards and Technology may shine some light on the link between alcohol and cancer. Doctor P.J. Brooks, one of the co-leaders of the research team, said the search for a biochemical link is now focused on a chemical called "acetaldehyde" which forms when the body metabolizes alcohol and its reaction with small molecules called "polyamines" that are naturally present in our cells.
Brooks: What we found is that the acetaldehyde can react with this other chemical that is present in our cells, and that causes kind of a chain reaction that ultimately results in a particularly dangerous type of DNA damage. We did these studies using concentrations of acetaldehyde that are within the range that might actually occur, particularly in the mouth, when people drink alcohol. So we believe then that these studies are biologically relevant, although it is important to point out that these are "test tube" studies still. So we still have to verify this work in living cells.
Schmalfeldt: Doctor Brooks said that researchers have long suspected acetaldehyde's role in the link between alcohol and cancer. He said the study gives scientists important new clues about its involvement. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: It turns out that involvement in early childhood education pays lifelong benefits for lower income children. Frances Sanchez has the story.
Intensive Early Childhood Program Leads To Gains In Adulthood: Greater College Attendance, Lower Crime And Depression
Sanchez: Lower income children who participated in an intensive early childhood education program showed higher rates of educational achievement, and lower rates of serious crimes and depression, according to a study funded by the National Institute of Child Health and Human Development, part of the National Institutes of Health. By becoming heavily involved in this intensive educational program participants achieved academic success from age 3 through the duration of college and beyond; Dr. James Griffin, Director of the Early Learning & School Readiness Program, at NICHD said parental involvement was a key component to the program's success.
Griffin: They really stressed parent involvement. They had the parents come into the classroom, they had them help out with field trips and they even offered services to the parents. Like helping them get their high school equivalency degree, their GED, parent child training, so they really did involve the parents.
Sanchez: The Child-Parent Centers program in the Chicago Public School System provided students with intensive instruction in subjects such as Math and reading in combination with educational field trips. The study followed children from age 3 or 4 through 24; however children only attended the program from pre-kindergarten through third grade. Researchers found that early investment in a child's life was highly associated with high academic success, a high economic status, low to no crime involvement, and good mental health.
Griffin: The children from a very young age were encouraged by their parents that education was a way out of the kind of poverty that they were experiencing. So what you see at age 24 is that they have less depression, probably because they're just a little bit more optimistic about life.
Sanchez: The study showed that children who completed the program had a greater appreciation for education and saw it as a vital tool for success which had enduring effects into adulthood. The CPC program also offers career development skills workshops, professional training and has a low teacher to student ratio and emphasizes oral and written communication. The findings of this study were published in the August issue of Archives of Pediatrics & Adolescent Medicine. From the National Institutes of Health I'm Frances Sanchez in Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, September 7th when episode 40 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website... www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me... the info is right there on the podcast web page. That e-mail address... email@example.com—once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland... an agency of the US Department of Health and Human Services.
#0038—August 10, 2007
Schmalfeldt: Welcome to episode thirty-eight of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—a report about how "sooner" is better than "later" when it comes to treating HIV-infected infants. Wally Akinso has a story about how it doesn't matter if it's diet or regular... people who indulge in soft drinks are at increased risk of developing metabolic syndrome. I'll have a report on how treating expectant mothers with a female hormone known as progesterone did not prove to be useful in preventing preterm birth in women carrying twins. And Lauren Waddell will tell us about some new, faster-acting anti-depressant drugs that are in the works. But first, an interesting study shows that your social networks may have something to do with your body style. That's next on NIH Research Radio.
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NIH-Supported Study Characterizes Social Networks of Family, Friends Influencing Obesity
Schmalfeldt: Your social network of friends and family seems to have an influence on your chances for developing obesity. That's the finding of a study funded by the National Institute on Aging, part of the National Institutes of Health. The study showed that obesity spreads within social networks and that the closer the social connection the greater the influence on developing obesity—even if people live in different households many miles apart—. Dr. Richard Suzman, Director of the Behavioral and Social Science Program at the NIA, explained the significance of the study.
Suzman: There are important implications, one of which is that it may be quite difficult to lose weight by one's self and it may be much easier to lose it as part of a group or network. And I think some of the weight loss groups have recognized this.
Schmalfeldt: A sedentary lifestyle and increased consumption of high-calorie foods are critical factors in the steep rise in the prevalence of obesity, the researchers noted. But the study suggested that a hierarchy of influence exists among family and friends on developing obesity, in which the attitudes, behaviors, and acceptance of obesity also might play an important role. Now, while these findings may give pause to a person fighting "the battle of the bulge", this is not to say that you should ditch your overweight friends or shun your chubby relatives. In fact, Dr. Suzman said, the opposite is true.
Suzman: It helps if you can get the support of friends, and you work on it together. And let me say this: There are other data that show that friends and social relationships have a substantial impact on people's health and, indeed, longevity. So, keep all the friends you have, make more.
Schmalfeldt: The findings were published in the July 26, 2007 issue of the New England Journal of Medicine.
Schmalfeldt: And on the subject of obesity and potential heart disease, it turns out that it doesn't matter whether that soda is diet or regular—not as far as your chances of developing metabolic syndrome are concerned. Wally Akinso has the details.
Adults Drinking Soft Drinks At Increased Risk of Developing Metabolic Syndrome
Akinso: Are you a middle-aged adult? Do you drink more than one softdrink per day? It doesn't matter if it's diet or regular. According to a study by the National Heart, Lung and Blood Institute at the National Institutes of Health, you may have a more than 40 percent greater rate of either having or developing metabolic syndrome—that's a cluster of conditions that increase the risk for heart disease. While the increased risk of metabolic syndrome associated with high-calorie, high-sugar regular soft drinks might be expected, the similar risk found among those drinking diet sodas may cause a few raised eyebrows, according to Dr. Caroline Fox, co-author of the study.
Fox: What's very intriguing about this study's finding is that it was both regular and diet soft drinks that were associated with metabolic syndrome. And what these results suggest is that soft drink consumption whether diet or regular maybe a marker for increased metabolic syndrome risk.
Akinso: Dr. Fox said the findings point to the importance of long-term observational studies, which allow researchers to take a closer look at how aspects of diet are interrelated with health risks. The results are from the Framingham Heart Study's, "Soft Drink Consumption and Risk of Developing Cardio-Metabolic Risk Factors and the Metabolic Syndrome in Middle Aged Adults in the Community," which was published online in the Circulation in July. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: When we come back, Lauren Waddell will tell us about some new, faster-acting anti-depressants that may be available soon. That's next on NIH Research Radio.
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Schmalfeldt: One of the problems with the current stable of anti-depressant medications is they seem to take so long to become effective. But those days may soon be over. Lauren Waddell has the story.
Faster-Acting Antidepressants Closer to Becoming a Reality
Waddell: In the past, those who suffer from depression have often had to wait many weeks, or even months, for their antidepressant treatment to start kicking in. Now, scientists at the National Institute of Mental Health, part of the National Institutes of Health, are discovering new ways to develop faster-acting antidepressant medications, ones that may start working in just a few hours. The most recent treatment is a drug called ketamine. Though it is not on the market due to certain side effects, researchers believe it holds great potential in the search for faster-acting anti-depressants. The rewards of having faster-acting treatments would be immense, both on a personal and public health level, according to Dr. Carlos Zarate, Chief of the Mood and Anxiety Disorders Research Unit at the NIMH, who worked on the study that developed and researched ketamine.
Zarate: The problems with the delay in onset of antidepressant action is people suffer tremendously. People may be bedridden; they may have disruption in their personal, professional lives. For example they can't hold their job, they might have problems with marriage, raising their children because if you're away for six weeks, eight weeks, literally unable to function adequately, that really disrupts your life. Not only that, there's an increase risk of suicide during the first month until our antidepressant takes effect. So, imagine if you could have an antidepressant effect within hours, or even one day, you would minimize the disruption in the personal, professional life of that individual, and in theory, one could argue that you would decrease the risk for suicide, in a sense that you are relieving depression symptoms very rapidly, in hours or a day, as opposed to weeks or months.
Waddell: Dr. Zarate suggested that as researchers come closer to developing faster-acting antidepressants, minus the difficult side effects present in ketamine, the true magnitude of these treatment options will become apparent. For more information on depression and current treatment options, visit NIMH on their Web site at www.nimh.nih.gov/healthinformation. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, MD.
Progesterone Treatment Does Not Prevent Preterm Birth in Twin Pregnancy
Schmalfeldt: Treating expectant mothers with a female hormone known as progesterone did not prove to be useful in preventing preterm birth in women carrying twins, according to a study supported by the National Institute of Child Heath and Human Development, part of the National Institutes of Health. Previous studies had shown that progesterone therapy was helpful in preventing preterm birth in women who carry a single child who were at risk because of a previous preterm birth. Dr. Catherine Spong, Chief of the Pregnancy and Perinatology Branch of the NICHD explains.
Spong: We tested in women who had twins and women who had triplets. Did the addition of progesterone in the same time period, starting in between 16 and 20 weeks and going through delivery, prevent preterm birth? And it was not efficacious, it did not reduce preterm birth in that cohort.
Schmalfeldt: Dr. Spong said this means physicians should not assume that progesterone therapy is useful in preventing preterm birth in all groups of at-risk pregnant women.
Spong: Clearly preterm birth is a major public health issue and we need to be able to reduce the rates of preterm birth. But there's no magic bullet. Progesterone is not something that everyone should be taking. We need to identify the women who meet the needs for progesterone, give them progesterone, and find other ways to stop preterm births in the other groups, such as multi-fetal gestation.
Schmalfeldt: Researchers will continue to test the effectiveness of progesterone on other at-risk women, such as women with shortened cervixes and women pregnant with triplets.
Schmalfeldt: When we come back, how "sooner" is better than "later" when it comes to treating HIV-infected infants. That's next on NIH Research Radio.
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Treating HIV-Infected Infants Early Helps Them Live Longer
Schmalfeldt: When it comes to treating infants infected with HIV, earlier is better than later. That's what's been learned from the initial results of an ongoing clinical trial in South Africa sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, which showed that more HIV-infected infants survive if they are given therapy early on, regardless of their apparent state of health. NIAID Director Dr. Anthony S. Fauci explains.
Fauci: Children were looked with regard to what the most appropriate time to treat them is, vis a vis the long range positive or negative effect. And groups of children were treated sooner rather than later. And another group was treated only when the CD4 count dropped to a certain level indicating that there was clear cut progression of disease. So, the fundamental principle is either treat early before you get evidence of deterioration, or wait until you start to see evidence of deterioration. And those two components of the study were compared. And at the end of the study it became very, very clear that the children who were treated earlier did far better than those that were not treated until it was very clear that they needed to be treated. So the thinking now is leaning much more towards earlier treatment of children for the long term benefits of that.
Schmalfeldt: This finding came to light after a routine review by the trial's data and safety monitoring board—an independent committee that regularly reviews interim data from the study to ensure the safety of participants. As a result of these preliminary findings, Dr. Fauci said all children in the study will now be treated sooner, rather than waiting to see if they show signs of deterioration.
Fauci: The data was so powerful to indicate that the children who were treated earlier as opposed to delayed did so much better, it would have been unethical to continue the limb of the study to delay treatment in other children.
Schmalfeldt: For more information, log on to www.niaid.nih.gov.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, August 24th when episode 39 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website... www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address...email@example.com—once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland... an agency of the US Department of Health and Human Services.
#0037—July 27, 2007
Coming up on this edition—Lauren Waddell has a story about how child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism. We'll look at an NIAAA survey that shows there's a "Lost Decade" between the age of onset of an alcohol use disorder and treatment. Wally Akinso has a report about a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases that indicates that surgery may be the preferred option for some back conditions. And Lauren will be back with a story about inherited listening skills. But first, there's a new National Institute of Aging publication designed to help folks better understand Older America.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-seven of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—Lauren Waddell has a story about how child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism. We'll look at an NIAAA survey that shows there's a "Lost Decade" between the age of onset of an alcohol use disorder and treatment. Wally Akinso has a report about a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases that indicates that surgery may be the preferred option for some back conditions. And Lauren will be back with a story about inherited listening skills. But first, there's a new National Institute of Aging publication designed to help folks better understand Older America. That's next on NIH Research Radio.
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New NIA Publication Features Health and Retirement Study
Schmalfeldt: It's a comprehensive look at the state of "Older America." A new publication, "Growing Older in America: The Health and Retirement Study", is available online from the National Institute on Aging, part of the National Institutes of Health. This study offers a look at the condition of older Americans, their health, work and economic status, as well as their retirement and family lives. It's based on the Health and Retirement Study, a national survey of Americans over age 50. Dr. Richard Suzman, Director of the Behavioral and Social Science Program at the NIA, said there are some surprising findings in the study.
Suzman: One of the things the study has done is (it has) given rise to other countries producing copies of the study so we can do comparisons. And we were very surprised to find out that those in the US, and we just looked at whites to keep it more controlled, but they had objectively worse health than their counterparts in England. When they controlled for things like smoking, exercise, obesity and other risk factors, there's still a significant amount - unexplained - of difference, so it's given rise to some interesting puzzles.
Schmalfeldt: Dr. Suzman said another surprising finding of the study was the impact of a serious illness within the age 65 and older group, and its effect on the family's financial status.
Suzman: It appeared that the onset of a serious disease, especially when coupled with some chronic resulting disability, ate up a fairly large fraction of peoples' wealth over a short time. And a good deal of that was not out-of-pocket medical expenditures, but loss of earnings, either from the individual affected or somebody else in the family like a spouse. So it seemed as if people were relatively uninsured for disability.
Schmalfeldt: The online publication is intended to familiarize policymakers, researchers, health and retirement experts, the news media and anyone interested in examining data on the combined health and economic conditions of older Americans. For more information, log on to www.nia.nih.gov.
Schmalfeldt: Could child abuse in her past have an effect on a woman's risk for alcoholism? Lauren Waddell filed this report.
Gene Variant Increases Risks for Alcoholism Following Childhood Abuse
Waddell: Child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism, at the National Institutes of Health. Researchers for the study have found that the existence of a particular variant of the monoamine oxidase A - or MAOA gene can have a significant impact on an individual's resiliency to intense childhood trauma. Dr. Francesca Ducci, a visiting fellow with the Laboratory of Neurogenetics at the NIAAA, did significant work on the study and found that.
Ducci: Subjects who are exposed to sexual abuse during childhood are more likely to later on develop alcoholism and ASPD.
Waddell: ASPD stands for Anti-Social Personality Disorder, and is one of the possible risks stemming from childhood abuse. Dr. David Goldman, Chief of the Laboratory of Neurogenetics at NIAAA, said that linking abuse to serious psychiatric disorders, more than just everyday behavioral problems, is an important key finding.
Goldman: Now this study, for the first time, really underlines that the gene also has an important effect on discontrolled behaviors in women. And it's really the first time that this gene has been linked not just to discontrolled behaviors or personality, but to a major psychiatric diagnosis, namely alcoholism, and also to the Anti-Social Personality Disorder. Moving this from the realm of a behavioral difference to the realm of vulnerability to a devastating disease like alcoholism, is a further advance in knowledge.
Waddell: Dr. Goldman added that this study is particularly interesting because it clearly shows how a gene-environment interaction can have significant effects on serious diseases, such as alcoholism. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, Maryland.
Schmalfeldt: When we come back, Wally Akinso has a report on whether or not back surgery is the preferred treatment for some common back ailments. That's next on NIH Research Radio.
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Schmalfeldt: If you've ever had a back problem, you're familiar with the argument: Surgery or conservative treatment. Now, there's evidence that surgical treatment is the treatment of choice for some common back problems. Wally Akinso has this report.
NIAMS Says Surgery May Be Preferred Option for Some Back Problems
Akinso: Surgery versus conservative therapy: That's the choice that faces many people with a variety of common back problems. Now a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases indicates that surgery may be the preferred option for some conditions. The study shows that for degenerative spondylolisthesis with spinal stenosis, surgery provides significantly better results than nonsurgical alternatives. Degenerative spondylolisthesis is a condition in which the breakdown of cartilage between the vertebrae of the spine causes one vertebra to slip over the one below, causing stenosis, or a narrowing of the canal through which spinal nerves pass. Dr. James N. Weinstein lead author of the study and Chairman of the Departments of Orthopaedics at Dartmouth-Hitchcock Medical Center and Dartmouth Medical School discusses the trial.
Weinstein: SPORT is the acronym we use which is Spine Patients Outcomes Research Trial. And the reason we did that is we wanted to look at several of the most common reasons for which patients have surgery in the United States. The study was designed to look at the three most common reasons for which patients have surgery in the United States and that's the herniated disk or where a disk is pressing on a nerve in your lower back. Spinal stenosis, imagine if you had your right hand grabbing your small middle and ring finger and squeezing them as tight as you could that's spinal stenosis of varying degrees. And then we looked at spinal stenosis with one vertebra slipping forward with the same kind of compression of the fingers but one of the bones in the back moving slightly forward on the other. The idea was to understand whether surgical or nonsurgical treatment would be better for patients with those 3 conditions.
Akinso: Dr. Weinstein said degenerative spondylolisthesis can result in narrowing of the spinal column, which can put pressure on the nerves, resulting in pain in the buttocks or legs with walking or standing. Dr. Weinstein added that it's important to give physicians and patients solid information about treatment.
Weinstein: I think the idea that we hope to provide through SPORT is the benefits of surgical versus nonsurgical treatment and to put that information into what I would like to call an informed choice format. Typically when a patient goes to their doctor, the doctor gives them a diagnosis. Iif they're going to recommend surgery, asking them to sign an informed consent. I think the informed consent process is rather outdated and arcane. And what we should be moving towards is an informed choice method, so patients who face a decision of one treatment versus another when the results might be equivalent or similar should be left in the patient's hand in consultation with their doctor. So the SPORT information provides significant information to patients about making a choice about surgical and nonsurgical treatment for these conditions.
Akinso: The study, published in the May 31st issue of the New England Journal of Medicine, is the second in a series reporting findings of SPORT. Dr. Weinstein said while it is generally not a good idea to rush into back surgery, the trial shows that there are conditions for which surgery clearly is the most effective treatment choice. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: Are you one of those people who can listen to two things at once and understand both? Thank your Mom and Dad for that. Lauren Waddell explains.
Waddell: The ability to hear, and actually comprehend, two distinct conversations simultaneously, such as a phone conversation in one ear and a friend talking in the other, isn't just a reflection of your dedicated friendship. It is also largely a result of your genes, according to a new study by the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health. The study, which took place at a twins convention in Twinsburg, Ohio, was led by NIDCD scientist Dr. Robert Morell, and shows a genetic link to auditory processes.
Morell: Our novel finding is that because we gave these tests to sets of twins, we were able to demonstrate that that variability is actually due to shared genes, so it's largely a heritable trait.
Waddell: Dr. Morell worked alongside Dr. Carmen Brewer, who is Chief of the Audiology Otolaryngology Branch at the NIDCD. Both Dr. Morell and Dr. Brewer brought up the high heritability of dichotic listening, which is the ability to listen to two things at once, and at about 75 percent is comparable to the heritability of diabetes or height. Dr. Brewer explains the significance of understanding the causes of poor dichotic listening.
Brewer: It helps us to understand the potential causes of poor dichotic listening performance that don't seem to be related to an insult or an injury and when a person has poor performance, you want to know what's causing it. So this leads us to have an understanding of a potential ideologic diagnosis or a potential underlying cause, that this child is doing poorly not because they have necessarily a disease, or they've had an injury to their auditory system, but because this is a trait that they've inherited.
Waddell: Researchers believe this information will benefit both older people who struggle with hearing loss and loss of comprehension, as well as children who experience auditory processing disorders. For more information about NIDCD research and programs, see the web site at www.nidcd.nih.gov. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, Md.
Schmalfeldt: When we come back, they're calling it "The Lost Decade". We'll explain, coming up next on NIH Research Radio.
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Alcohol Survey Reveals 'Lost Decade' Between Ages of Onset Disorder and Treatment
Schmalfeldt: They're calling it "The Lost Decade." It's the nearly 10-year gap between the time when a person experiences onset of alcohol dependence or abuse and the time that person eventually seeks treatment. According to the National Institute of Alcohol Abuse and Alcoholism's 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions - also known as NESARC - this gap is nearly unchanged from what was reported in 1991-1992. Dr. Mark Willenbring, Director of the Division of Treatment and Recovery Research at the NIAAA said this is dismaying information, given the effectiveness and availability of proven treatments and the fact that alcoholism is not a difficult disease to diagnose.
Willenbring: Clinicians should basically be screening for the presence of heavy drinking, and by that we mean exceeding our guidelines which is no more than three drinks in one day for a woman and no more than four for a man. If they simply ask about that, then they will identify heavy drinkers earlier in the course of the illness.
Schmalfeldt: . Willenbring said that reluctance to seek treatment plays a role in this "lost decade" between onset and treatment.
Willenbring: Alcoholism is a very stigmatizing disease and people are very reluctant to accept a diagnosis. Entering a treatment program is in some ways a kind of public procedure. It changes a lot of things in your life. Also, people lack access to treatment. Insurance companies, for example, often set higher co-pays and more limits on care than they do for other chronic disorders. And finally, the treatments that are offered in most centers around the country, which is group counseling and AA, are treatments for the most part that people don't like much.
Schmalfeldt: However, Dr. Willenbring said there is some optimism to be found in the NESARC survey.
Willenbring: The good news is that the average length of the longest episode of alcoholism is about four years, and 72 percent - almost three quarters of people who have alcoholism - only have one episode. So a lot of people are getting well from this disorder.
Schmalfeldt: For more info, log on to www.niaaa.nih.gov.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, August 10th when episode 38 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail email@example.com - once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0036—July 13, 2007
Coming up on this edition - even though Father's Day has come and gone, Wally Akinso has some advice for dads that can help them assure they'll be around for many Father's Days to come. We'll have a report about a study shows that retinopathy - or deterioration of the retina - may be prevented or lessened by a change in the diet. Wally returns with a look at the first anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. But first, analyses of a national sample of individuals with alcohol dependence reveals five distinct subtypes of the disease, according to a new study by scientists at the National Institute of Alcohol Abuse and Alcoholism.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-six of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—even though Father's Day has come and gone, Wally Akinso has some advice for dads that can help them assure they'll be around for many Father's Days to come. We'll have a report about a study shows that retinopathy—or deterioration of the retina—may be prevented or lessened by a change in the diet. Wally returns with a look at the first anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. But first, analyses of a national sample of individuals with alcohol dependence reveals five distinct subtypes of the disease, according to a new study by scientists at the National Institute of Alcohol Abuse and Alcoholism. That's next on NIH Research Radio.
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Researchers Identify Alcoholism Subtypes
Schmalfeldt: In a report that should help dispel the notion of the "typical alcoholic," five distinct subtypes of the disease have been identified by scientists at the National Institute of Alcohol Abuse and Alcoholism, part of the National Institutes of Health. Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment of their alcoholism. However, recent reports from the NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions - also known as NESARC - suggest that only about one-fourth of people with alcoholism have ever received treatment, meaning a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease. The current study focused on the nearly 15-hundred NESARC survey respondents who met diagnostic criteria for alcohol dependence, and included individuals in treatment as well as individuals not seeking treatment. The researchers identified unique subtypes of alcoholism based on the respondents' family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders. There's the "Young Adult" subtype - comprising 31.5 percent of American alcoholics. These are young adult drinkers with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, who rarely seek any kind of help for their drinking. There's the "Young Antisocial" subtype - 21 percent of US alcoholics. They tend to be in their mid-twenties, had early onset of drinking and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder and anxiety problems, and more than 75 percent of this group smoked cigarettes and marijuana. Many also had cocaine and opiate addictions. More than a third of this group seek help for their drinking. Third is the "Functional" subtype. This group makes up about 19.5 percent of American alcoholics. They are typically middle-aged, well-educated with stable jobs and families. About a third of them have a multigenerational family history of alcoholism, about a quarter of the group had major depressive illness sometime in their lives - nearly 50 percent were smokers. The fourth group is the "Intermediate Familial" subtype. This group makes up 19 percent of US alcoholics. They are middle-aged with about 50 percent coming from families with multigenerational alcoholism. Almost half have suffered from clinical depression, and 20 percent had bipolar disorder. Most were tobacco smokers, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent of this group ever sought treatment for problem drinking. Finally, there's the "Chronic Severe" subtype. Making up 9 percent of American alcoholics, this group is mostly middle-aged individuals who had early onset of drinking and alcohol problems with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent of this group come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders, including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment. The study authors also reported that co-occurring psychiatric and other substance abuse problems are associated with the severity of alcoholism and entering into treatment. Attending AA meetings and other 12-step programs is the most common form of help-seeking for drinking problems - yet help-seeking remains relatively rare. You can read more about this study in the online journal "Drug and Alcohol Dependence" .
Schmalfeldt: After this short break, Wally Akinso has a little post Father's Day advice for American Dads. That's next on NIH Research Radio.
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Schmalfeldt: Father's Day may have come and gone, but Wally Akinso has some advice for Dads who want to be around for many Father's Days to come.
Fathers Take Care of Yourselves when dealing with CVD and Diabetes
Akinso: Dads of the world, it's time to put the sweets down and get physically active if you want to spend many healthy years with your family on father's day. Cardiovascular disease is a major complication and the leading cause of early death among people with diabetes. In fact, 2 out of 3 people with diabetes die from heart disease or stroke. In the U.S., almost 11 million of all men aged 20 years or older have diabetes. Dr. Lawrence Blonde, Chair of the National Diabetes Education Program shared some ideas on how men can deal with diabetes.
Blonde: Men can learn to manage their diabetes by regularly seeing their health care professionals; making sure that they get diabetes education that is provided to them ideally by certified diabetes educators working as part of a diabetes team. And then they can go to resources like the National Diabetes Education program's website.
Akinso: Dr. Blonde said men with diabetes can lower their risk of having a heart attack, stroke or other diabetes complication by managing the ABC of diabetes, which are A1C - a measure of average blood glucose, while also keeping a close eye on their blood pressure, and cholesterol. Dr. Blonde said men should ask for support from their loved ones to make managing their diabetes a family affair.
Blonde: People with diabetes there's a greater risk that their family members may have diabetes and so it's important that those individuals also get appropriately screened for diabetes.
Akinso: Dr. Blonde added that men should work with their health care team to develop a self-care plan, which includes eating healthy and being more physically active. The NDEP is apart of the National Institute of Diabetes, Digestive, and Kidney Diseases. For more information, visit www.ndep.nih.gov or call 1-800-438-5383. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Omega-3 Fatty Acids Protect Eyes Against Retinopathy, Study Finds
Schmalfeldt: A study shows that retinopathy - or deterioration of the retina - may be prevented or lessened by a change in the diet. The study - a collaborative effort by researchers at the National Eye Institute and the National Institute on Alcohol Abuse and Alcoholism at the NIH, along with Children's Hospital Boston, Brigham and Women's Hospital, Massachusetts General Hospital and the University of Goteborg in Sweden, demonstrated that omega-3 polyunsaturated fatty acids protected against the development of retinopathy in mice.
SanGiovanni: What we found was that there is obviously an influence on these inflammatory processes - things that would lead to inflammation in the eye - and the omega-3 fatty acid-fed animals actually had a lower intensity of inflammation within the retina to the point that it actually helped new vessels - damaged vessels or missing vessels - grow back within the retina.
Schmalfeldt: That was Dr. John Paul SanGiovanni, an NEI staff scientist and one of the lead authors of the study, which looked at the effect of the omega-3 fatty acids EPA and DHA - derived from fish. Although this study provides new evidence suggesting the possibility that omega-3 fatty acids act as protective factors in diseases that affect blood vessels in the retina, Dr. SanGiovanni said more research is needed.
SanGiovanni:We have a 4,000-person trial that's currently underway. It's known as the Age-Related Eye Disease Study -2. And in that study we're actually giving people omega-3 fatty acids and will follow them for five years.
Schmalfeldt: The clinical trial will, in part, assess the affect of omega-3 fatty acids DHA and EPA on the progression of age-related macular degeneration, the leading cause of vision loss in Americans 60 years of age and older. An upcoming clinical trial at Children's Hospital Boston will test the effects of omega-3 supplements in premature infants. For more information on the Age-Related Eye Disease Study-2, log on to www.clinicaltrials.gov.
Schmalfeldt: When we come back, Wally Akinso tells us about the one year anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. That's next on NIH Research Radio.
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Schmalfeldt: Father's Day may have come and gone, but Wally Akinso has some advice for Dads who want to be around for many Father's Days to come.
Celiac Disease Awareness Campaign Marks First Anniversary
Akinso: It's the one year anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. The campaign's mission is to heighten awareness of celiac disease among health professionals and the public. Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in products we use every day, such as stamp and envelope adhesive, medicines, and vitamins. Dr. Frank Hamilton, NIDDK's Chief of the Digestive Diseases Program in the Division of Digestive Diseases and Nutrition, discusses the campaign's accomplishments within the year.
Hamilton: I think our biggest accomplishment is really getting the awareness about celiac disease. We've been very pleased and honored that we've invoked the community to really go out and do some public speaking as well as having the societies join with NIH and highlighting the importance of celiac disease not only among physicians but also among the lay community. Some of the major contributions we think that we've accomplished in this last year is a heighten awareness of what celiac disease; there been several publications not only in the Washington, D.C. area but also in the USA Today and Parade Magazine about what celiac disease is. So theses are some major accomplishments that we've been very pleased that the campaign has really done to make people aware of this condition.
Akinso: Dr. Hamilton said the disease is largely under diagnosed for several reasons, for instance celiac disease can present through a broad range of symptoms, many of which physicians do not readily associate with the disease. For more information about celiac disease and campaign materials, visit www.celiac.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, July 27th when episode 37 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail email@example.com - once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0035 — June 29, 2007
Coming up on this edition, an interview with the Director of the Office of Cancer Survivorship at the National Cancer Institute. We have a report on how urological diseases cost Americans $11 billion each year. And Bill Schmalfeldt shares a final report on his experience as a patient in a clinical trial. But first, Wally Akinso has a report about a blood test that might signal good news for folks suffering from throat cancer.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-five of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, an interview with the Director of the Office of Cancer Survivorship at the National Cancer Institute. We have a report on how urological diseases cost Americans $11 billion each year. And I'll have a final report on my experience as a patient in a clinical trial. But first, Wally Akinso has a report about a blood test that might signal good news for folks suffering from throat cancer. That's next on NIH Research Radio.
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Schmalfeldt: And now, Wally Akinso with some possible good news for folks suffering from throat cancer.
Blood Test May Help Signal Tumor's Remission, Return in Throat Cancer Patients
Akinso: A blood test that detects proteins commonly released by a growing tumor could one day become a tool for monitoring the effectiveness of chemotherapy and radiation treatment in people with advanced throat cancer, according to a study by the National Institute on Deafness and Other Communication Disorders and the National Cancer Institute. Scientists found that throat cancer patients who showed a decline in several cancer-related proteins following chemotherapy and radiation treatment were more likely to remain in remission, while those who experienced a large rise over time in those proteins frequently exhibited a return of throat cancer. In the study, researchers tested the blood of 30 patients who had undergone chemotherapy and radiation treatment for advanced throat cancer. Dr. Carter VanWaes NIDCD's Chief of the Head and Neck Surgery Branch, talked about the findings.
VanWaes: The study showed that blood levels of most of the factors went down in the patients who responded well and went into long-term remission. But the blood levels rose in those patients who had a relapse of cancer, in some cases, before doctors could see them.
Akinso: Dr. VanWaes added that the findings could help lead to the development of a blood test that enables doctors to detect the recurrence of throat cancer early on, when there is still time to pursue a second line of treatment, such as surgery or drug therapy.
VanWaes: Doctors hope that someday soon blood test like this will lead to earlier diagnosis and help them advise their patients about which treatments might be best for different types of cancer. And new drugs targeting a master switch controlling these factors are being studied at NIH and elsewhere for throat and other cancers.
Akinso: Dr. VanWaes said that the importance of this study is that it presents the ability to have a test that can be used for individual patients and show whether or not they're responding to their treatment or if the cancer is coming back. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.
Urologic Diseases Cost Americans $11 Billion a Year
Schmalfeldt: $11 billion a year! That's how much Americans pay to treat bladder, prostate and other urinary tract diseases, according to a new report from the National Institutes of Health. Medicare's share of that burden exceeds $5.4 billion. According to the authors of "Urologic Diseases in America" - a report funded by the National Institute of Diabetes and Digestive and Kidney Diseases - the five most expensive urologic problems, in descending order, are urinary tract infections, kidney stones, prostate and bladder cancers, and benign prostate enlargement. The report described more than a dozen diseases of children and adults - among them congenital abnormalities, erectile dysfunction, chronic prostatitis, interstitial cystitis, urinary incontinence, and a chapter on sexually transmitted diseases contributed by the Centers for Disease Control and Prevention. You can learn more by logging on to http://kidney.niddk.nih.gov - click on "statistics" to find Urologic Diseases in America.
Schmalfeldt: When we return we'll discuss the challenges that face cancer survivors with Dr. Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute. That's next on NIH Research Radio.
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Schmalfeldt: Cancer survivorship - it's a topic that you really don't hear a whole lot about, and that's interesting in itself because more and more people are surviving cancer. It's not a death sentence any more, in many cases, it's a life sentence. You might be surprised to know that here at the National Institutes of Health we actually have an Office of Cancer Survivorship. And here with us right now on NIH Research Radio is the Director of the Office of Cancer Survivorship at the National Cancer Institute, Dr, Julia Rowland. Thank you for joining us today.
Rowland: Bill, it's lovely to be here today and I really welcome the opportunity.
Schmalfeldt: Tell us a little, if you will, about the mission at the Office of Cancer Survivorship.
Rowland: Well, the ultimate goal at the office is really to enhance the length and quality of life of all those who carry a diagnosis of cancer.
Schmalfeldt: I know that when you hear about people who have survived some horrible event, you hear about the "guilt of survivorship." Does that enter into cancer survivorship at all?
Rowland: That's certainly an issue for many individuals who carry this history - "why me? Why did I do well? Why did I recover from this when there are so many like me who have succumbed to this disease?" So certainly there is an issue of that. And along with it, of course, there's the fear that many survivors tell us that they live with from day to day, and that's the fear that the disease will come back.
Schmalfeldt: Do you ever get over that?
Rowland: That's a really good question. In general, people will tell you it never really goes away. But people will find they can park it somewhere and get on with their lives and live rich, full, rewarding existences. For some, though, it's a real hurdle with daily reminders - and certainly we've seen a lot of stories in the press recently about public figures talking about their illness coming back. And when those events occur they raise a lot of anxiety in people who are survivors themselves.
Schmalfeldt: How did the National Cancer Institute come about this decision to start the Office of Cancer Survivorship?
Rowland: Well, the office was actually established back in 1996 in direct response to compelling and articulate response out of the advocacy community saying "it's wonderful you have all these advances, the earlier detection, the better treatments, more supportive care, and that people are living long term with this illness, but what we don't know is to what you are returning individuals, what are the kinds of problems that individuals face after treatment, and what are you doing about that?" Essentially, it was a challenge back to the NCI to say "congratulations on your success, but you need to be cognizant that cancer cures and care come with a cost."
Schmalfeldt: And what got you interested in this particular field?
Rowland: Well, I actually stumbled into this area in some ways in my graduate career. I was doing research in developmental psychology, so I was very interested in illnesses that occur across the life course, when in the time of an individual's life do they become ill. and one of my professors referred me to a physician who at that time was doing research up in the Bronx, looking at women who were breast cancer survivors and talking to them about their quality of life. And I was instantly hooked. I thought this was as fascinating area with lots of work to be done.
Schmalfeldt: What is on the horizon in the area of cancer survivorship? What research are you guys doing? What exciting things are we going to be hearing about in the future?
Rowland: I think some of the exciting things we're looking at, partly it goes back to the mission of the office, which is "tell us a little bit more about what happens to individuals post treatment". So, what has happened in the past 10 years since the office was created is that the medical community now recognizes that cancer survivorship - that post treatment period is an area of unique issues in and of itself. And that's very exciting because it has placed this solidly in the area of what we sometimes refer to as the "cancer control continuum." It has its own unique issues and there are researchers and clinicians who are addressing specifically that particular piece of recovery and wellness. What's been very exciting as we listen to the voice of survivors is recognizing we need to attend to their health behaviors after cancer. Interestingly, some relatively simple things - recommendations to stay physically active after your cancer diagnosis - may have important impact on disease recurrence and possibly long-term survival. So those kind of findings are very provocative, very exciting, because this is something everybody could do.
Schmalfeldt: Now this goes beyond the cancer patient him or herself. This is everyone who knows and loves the cancer patient.
Rowland: Absolutely. Back in 1986 a group of about 24 individuals gathered and created what is now known as the National Coalition for Cancer Survivorship. And when they did that at the time and looked at how a survivor was labeled, essentially, in that early period, the medical definition for "survivor" was someone who remained five years disease free. And in their wisdom, they said this is no longer acceptable, because you can't not be thinking about the quality of life issues for five years. You can't decide five years later, "Gee, I would have liked to have had kids."
Schmalfeldt: You're thinking about those every day.
Rowland: Absolutely. And they need to be part of the decision making in your care. And when they decided they needed to change that definition, it was the coalition that gave us the language that we use for survivors now, that anybody who is diagnosed with cancer may refer to him or herself as a cancer survivor from the moment of diagnosis.
Schmalfeldt: From day one.
Rowland: From day one through the balance of their lives, whether they want to call themselves a survivor or not, but they're entitled to that. And there were two important messages they wanted to convey. Hope. You have a life, you have the opportunity to think about a life after cancer. As you said, we're turning these more and more into curable diseases, or more often, chronic illnesses that you can live long term with. Included under that larger umbrella were family members and caregivers because they recognize that they are part of this journey - often, an integral part of it.
Schmalfeldt: Well, I know that as a person with a chronic condition myself, and the listeners to this podcast know that I have Parkinson's Disease and have been going through some clinical trial surgery for that, if you're not careful, you tend to think of everything that happens in your life in terms of the disease. How do you convey to a cancer survivor that there's more to you than just the fact that you had cancer?
Rowland: That's a really important point, Bill, and you know as you talk about your own experience with Parkinson's Disease, cancer survivors will tell you that after this diagnosis and treatment a headache is no longer a headache - it's a metastatic brain tumor. This is what you worry about, and it's part of the territory. We talked earlier about fear of recurrence. It's trying to find some place to park that worry but get on with your life. And that's one of the challenges that individuals must deal with and find some comfortable resolution around if they're going to move forward.
Schmalfeldt: We hear so much about the fight to research the causes of cancer, the research for new treatments, preventions, We don't really hear enough, I think, about what to do when you've had cancer and what to do afterwards. And that's why I think this is a very valuable discussion we're having today. What are some of the web resources available - your own web site, for instance?
Rowland: Absolutely. The URL is www.survivorship.cancer.gov. You can come and find out what kind of research we're supporting with public dollars here in the United States, very cutting edge research here. We also have on that site links to major reports that have come out. There have been in the last five years five major reports addressing the issue of cancer survivorship. So this is an issue that has really garnered public attention. People are excited about it. And these major reports we're hoping are not only going to stimulate more attention to, more funding for this kind of research and answers to those very questions you've posed.
Schmalfeldt: Anything else you want to add before we wrap it up?
Rowland: Well, we were talking earlier about language. Many people don't like to label themselves as a survivor.
Schmalfeldt: Some people don't even like to say the word "cancer" as if saying the word will get the tumor to start growing again.
Rowland: Absolutely. And I think that when the coalition adopted that language it was not their intent to "label" people, but rather to change the culture of care, to take away the stigma of having the disease, but also to say there's a lot of hope here and to say that people can live very satisfying and productive lives after cancer. An important take home message here is that after you've had a cancer diagnosis, it is important to ask what you can be doing to promote and maintain your health after these treatments.
Schmalfeldt: A patient is his or her own best advocate in this case.
Rowland: Absolutely! And needs to be actively engaged in it, knowledgeable about it, asking those questions about it, "What can I do, what do I need to know, how do I promote and ensure my health going forward?"
Schmalfeldt: A lot of reason to be optimistic, it sounds like.
Rowland: Absolutely. 10-point-8 million survivors in the United States alone today, a very promising figure.
Schmalfeldt: Well thank you for being with us and sharing some of that optimism with us today. Dr. Julia Rowland, Director of the Office of Cancer Survivorship at the National Cancer Institute, thanks for spending a few minutes with us on NIH Research Radio.
Rowland: My pleasure, Bill.
Schmalfeldt: When we come back, a personal account of what it was like being a patient in a clinical trial, along with some reasons why you might want to consider helping in the ongoing search for new discoveries and treatments yourself. That's next on NIH Research Radio.
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Brain Stimulation - First Hand
Schmalfeldt: It was about four months ago, on the February 23rd edition of NIH Research Radio, that I announced I would be taking part in a clinical trial to study the safety and tolerability of Deep Brain Stimulation of the Subthalamic Nucleus in Early Parkinson's Disease. This procedure, sometimes referred to as a "pacemaker for the brain", involves the implantation of a device which sends electrical impulses to specific parts of the brain. The FDA approved DBS for Parkinson's disease in 2002, but only in cases of advanced disease where medications are no longer effective. One purpose of this clinical trial is to determine whether or not DBS, if performed earlier in the progression of the disease, will in fact slow down or halt the progression of PD. This research is being conducted at Vanderbilt University Medical Center in Nashville, TN. However, much of the science that led to the FDA approval of DBS was conducted by and supported by the National Institute of Neurological Disorders and Stroke here at the NIH. Dr. Joseph Pancrazio is the NINDS Extramural Program Director for Neural Engineering and Neural Prostheses. He talked about how NIH Research led to the development of DBS.
Pancrazio: The NIH has supported a lot of the fundamental work, a lot of the fundamental studies of neural circuitry that are responsible for the control of movement. That helped identify what the neural targets were for Deep Brain Stimulation. It's also had a very long-term effort in supporting the development of neural prosthetics, of neural electrodes, and a lot of the work that was done under the neural prosthesis program here at NIH has identified the safety levels that are necessary for electrical stimulation and have identified what are the maximal levels of stimulation currents, what are the right types of materials that can be used in implanted stimulators.
Schmalfeldt: Different institutions perform the surgery in different ways. At Vanderbilt, the surgery is divided into three different phases. Phase one involves the implantation of several small, short-term anchors into the surface of the skull with the patient under general anesthesia. This allows imaging caps, and then - eventually - an individually-crafted platform - to be mounted securely on the skull. The imaging caps can be seen in CT and MRI scans done on the same morning as the markers are installed with the patient still under anesthesia - thereby ensuring a clear, motionless picture. These pictures provide the neurosurgeon with reference points for the fabrication of the platform which will be used during the DBS electrode implantation - replacing the huge, metal stereotactic frame that once was required for this surgery. That frame was installed on the morning of surgery and required that the patient's head be bolted to the operating table. Surgeons at Vanderbilt believe this newer way of doing it provides the patient with additional comfort without sacrificing accuracy. And, the individually-made polymer platform makes for an interesting paperweight and conversation piece following surgery. I had these bone anchors installed on the morning of June 5, and was discharged the following morning. For a week, I went about my business with these four metal bone markers in my skull, with four small stapled incisions in my head that made me resemble, however slightly, the Peter Boyle character in the movie "Young Frankenstein." On June 13, I returned to the operating room at Vanderbilt for phase two - stereotactic mapping of the target and DBS electrode implantation. After being prepped in the pre-op area of the recovery room, I was rolled into the OR. I had brought my iPod along with 132 songs on a playlist I called "DBS Ditties." This included an eclectic mix of jazz, classical music, tunes from the 30s, and lounge music. My neurosurgeon, Dr. Peter E. Konrad, director of Functional Neurological Surgery, and associate professor of Neurological Surgery and Biomedical Engineering arrived , brandishing an iPod player, he took my iPod, plugged it in, and I told him to go to the "DBS Ditties" playlist. This generated a bit of a chuckle among the crew, and we began with Mozart's "Concerto for Piano and Orchestra, No. 24 in C Minor, KV 491, Allegro." It set a dramatic tone as the crew scrubbed my head, set up the plastic sheeting, and generally made ready to dig in for their morning's work. It was important for the success of the surgery that I be placed in as comfortable a position as possible. And they were able to do this quite simply. Imagine being in a large lounge chair aside a swimming pool for hours. My neck was fully supported, they put pillows under my knees, foam pads under my heels, and foam rests under the entire length of each arm. Then Dr. Konrad said it was time to numb up my skull. I had been expecting to be sedated for this portion, but wasn't feeling the effects yet. "This is going to feel like giant hornet's stinging," Dr. Konrad said. And he wasn't far off. And I will tell you with all honesty - this was the only painful part of the whole procedure. Since the brain is unable to register sensation, everything else that followed was absolutely painless. I didn't feel it at all when they pulled out the staples over the bone markers, nor did I feel it when they cut two four inch lateral incisions into the top of my head. I was good and groggy when they drilled holes into my skull. Dr. Konrad explained that the driver on the drill was set to cut off instantly when there was no further resistance from skull - thereby avoiding the damage that could have been done to the covering of my brain. And darned if it didn't cut off the instant it was supposed to. I felt the vibration through my entire skull, and smelled the kind of "burned bone" smell one might recall from drilling at a dentist's. I felt myself being roused from my groggy reverie, and asked if this was being done intentionally. I was assured that this was the case, because they needed me awake and alert for the next phase. As I lay there, fully awake and listening, they began inserting the probes. First, the "listening" probes. Now keep in mind that for the last eight days, they had a good map to go by - my CT and MRI scans. And based on previous experience and using data from other patients they had a pretty good idea of where their "target" would lie. The subthalamic nucleus isn't highlighted on the scans. And every brain is slightly different. But you go with the averages, and you have a general idea of where this tiny, football-shaped piece of brain will be found. So, since my right side is the most profoundly affected, they advanced the "listening" probe into my left brain. As the probe advanced, we could hear what sounded like an AM radio that wasn't set on a station, picking up faint static. As the probe approached the target, the static started to pick up in intensity, like there was a thunderstorm in the distance. They attempted a few different approaches, and each time in the area of the STN, there were the crackly sounds of neurons being fired. and they were able to increase the intensity even further by manipulating my right shoulder, elbow, wrist, and foot, demonstrating that these were movement neurons that were misfiring. Dr. Konrad remarked how easy it had been to find the area. Now that they had secured the target area, it was time for the stimulation test. This was, in a word, freaky. I had no idea what to expect, save for some possible pulling, numbness, tingling and the like. But they needed to find that "sweet spot" between "no effect" and "side effect" and this was the only way to do it. (Now, keep in mind that what follows isn't exact, that for the sake of narrative I am playing fast and loose with the numbers being called out, but that this is generally how it went.) They started with the left brain and advanced the probe to an area close to the target they had identified. My neurologist, Dr. P. David Charles is Associate Professor and Vice-Chairman of Neurology for Education and Development at Vanderbilt. He held my right arm and began to manipulate it. "One. No efficacy," he said, meaning that set at 1, the stimulation had no effect. He called for it to be raised to 1.5. "There it is," he said. And he continued manipulation. He asked me to open and close my fist, and to rotate my hand. Even though I had been off the medication since the previous Sunday, my hand was loose and free. "You can really feel it," he said about the stimulation. "The cogwheeling (that ratcheting stiffness in a limb that comes with Parkinson's) just melts away. Raise it to 2." He asked me how I felt, and I replied "fine." "OK, 2.5 then." I felt something. even now, it's still almost impossible to describe the feeling. It was something like nausea, but not quite. But "nausea" was the only word I could think of for it. Dr. Charles told me to take a few deep breaths and we'd try one more. "Up to 3," he said. "How's this? Any different." I tried to speak, but nothing came out of my mouth. I was able to force out some garbled syllables to convey my inability to speak. And also, I noticed I couldn't move my eyes. Dr. Charles held a fist up for me to look at, and I was able to follow it on one direction, but not the other. "Turn it off," he said. And as if a magnet that had been holding my eyes and tongue had been turned off, I was able to at least try to explain what had happened. But words still failed me, and I was more than just a little freaked out by the experience. But now that I knew this was likely to happen with each successive testing of the electrodes, I was ready for it and felt I could make a good effort to define and describe what was going on with me. Bit by bit, the electrode in my left brain made its way towards, into, and through the target area in my STN. We found that with therapeutic stimulation, the symptoms on my right side were eliminated. With too much stimulation, I had varying degrees of dysarthria (difficulty in speech) and eye-freeze. The speech difficulty ranged from speaking in a slow, slurred voice, to being completely unable to think of the proper word, or even to think of a word to say. Testing my right brain followed a similar course. The only difference was when they reached the high end of stimulation on the last few passes, my mouth pulled to the left with a half-grimace as I tried to speak, and my gaze was averted in that direction as well. But the instant the stimulation was turned off, I would return to normal. At this point, the doctors were satisfied with the electrode placements and they agreed to lock them in place and close me up. They put me back into sedation and I listened as the doctors chatted amongst themselves as they applied the absorbable sutures and covered the incisions with derma bond liquid sutures - like Crazy Glue, but more expensive. They created pockets in the skin under my scalp for the wire leads from the electrodes that will be attached to the IPG devices when they are implanted on July 3. Then I will return to have the devices programmed on July 9th. Once we're all satisfied with the programming, the hopes are that I will be able to decrease the amount of Parkinson's medication I take on a daily basis, thereby reducing the risk for side effects from the medications. And therein lies the benefit of DBS in Parkinson's Disease. But there are other conditions for which DBS may one day be the treatment of choice, according to Dr. Pancrazio at the NINDS.
Pancrazio: Well, there's a range of disorders, many of them mental health disorders, for example, depression, obsessive-compulsive disorder. There's some motor disorders like Tourettes, where there's been some early work done. And I think there may be some opportunities for brain injury - at least, a class of brain injury where patients have entered into a vegetative state - there may be circuits in the brain where electrical stimulation may prompt arousal and enable an individual who's been in a vegetative state to regain some level of function. That would be in a very specific set of patients. These are areas where we are seeing deep brain stimulation make significant inroads. Or, at least, these might be opportunities for deep brain stimulation to relieve the burden of disease.
Schmalfeldt: Of course, further advances in DBS will rely on volunteers who will step forward and take part in clinical trials.
Pancrazio: Ultimately it comes down to someone who's willing to endure an implant and be able to be those pioneers who are so necessary for advancing the field.
Schmalfeldt: And that's where you come in. Have you ever thought about where the people who take part in clinical trials come from? They're folks just like you - either healthy volunteers or people with a variety of conditions who just might be walking around with that key to unlock the cabinet of medical discovery. If you think you'd be interested in taking part in a clinical trial, visit www.clinicaltrials.gov. Because if you had the key to unlock the cabinet, you'd use it. Wouldn't you?
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, July 13th when episode 36 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail email@example.com - once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0034 — June 15, 2007
Coming up on this edition, once again we'll delve into the archives and bring you some stories you may have missed if you've just recently discovered this podcast. This time, five stories from 2006. Wally Akinso shares a report from the National Diabetes Education Program about how it's never too early to prevent diabetes. Matt Thornton has a report from July 2006 on hyperthermia concerns raised by the warm summer weather. From September 2006, we'll look at a disease called P-A-D. that really hits below the belt. And Wally returns with a look at how those who start drinking in their early teens are on a faster track towards developing alcohol dependency at some point in their lives. But first, a fascinating look at the early development of language.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-four of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, once again we'll delve into the archives and bring you some stories you may have missed if you've just recently discovered this podcast. This time, five stories from 2006. Wally Akinso shares a report from the National Diabetes Education Program about how it's never too early to prevent diabetes. Matt Thornton has a report from July 2006 on hypothermia concerns raised by the warm summer weather. From September 2006, we'll look at a disease called P-A-D. that really hits below the belt. And Wally returns with a look at how those who start drinking in their early teens are on a faster track towards developing alcohol dependency at some point in their lives. But first, a fascinating look at the early development of language. That's next when NIH Research Radio continues.
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Shared Evolutional Ancestor May Be Linchpin in Evolution of Language
Schmalfeldt: What do these sounds mean to you?
SFX: (Coos, barks and screams of a rhesus monkey.)
Schmalfeldt: Nothing, right? Well, that's because you're not a rhesus monkey. If you were a rhesus monkey, those sounds would mean a great deal to you. How rhesus macaque monkeys process those sounds to discern their meaning may lead scientists to an understanding of the point in the evolutionary timeline when the building blocks of language first appeared in human development. According to research conducted by scientists at the National Institute on Deafness and Other Communication Disorders and the National Institute of Mental Health, the parts of the brain the rhesus monkey uses to make sense of the sounds you just heard correspond to the two principal language centers of the human brain. Scientists say this advances the theory that a shared ancestor to humans and present-day non-human primates may have possessed the key neural mechanisms on which language was built. Now, monkeys are not capable of language in any real sense of the word, according to Dr. Allen Braun, chief of NIDCD's Language Section.
Braun: But they are capable of processing "meaning" that's encoded in an acoustic signal, which is the case with their calls. In the areas of the brain that are involved with processing that meaning are areas that we think eventually became bootstrapped to process these combinatorial features of language in humans.
Schmalfeldt: To measure the brain activity of monkeys as they tried to make sense of various sounds, brain scans were done as they listened to three types of sounds - the recorded coos and screams of other rhesus monkeys, as well as other assorted non-biological sounds, according to Dr. Ricardo Gil da Costa of the Gulbenkian Science Institute in Portugal, who conducted the study during a three-year joint appointment at the NIDCD and NIMH.
Gil da Costa: What we did was building up a set of non-biological sounds that included a lot of different things, from modern human environment like telephones ringing, doors closing, et cetera, to natural sounds like rain, water flowing, that kind of thing, to computer-synthesized noise. Now what we tried was to make this set of non-biological sounds as broad as possible in a way, and in the other way make sure we'd include most of the bio-acoustic features that are present in both coos and screams separately.
Schmalfeldt: Based on these findings, scientists suggest that the communication centers in the brain of the last common ancestor of humans and rhesus monkeys - particularly those parts of the brain used for interpreting species-specific vocalizations - may have been recruited during the evolution of language in humans. In the light of an earlier study from the same group which showed that these kind of monkey calls activated brain regions that process high-order visual and emotional information, researchers suggest the language areas of the brain may have evolved from a much larger system used to extract meaning from socially-relevant situations - a system in which humans and non-human primates might share similar neural pathways. Further studies will look into which regions of the non-human primate brain are activated when animals listen to other meaningful sounds such as predator calls, sounds made by humans or other relevant environmental noises. In addition, scientists will study the pattern of brain activation caused by non-auditory stimuli - such as visual images of monkeys producing visualizations. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: When should you start thinking about preventing diabetes? Right now! Wally Akinso has this report.
It's Never Too Early to Prevent Diabetes
Akinso: It's Never Too Early to Prevent Diabetes. That's not just good advice. It's the name of the latest diabetes prevention campaign message put out by the National Diabetes Education Program. Specifically, the campaign is designed to spread the word about the risk for type 2 diabetes that's faced by mothers and their babies due to a condition known as gestational diabetes mellitus or GDM. The condition affects about 7 percent of all U.S. pregnancies annually, resulting in about 200,000 cases a year. After pregnancy five to ten percent of women who had GDM progress to have type 2 diabetes and their children are at increased risk for obesity and diabetes during childhood and adolescence compared to other children. The campaign offers materials to help women with a history of GDM take steps to prevent or delay type 2 diabetes and help their children lower their risk for the disease according to Dr. Griffin Rodgers acting Director of the National Institute of Diabetes and Digestive and Kidney Diseases.
Rodgers: The resources offered are prevention materials of a form of a packet or booklet. This booklet, which is entitled-" Small Steps, Big Rewards, Prevent type 2 Diabetes", has a lot of informational materials both in English and in Spanish. It has practical advice that people can use on how one can stay fit and increase one's exercise. In addition it also contains valuable information on how to follow a sensible eating plan.
Akinso: The campaign comes from the results from a NIDDK funded study, The Diabetes Prevention Program, which found that people at an increased risk for type 2 diabetes can prevent or delay the onset of the disease by losing five to seven percent of their body weight through increased physical activity and a low fat, low calorie eating plan. Dr. Rodgers believes that diabetes prevention is proven, possible and powerful.
Rodgers: What we hope to achieve is increased awareness. In addition, we hope to share a positive message, and a message of hope and empowerment; to counter, you know, in a sense what has been seen in some communities almost sort of a fatalistic belief: "That is my parents have diabetes." "My grandparents have diabetes." "I'm quite likely to develop diabetes myself and so there's really nothing that I can do about." Well the purpose of this campaign is really to empower people to realize that with small steps, the diet program and weight loss as well as exercise in fact they can prevent diabetes. And there is very good scientific and medical evidence to prove that. In addition, we hope that the people that hear this message will share it with their friends, co-workers, and family members. And thereby serve as our ambassadors to attempt to amplify the number of people that this message actually reaches.
Akinso: The NDEP has materials for health care professionals and for people at risk for diabetes-including older adults, American Indians, and Alaska Natives, Hispanics, African Americans, and Asian Americans and Pacific Islanders. For information, visit, www.ndep.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: When we come back, some time-tested advice on how to avoid heat injuries during the warm months of summer. That's next on NIH Research Radio.
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Schmalfeldt: The warmer days of summer are here, just like every year. And just like every year, the spike in temperatures can lead to a spike in reported cases of heat stroke and heat exhaustion. Matt Thornton filed this report in July 2006.
Warm Weather Raises Hyperthermia Concerns
Thornton: The lazy, hazy, crazy days of summer are here. Everywhere, folks are enjoying warm weather pursuits like going to the beach, hiking, camping and spending quality time outdoors. Yet, as much as you may enjoy the heat, too much heat can be dangerous - especially if you're over 50 or having health problems. You've heard of "heat cramps", "heat exhaustion", and "heat stroke". Your doctor refers to these conditions collectively as "hyperthermia". If left untreated, hyperthermia can lead to death. Dr. Jack Guralnik, Acting Chief of the Laboratory of Epidemiology, Demography and Biometry with the National Institute on Aging talked about the symptoms you should be aware of when spending time in the hot summer sun.
Guralnik: There're a number of different conditions that we think about when we consider Hyperthermia. People can get cramps in the muscles of their arms and legs. This is called heat cramps, they can get swelling in their ankles and feet. There is a common condition called heat exhaustion where individuals feel thirsty, dizzy, weak, somewhat uncoordinated. And then finally the worst from of heat related problem is heat stroke where you actually loose the ability to control your body temperature and where the body temperature can go up above 104 degrees. And in heat stroke it's quite a dangerous situation that can lead to death.
Thornton: You can take steps to avoid hyperthermia by drinking plenty of liquids, while avoiding drinks that contain caffeine or alcohol. If living in a home or an apartment without air conditioning keep windows open for cross-ventilation. For more tips on how to avoid hyperthermia, visit www.nia.nih.gov. From the National Institutes of Health, I'm Matt Thornton in Bethesda, Maryland.
Schmalfeldt: Next on this special Archives Edition of NIH Research Radio, Wally Akinso shares a report from July 2006 that gives yet another reason for teenagers to steer clear of alcohol consumption.
Early Teen Drinkers at Higher Risk for Alcoholism
Akinso: Those who start drinking in their early teens are on a faster track towards developing alcohol dependency at some point in their lives, according to a study by the National Institute on Alcohol Abuse and Alcoholism. Dr. Ralph Hingson, Director of the Division of Epidemiology and Prevention Research at NIAAA, said the study underscores the need for research to clarify how early drinking relates to the risk of lifetime alcohol problems.
Hingson: We tried in our analyses to control for factors that are known to be related both to starting to drink at a younger age and the development of dependence. So analytically, in our study we controlled for age, gender, race and ethnicity, marital status, education level, history of smoking, history of illicit drug use, family history of alcoholism, childhood antisocial behavior, and childhood depression. There may be other factors that also contribute to both starting to drink at an early age and to the development of dependence that were not included in the survey. There may be genetic factors, there may be issues of parental permissiveness, lack of rigorous enforcement of the age 21 law in the communities that young people are growing up in. All of these factors contribute to both to the development of starting to drink at a younger age and the development of dependence later on in life.
Akinso: Over 40,000 adults 18 and older, participated in the survey. According to Dr. Hingson, of those who began drinking prior to age 14, 47 percent developed alcohol dependence compared to 9 percent who waited until age 21 or older to start drinking. Dr. Hingson said he believes that analysis of the study suggests that interventions that delay drinking onset may not only reduce the acute consequences of drinking among youth, but may help reduce alcohol dependence among teens, and adults. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Schmalfeldt: When we come back, there's a kind of heart disease that really hits below the belt. That's next on NIH Research Radio.
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P.A.D. - Heart Disease That "Hits Below the Belt"
Schmalfeldt: You might think it's just a sign that you're no longer a spring chicken. That heavy feeling in your legs when you walk. Or it could be a cramping in your leg muscles that goes away as soon as you take a load off of your feet. You don't give it any thought, because, what the heck? You're getting older, right? And as soon as you rest up a bit, the discomfort is gone. Well, that might not be a sign of advancing age. In fact, that's a symptom of a disease affecting more than eight million men and women that could lead to heart attack, stroke or other complications. It's called "peripheral arterial disease" or "PAD". That's a condition that occurs when arteries - particularly those in the lower legs, become clogged with fatty deposits that limit blood flow. Just like clogged arteries in the heart, having clogged arteries in the legs increases the risk of heart attack and stroke.
Hirsch: PAD is, I think, the single-most important cardiovascular disease that the public has not heard of.
Schmalfeldt: That was Doctor Alan Hirsch, a professor of epidemiology and community health at the University of Minneapolis School of Public Health. He's chair of the PAD Coalition. Dr. Hirsch said people who have the symptoms I described earlier would be well advised to check with their health care providers, as far too often PAD is left untreated until it's at its most severe. Now, the National Heart, Lung and Blood Institute at the National Institutes of Health has teamed up with the PAD Coalition to launch an awareness campaign called, "Stay in Circulation: Take Steps to Learn about PAD." They encourage folks over age 50 to be alert to PAD symptoms and to talk to their doctors about the risks. Dr. Hirsch said establishing a diagnosis is relatively easy.
Hirsch: There is a simple test called the ankle brachial index or ABI for short. And the ABI is a simple comparison of the blood pressure in the ankle and the arm using an ultrasound device. It's painless, it's inexpensive, and actually can be conveniently performed with ability to accurately form the diagnosis. So no individual with PAD or who's at risk of PAD needs to fear the testing that easily establishes the diagnosis.
Schmalfeldt: Dr. Hirsch referred to PAD as heart disease "that hits below the belt" since nearly one in four persons diagnosed with PAD could suffer a heart attack, stroke or amputation within five years after diagnosis, although those numbers can be modified by treatment of the disease.
Hirsch: There are three main approaches, and they include changes to lifestyle - heart healthy behaviors, such as immediately quitting smoking, lowering one's blood cholesterol, improving one's blood pressure and blood sugar numbers if someone has diabetes, and again, eating a healthy diet and fostering good physical activity. But like other diseases, there are specific medications that can help accomplish the goals, that lower the blood pressure, cholesterol, and improve diabetes or improve walking for those who have leg symptoms. And a smaller number of individuals can certainly achieve great help by procedures like angioplasty, stents or bypass graft surgery.
Schmalfeldt: People most at risk for PAD include those over 50 - especially African Americans, as well as folks who smoke or have a history of smoking, those with diabetes, high blood pressure, high cholesterol, or those with a personal or family history of other vascular disease such as heart attack or stroke. To get more information about the "Stay in Circulation" campaign, visit www.aboutpad.org. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, June 29th when episode 35 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail email@example.com - once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0033 — June 1, 2007
Coming up on this edition, we'll delve into the archives and bring you some stories you may have missed if you've just recently discovered this podcast. This time, four stories from 2005. Some advice on how to beat the heat from the National Institute on Aging; Wally Akinso filed a report in August 2005 about survey results that show that a lack of physical activity is playing a key role in teenage girls gaining weight. Also from that month, a study that showed that teen drivers are more likely to exhibit unsafe driving behaviors when there is another teen as a passenger in the vehicle. But first, from July 2005, a report about how the National Kidney Disease Education Program urges families—especially African-American ones —to use summertime reunions to spread the word about kidney disease.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-three of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, we'll delve into the archives and bring you some stories you may have missed if you've just recently discovered this podcast. This time, four stories from 2005. Some advice on how to beat the heat from the National Institute on Aging; Wally Akinso filed a report in August 2005 about survey results that show that a lack of physical activity is playing a key role in teenage girls gaining weight. Also from that month, a study that showed that teen drivers are more likely to exhibit unsafe driving behaviors when there is another teen as a passenger in the vehicle. But first, from July 2005, a report about how the National Kidney Disease Education Program urges families— especially African-American ones—to use summertime reunions to spread the word about kidney disease. That's next on this special archives edition of NIH Research Radio.
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Schmalfeldt: In July 2005, I filed this report on the NIH Radio News Service web site on how family get-togethers in the summertime present a great opportunity to discuss family health history. Even though this report is nearly two years old, it's still a good idea! Schmalfeldt: For a lot of families, summer means family reunions. The National Kidney Disease Education Program wants families, especially African-American families, to use these reunions to spread the word about kidney disease. Doctor Thomas Hostetter is the director of the NKDEP, part of the National Institute of Diabetes and Digestive and Kidney Diseases.
Hostetter: Well, our overall goal is to reduce chronic kidney failure. African-Americans have a lot more kidney failure than the other segments of the U.S. population. In fact, African-Americans have about a four-times increased risk of developing kidney failure compared to the white population.
Schmalfeldt: How to bring up the subject of kidney disease at a family reunion? Hostetter: We have some discussion points that the family could use much like you find now on the back of books if you want to discuss it at your book club. We have that as part of this package which can be downloaded from our website. Schmalfeldt: That website is www.nkdep.nih.gov/familyreunion. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: Summertime is a time to be active. But all too many young people think being active is something that is done in front of a TV screen with a video game controller in hand. In August 2005, Wally Akinso filed this report on the NIH Radio News Service web page with some advice for teen girls.
Akinso: A lack of physical activity is playing a key role in teenage girls gaining weight, according to results from the Health and Growth Study, which was funded by the National Heart, Lung, and Blood Institute. Teenage girls, who were inactive gained an average of 10 to 15 pounds more than active girls according to Doctor Eva Obarzanek, a NHLBI research nutritionist.
Obarzanek: When they divided the girls into three levels of activity those that were active, those that were very inactive and those in between, the difference in weight gain over that nine year follow up was quite substantial. A little bit more for the black girls at 15 pounds and a little bit less for the whites girls at 10 pounds. So there was a very large difference in weight between active and inactive girls by the time they were ages 18 and 19.
Akinso: Doctor Obarzanek feels an increase of brisk walks and other different kinds of activities can stablize this problem.
Obarzanek: Well what we need to do is to somehow prevent the decline in physical activity that occurs with girls. The best way to do that is really schools should have a very strong role. They should provide physical ed daily, so that girls should be active during their P.E. class. Schools should also provide noncompetitive physical activity opportunities. Keep the gyms open after school, keep the school yards open, and provide opportunities. Families can also help by engaging in physical activities together. It's good for the adults also. Instead of sitting around watching TV, the whole family can go out for a walk.
Akinso: The NHLBI has recently launched an obesity prevention program, known as "WE-CAN", which stands for, Ways to Enhance Children's Activity and Nutrition. Doctor Obarzanek believes this program encourages parents and children to adopt a healthier style of living. For information, visit http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/. This is Wally Ainso at the National Institutes of Health, Bethesda, Maryland.
Schmalfeldt: We're just weeks away from the official start of summer. And this advice on how to beat the heat is just as good today as it was when I first filed this report on the NIH Radio News Service web site in July 2005.
Schmalfeldt: It's something folks are saying all over the country!
Song: (Ella Fitzgerald singing.) It's too, too, too darn hot! It's too darn hot!
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And there's much more summer to come! That means much more suffering for older people who have more trouble dealing with the heat than their younger counterparts. Fortunately, the summer can remain safe and enjoyable for everyone who uses good, sound judgment and learns about preventive measures like those described in the National Institute on Aging's "hyperthermia" web topic. That's the general name given to a variety of heat-related illnesses. Symptoms may include headache, nausea, muscle spasms, and fatigue after exposure to heat. There are things you should do if you suspect someone is suffering from a heat-related illness: Get the victim out of the sun and into a cool place—preferably one that is air-conditioned. Offer fluids but avoid alcohol and caffeine. Encourage the victim to shower or bathe, or sponge off with cool water, then lie down and rest in a cool place. Heat stroke is especially dangerous for older people and requires emergency medical attention. A person with heat stroke has a body temperature above 104° and may have symptoms such as confusion, combativeness, bizarre behavior, faintness, staggering, strong rapid pulse, dry flushed skin, lack of sweating, possible delirium or coma. For more info, log onto nia.nih.gov, and search the keyword "heat." And while it's true there are plenty of hot days ahead this summer, try to keep it in perspective. In six months, we'll all have something else to complain about.
Song: (Dinah Shore and Bing Crosby singing.) Ah, but it's cold outside!
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Schmalfeldt: From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: When we come back, a final story from August 2005 that should give parents with young drivers in the family something to think about. That's next on NIH Research Radio.
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Schmalfeldt: It's one of those things that when you hear about it, you almost want to say, "tell me something I DON'T know!
Simons-Morton: Well, it's long been suspected that teens drive in a more risky manner than adults, but there's actually no data to show that—only the anecdotal data of every parent of a teenage driver.
Schmalfeldt: That was Doctor Bruce Simons-Morton, chief of the Prevention Research Branch at the National Institute of Child Health and Human Development with news that comes as no surprise to any parent of teens who pays the monthly auto insurance bill. But now, there is some data that indicates teen drivers are more likely to engage in risky driving when they have another teen in the car with them. The study showed that teen drivers—both male and female—were more likely to tailgate and exceed the speed limit if there was a teenage male passenger in the front seat. Also, female teens were slightly more likely to tailgate if there was a female teen passenger in the vehicle. Conversely, male teens were less likely to tailgate or exceed the speed limit when a teen female was in the front passenger seat. Still, crash rates were higher for 16- and 17-year old drivers in the presence of teen passengers. The study didn't determine why teens engage in these behaviors. Dr. Simons-Morton says they're getting to that part.
Simons-Morton: In future research we plan to examine in a great deal more detail what's going on inside the vehicle. We plan to have instruments in the vehicles, following volunteers for up to 18 months to see exactly how driving behavior among novice teen drivers changes in the presence of passengers and under various driving conditions which could really tell us a lot about teen driving risks.
Schmalfeldt: So what can parents and policy makers take away from this study?
Simons-Morton: The most important thing that the parent of a teen can do is limit the driving conditions of their novice teen driver. The two most important driving conditions that are related to crashes are nighttime driving and with teen passengers. Each teen passenger increases the risk of a crash. In terms of policy, most states have adopted graduated drivers licensing policies which do place limits, at least, on late night driving. But they tend not to be that strict. A few states have adopted restrictions on teen passengers, and I think we're going to see that more and more.
Schmalfeldt: You can see more information on these statistics by logging onto www.nichd.nih.gov. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, June 15th when episode 34 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website: www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address is: email@example.com—once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0032 — May 18, 2007
Coming up on this edition, part two of our observance of HIV Vaccine Awareness Day. Wally Akinso has some advice for women on how to stay heart healthy. Bill Schmalfeldt sits down with a young man who is taking his personal campaign against Alzheimer's Disease to the mountainous roads of Western America. And we'll hear some tips on how you can keep your skin "sun safe" during the warm summer months. But first, a study shows that most folks with drug use disorders never get treatment.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland. this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-two of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health — the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, part two of our observance of HIV Vaccine Awareness Day. Wally Akinso has some advice for women on how to stay heart healthy. I'll sit down with a young man who is taking his personal campaign against Alzheimer's Disease to the mountainous roads of Western America. And we'll hear some tips on how you can keep your skin "sun safe" during the warm summer months. But first, a study shows that most folks with drug use disorders never get treatment. That's next on NIH Research Radio.
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NIH Survey Shows Most People with Drug Use Disorders Never Get Treatment
Schmalfeldt: A study conducted by scientists at the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, determined that only eight percent of people identified as drug abusers — and fewer than forty percent of those diagnosed with drug dependence — have ever gotten any kind of intervention or treatment. Dr. Wilson Compton, NIDA's lead author of the study, said there is a clear need for a national public education program to destigmatize drug use disorders and to develop approaches to educate physicians and the public about treatment.
Compton: People will not always volunteer this information so it's important that they ask patients about it. We'd like to encourage what I call the "No Wrong Door" approach to treatment, where if somebody comes in for another behavioral health condition like a psychiatric illness like major depression or bipolar disorder or a serious anxiety disorder, that they get asked carefully about their use of illicit substances, because they do commonly co-occur.
Schmalfeldt: Dr. Compton said the findings emphasize the importance of the detection and referral roles of primary care physicians. He said future research efforts should focus on developing instruments to screen, identify and refer patients with suspected drug abuse or dependence in primary care settings.
Interview — Joshua Elder
Schmalfeldt: Sitting in my glorious and cavernous studio office with me here is Joshua Elder. First of all, tell us a little bit about what you do here at NIH.
Elder: I graduated last year from the University of Pittsburgh with a degree in chemistry, and I wasn't sure whether I wanted to do an MD or an MD/PHD as a course of study, so I chose to spend a year here to be engaged in biomedical research and I do research in Building 35 at the National Institute on Aging in neurogenetics.
Schmalfeldt: And you're on you way to medical school when?
Elder: Starting medical school August 6th at David Geffen School of Medicine at UCLA.
Schmalfeldt: When you get that big sheep's skin, what's your idea for a specialty?
Elder: I'm thinking neurology at this point, or neuroradiology as a specialty because of my work here and because of my interest in Alzheimer's and other neurodegenerative disorders.
Schmalfeldt: Ah! Interest in Alzheimer's. Funny you should mention that since you're just about to go on a bike ride of 25-hundred miles to raise money for Alzheimer's research. Tell us about that. What got you interested in Alzheimer's to the point where you're willing to go 25-hundred miles on a bicycle?
Elder: I think you sort of have to take into account my background. My grandfather was a physician for over 50 years. He had served in the South Pacific. When my parents retired from the military, we settled close to my parents' childhood homes in New Jersey and Pennsylvania. I became very close to my grandfather at that time. He used to bring me into his hospital, show me the ins and outs. And that was really an impressionable time to me, hearing his stories about the South Pacific where I sort of thought of medicine as an avenue that would really interest me. I continued that pursuit and in college, obviously, I began my premedical studies. While I was in college, my grandfather was diagnosed with Alzheimer's. As I was beginning to find my niche within the medical community, that's when this disease was illuminated in my mind.
Schmalfeldt: So this is a very personal thing for you. Here's this man who launched you on this voyage towards becoming a doctor and you saw what this devastating disease has done to him. What stage of Alzheimer's is he in now?
Elder: He's to the point now when we talk he does not recall any of his memories. Some early memories from his days in the South Pacific he does remember — very vivid. But he forgets, often, his children. He forgets where he is, how to put clothing on, what he needs to eat, what pills to take during the day, what's going on with him. He still has that aspect of brilliance in him that he knows what's happening to him, and he tries to fight it. But obviously this disease is just horrible and...
Schmalfeldt: It's cruel. It's a very cruel disease. Rather than just sitting back and saying what a terrible thing this is, you're one of those rare people who's actually doing something about it. Why don't you tell us a little bit about this Great Divide Mountain Bike ride you have coming up.
Elder: Well, I had about two-and-a-half months between my time here and starting medical school. And I've had a lot of thoughts about what I could do. So I had the idea of doing a bike trip. And I wanted to somehow coordinate this with raising awareness about Alzheimer's. And it helped to know that my Dad, when I was about 11 or 12 years old when we were living in Germany, my Dad and Mom organized this thing called Operation Provide Schools where they biked from Ramstein, Germany to Zagreb, Croatia. And they raised over seven tons of supplies for war torn Croatian students, and they made CNN coverage. This was a very impressionable thing for a child. I thought of it as an avenue that I might later be able to get into as an adult. And now I'm at that stage and I have the time before medical school begins, and I really want to venture into this domain of cycling and I really think I could raise awareness through out this trip.
Schmalfeldt: Ever ridden that far on a bike before?
Elder: Not quite to the extent that we're going to do, but I did ride 16-hundred miles around the perimeter or Ireland and Northern Ireland a few years ago. It's wonderful to know that I have a lot of support behind me. I'm officially endorsed by the Alzheimer's Association and I'm officially sponsored by Life Matters. And they've given me a tremendous amount of support and they're definitely going to carry me through on this ride.
Schmalfeldt: Who is "Life Matters"?
Elder: Life Matters is an assisted living facility that covers a lot of the Virginia communities, the Maryland communities, and also the DC communities. They're based right here in Bethesda.
Schmalfeldt: Now the cycling enthusiasts listening to this are going to want to know what kind of gear you're using. Tell us about your bike.
Elder: I'm bringing an Iron Horse Full Suspension bike. I got it from Performance, and Performance has also been very helpful throughout my venture here. In addition to that, that's just sort of the beginning in the domain of cycling gear, I'm bringing a bob trailer, and that's what I have to carry all my supplies on. A lot of people ask the misguided question of, "Where's your van of support?" And I'm like, "Van of support? We ARE our van of support." We're carrying all of our trailers and all of our supplies with us — probably 55 to 65 pounds at some points — all of our water, all of our food, all of our tent gear supplies, bicycle equipment, bicycle tools, everything. You name it, we're bringing it with us.
Schmalfeldt: Now describe, if you would, the fundraising aspect of this, because we know folks are going to hear this story, they're going to go to your website, which is www.joshuaelder.com, they'll be able to follow your trip. And, of course, folks are going to want to know how they can help raise money to fight this most cruel of cruel diseases. How do they contribute?
Elder: What we want to do is, we want to try to raise over $80-thousand. And we're going to do that by spreading the word along the way — the Alzheimer's Association is going to send out national press releases. And how people can contribute, they can go to my website and they can click on the "contribute" link. I've also made it clear that all the money that's being raised is going to Alzheimer's research. None of the money is going to administrative costs — which I was very adamant about, because if I'm spending this amount of time and energy to support what we're trying to do, I want to make sure it's all going to the right place.
Schmalfeldt: Now you actually hit the road on May 14th. When do you think you'll actually hit that 25-hundred miles?
Elder: Two months is sort of our guideline. The trip is obviously around 25-hundred miles and if we average about 40 miles a day we'll be able to make that happen in about two months.
Schmalfeldt: And you're starting where?
Elder: We're starting in Antelope Wells, New Mexico. It's on the border of New Mexico and Mexico. And we continue through New Mexico, Colorado, Wyoming, parts of Idaho, and then through Montana and then at the end finishing up on the border of Canada.
Schmalfeldt: All very straight and level terrain. You must really care about this disease.
Elder: I do. I really do.
Schmalfeldt: Well, here's what I want from you then. What I'd like you to do, and of course we'll check into your website and take a look every now and then, what I'd like you to do is set up times to give us a call.
Elder: That would be great.
Schmalfeldt: Let us know where you are. Let us know about the people you're meeting along the way, the sights you're seeing. So, it's a pleasure to sit here on NIH Research Radio and talk to somebody who is not just letting this happen. We're talking to Joshua Elder. He's a future doctor. This is a person I'm predicting we'll be hearing great things from in the future. Thank you for spending some time with us. That website once again — www.joshuaelder.com. We'll be talking more to you, young man.
Elder: Thank you very much, sir.
Schmalfeldt: When we come back, part two of our look at the 10th Annual HIV Vaccine Awareness Day. That's next on NIH Research Radio.
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Quest for an Effective HIV Vaccine Presents New Possibilities, Challenges
Schmalfeldt: May 18 marks the 10th annual HIV Vaccine Awareness Day — an opportunity to reflect on the more than two decades of progress worldwide in the search for a safe and effective HIV vaccine. Dr. Gary Nabel, director of the Dale and Betty Bumpers Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, explained the challenges facing researchers as they look for a vaccine.
Nabel: HIV as a target is really a formidable target. It's very difficult to make a vaccine against this virus because, in fact, it's not one virus — it's millions of different viruses. So whenever we try to develop any kind of vaccine, we have the problem of trying to provide enough of a stimulus to the immune system that it might recognize the millions of different variants that any individual could be infected with in the world. As if that weren't enough, the virus has also acquired the ability to evade neutralization by the immune system. And it seems to do this by changing the shape of some of the critical proteins on the surface of the virus. There's one particular protein that it uses to attach to cells called the "envelope", and that envelope protein never stays in the same form on the surface of that virus as it would during the process of infection. So, basically, we're dealing with a lot of diverse viruses and we're dealing with a virus that has learned to camouflage itself by changing its shape, and that's what really makes it a tremendous challenge.
Schmalfeldt: Dr. Nabel said the search for a vaccine is something of a medical detective story, with different leads being followed as new clues are discovered. The chase is complicated by the fact that this culprit — the HIV virus — is different from any virus medical researchers have ever done battle against.
Nabel: HIV has infected now more than 60-million people. And in contrast to almost every other virus that we've generated vaccines for, we don't have any documented cases of natural immunity to this virus. Typically when we manufacture a vaccine that's what we count on — we count on examples from nature to follow, and then we mimic what nature normally does. So, in a way, we're really developing a new paradigm for vaccine development. And it's really one of the greatest scientific challenges of our generation — perhaps in medical history — because this virus has shown that, despite the fact that it can infect large, large numbers of people, the human body has not yet figured out a way to counteract it.
Schmalfeldt: The NIAID launched the first HIV vaccine trial in Bethesda, Maryland 20 years ago. And along with the challenges researchers face, the quest for an effective HIV vaccine presents some exciting new possibilities. For instance, according to scientists at the NIAID, the first successful preventive HIV vaccines, if administered prior to HIV infection, may reduce HIV levels in the body, thereby delaying the progression to AIDS and the need to start retroviral drugs. These vaccines might also reduce the chance that a person infected with HIV would pass on the virus to other people. Dr. Nabel said he's optimistic about the future.
Nabel: Just being in a position to be able to do those trials now with pretty good vaccine candidates, and with some of really the latest technology both in vaccine production and in measurements of human immune responses is quite a tribute to the many dedicated scientists and actually the many dedicated vaccine volunteers who've participated in the studies that are ongoing.
Schmalfeldt: Vital to the search for an effective vaccine is the collaboration between the academic and private sector, government researchers, non-governmental organizations and the thousands of volunteers who have decided that they want to be part of the generation that ends AIDS. One of those volunteers is "Amber" — to maintain her privacy, we're just using her first name. She explained why she chose to be part of the search for a vaccine.
"Amber": I know that there's a heavy burden to find a vaccine for HIV and I wanted to be part of that discovery or that solution to HIV. So, you read a lot in papers about how HIV affects different families and the communities, especially myself as an African-American woman, just the rates of HIV are higher in that population and in other minority populations. And I just wanted to have some part in finding the solution.
Schmalfeldt:"Amber" believes that the day isn't far off when researchers will announce a safe and effective vaccine for HIV. She says there will be a certain sense of pride and satisfaction for having helped in the search.
"Amber": It's going to feel great. I'm going to feel, like, this is wonderful. They've gotten enough people involved, they were able to do what they needed to do from volunteers like myself, and I'll just feel really elated and glad that there's finally a solution.
Schmalfeldt: In the coming years, several major clinical trials testing different vaccine candidates and approaches will be completed. Later this year, there are plans to launch an 85-hundred person trial in the United States, Latin America, the Caribbean and Sub-Saharan Africa. Although none of these trials is expected to lead immediately to a licensed vaccine, Dr. Nabel said each study adds to the body of knowledge that helps shape future vaccine efforts.
Nabel: This is going to be a long road. I think that these initial studies will hopefully allow us to put a stake in the ground to say that it is possible to generate immunity and to tell us what mechanisms may be most effective. And then it will be up to us to refine that going down the road. So we've made a lot of progress, we're doing things that simply were not possible five years ago. And in the realm of vaccine development, the kinds of progress you've seen in that time frame are truly unprecedented. Having said that, we need to dig in for the long haul because this will be an iterative process. We will build on the knowledge that we gain in each step.
Schmalfeldt: For more information on how you can be part of the generation that ends AIDS, log on to www.bethegeneration.org.
Schmalfeldt: When we come back, Wally Akinso has some simple advice — "Ladies, Love Your Heart!" That's next on NIH Research Radio.
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Schmalfeldt: Think of it as a "how to manual" for women in the fight against the number one killer. Wally Akinso explains.
"Ladies, Love Your Heart!": 20th Anniversary of the Healthy Heart Handbook for Women
Akinso: Ladies, it's time to love your heart! That's the message contained in the 20th anniversary edition of the must-read handbook, "The Healthy Heart Handbook for Women." The handbook, a publication of the National Heart, Lung and Blood Institute, contains new information about women and heart disease and offers practical suggestions for reducing the risk of heart-related problems. Dr. Patrice Desvigne-Nickens, leader of the NHLBI's Medicine Scientific Research Group, talks about some of the interesting highlights from the handbook.
Desvigne-Nickens: This handbook is really very practical, giving advice and how to information. There are tips on following a nutritious eating plan. There's also, for example, a program that allows you to tailor physical activity to your own needs. There's also tips on how to get your whole family involved in healthy living. This is really a how-to. There is practical information for example questions that you can use to discuss heart disease with your doctor, a quiz about heart attack risk. There's information about diabetes. There's even information about how to stop smoking. Perhaps one of the more important tools contained in this book are stories of women and how they experience and live with heart disease.
Akinso: As part of The Heart Truth campaign, the booklet points out that heart disease is number one killer of women. Dr. Desvigne-Nickens said since nearly one in four American women dies from heart disease, it is critical to know that high blood pressure, high cholesterol, diabetes, smoking or being overweight are all major risk factors.
Desvigne-Nickens: Well the message in the handbook is really very simple. To have a healthy heart, it's critical to know your risk factors and to take measures to control them. This is an important time that information empowers you. Knowing your risk allows you to take measures to control risk and therefore improve your longevity and quality of life from the heart health perspective.
Akinso: The "Healthy Heart Handbook" is available for $4.00 from the NHLBI Information Center. The number is 301-592-8573; it's also online at www.nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
HINTS Brief Suggests People Not Paying Enough Attention to Sun Safety
Schmalfeldt: May is Skin Cancer Awareness Month. Why May? Summer's on the way, and with the advent of long, warm, sunny days, folks are shedding their cool weather gear and are heading back to the beaches, parks, and other places to enjoy the warmth of the sun. But how many of them are keeping sun safety in mind? That's the question posed by the Health Information National Trends Survey — otherwise known as HINTS — a data collection program which was created to monitor changes in the rapidly evolving field of health communication. Dr. Lila Finney Rutten is Program Director in the Health Communications Informatics Research Branch of the National Cancer Institute. She said recent results of the survey show folks don't seem to be taking sun safety as seriously as they should.
Rutten: In 2005 the HINTS Survey asked a series of questions on sun safety behaviors. And, in particular, we asked about the extent to which the American public was engaging in behaviors such as wearing sun screen, the extent to which they were wearing hats, long-sleeved shirts and long pants. And what we found in the survey is that the level of sun-protective behavior in the population is actually fairly low, with only about half of the population engaging in these behaviors at least some of the time.
Schmalfeldt: Why is it important for folks to keep sun safety in mind?
Yaroch: It's important, because about one million new cases of skin cancer are diagnosed each year. Melanoma is actually one of the most deadly forms of skin cancer.
Schmalfeldt: That was Dr. Amy Yaroch, Program Director in the Health Promotion Research Branch of the NCI's Behavioral Research Program. She said a single blistering sunburn is enough to significantly raise your risk for skin cancer. Other risks include being fair-skinned and repeated exposures to the sun. She said there are ways to enjoy the outdoors in the summer without increasing your risk for skin cancer.
Yaroch: Well, there's a lot of things that you can do. First of all you can wear a sun screen with an SPF of 15 or greater. You can cover up, and what that means is to wear a wide-brimmed hat that shades your face and your neck and your ears. You can wear long-sleeved shirts and long pants as well as sunglasses and seek shade between peak hours which would be between 10 and 2.
Schmalfeldt: Dr. Yaroch also said early detection is key in preventing the devastating effects of skin cancer. She said dermatologists recommend monthly checks to see if you have anything on your skin a doctor should take a closer look at. To help you remember what to be looking for, think of "A-B-C-D" — meaning most early melanomas are asymmetrical, their borders are uneven, their colors can have varied shades of brown, black or tan, and their diameter are usually the size of a pencil eraser or larger. There are several websites you can browse for more information about sun safety. For more on the HINTS Survey, visit hints.cancer.gov/briefs.jsp. or you could visit www.cancer.gov.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, June 1st when episode 33 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website: www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. The info is right there on the podcast web page. That e-mail address: email@example.com — once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
#0031 — May 4, 2007
Coming up on this edition, a clinical trial from the National Heart, Lung and Blood Institute shows that people with pre-hypertension who reduced their sodium intake by 25 to 35 percent had a 25 percent lower risk of total cardiovascular disease over the 10 to 15 years during which they cut back on salt. Special Correspondent Belle Waring tells us about a clinical research trial she's volunteered for. The National Eye Institute marks Healthy Vision Month with some information on how to get yourself checked for glaucoma. There are some new insights into how cells repair their DNA that could point the direction to a possible way to stop or slow the onset of Huntington's disease. And we hear about the importance of HIV Vaccine Awareness Day, which is coming up on May 18. But first, Wally Akinso shares a report that shows how having elevated risk factors as a young adult increases the likelihood of coronary calcium deposits later in life.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland. this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty-one of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, a clinical trial from the National Heart, Lung and Blood Institute shows that people with pre-hypertension who reduced their sodium intake by 25 to 35 percent had a 25 percent lower risk of total cardiovascular disease over the 10 to 15 years during which they cut back on salt. Special Correspondent Belle Waring tells us about a clinical research trial she's volunteered for. The National Eye Institute marks Healthy Vision Month with some information on how to get yourself checked for glaucoma. There are some new insights into how cells repair their DNA that could point the direction to a possible way to stop or slow the onset of Huntington's disease. And we hear about the importance of HIV Vaccine Awareness Day, which is coming up on May 18. But first, Wally Akinso shares a report that shows how having elevated risk factors as a young adult increases the likelihood of coronary calcium deposits later in life. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Schmalfeldt: That public service announcement you just heard was recorded by a group of elementary school students who visited the NIH Campus during "Take Your Child to Work Day" recently. In future podcasts, you'll hear the same message recorded by middle school and high school students. Moving on, if you needed one more reason to avoid the risk factors that lead to cardiovascular disease, Wally Akinso has just what the doctor ordered.
NHLBI Study: Having Elevated Risk Factors in Young Adulthood Significantly Raises Risk of Coronary Calcium Later On
Akinso: Having elevated risk factors as a young adult increases the likelihood of coronary calcium deposits later in life, according to a study by the National Heart, Lung and Blood Institute. Although on average, heart disease risk factors are less common in young adulthood, elevated risk factors at this age predict the development of later asymptomatic heart disease better than levels measured later when they are typically higher. Other studies have found that the amount of coronary calcium correlates with the amount of atherosclerosis or hardening of the coronary arteries and is related to the likelihood of developing heart disease in the future. Dr. Catherine Loria, lead author of the study, said they are learning more about the beginnings of heart disease and how to prevent it.
Loria: Another important finding was that risk factor levels of young adults in their twenties were just as informative as levels measured later of having coronary calcium, which suggest that we should begin assessing heart disease risk as early as possible.
Akinso: In the study, coronary artery calcium was more prevalent among men than women and among white men when compared to African American men. Dr. Loria said young men and women should work with their doctors to learn about their risk and then do everything they can to reduce it, such as eating a healthy diet and being physically active. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Reducing Sodium Decreases Long-Term Risk for Cardiovascular Disease
Schmalfeldt: You've heard all about the many benefits of reducing your sodium intake—preventing high blood pressure leading the list. Now, if you needed yet another reason to cut back on salt, new data from a clinical trial from the National Heart, Lung and Blood Institute shows that people with pre-hypertension who reduced their sodium intake by 25 to 35 percent had a 25 percent lower risk of total cardiovascular disease over the 10 to 15 years during which they cut back on salt. Dr. Jeffrey Cutler, NHLBI Project Officer of the Trials of Hypertension Prevention Program— also known as TOHP—said it's reasonable to assume that the reduction in heart disease risk goes hand-in-hand with the reduced risk of high blood pressure that results when a person reduces his or her sodium intake.
Cutler: That's the logical interpretation. There are data from both animal studies and human population studies that reducing sodium might have some benefits separable from its effect on blood pressure, but most likely the major chain of causation is through its effect on blood pressure.
Schmalfeldt: Two of these TOHP trials were conducted in 10 clinical sites - one from 1987 to 1990, the other from 1990 to 1995, with follow up for 10 to 15 years after each trial. This new follow-up data shows that the groups who reduced their sodium intake also had lower mortality from cardiovascular disease. Dr. Cutler said the news may even be better than it seems at first blush.
Cutler: The levels attained in these randomized trials conducted in the late 1980s and early 1990s were substantial, but they were not even at the level of what the guidelines recommended at that time. In fact, for much of the population, the guidelines are now recommending lower levels in part because of another study that NHLBI sponsored—the DASH Sodium Study—which showed that for a given amount of sodium reduction, the blood pressure reduction is greater in the lower range levels than at the higher range levels. So, we're operating in THOP, for the most part, in the range above the area where you get the maximum benefit. So it is very likely that this study underestimates the potential public health benefit.
Schmalfeldt: The new data has been published online by the British Medical Journal.
Schmalfeldt: The last time Special Correspondent Belle Waring went to donate blood, she wound up getting involved in a clinical research study that could benefit us all. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Schmalfeldt: You've heard the expression, "when life hands you lemons—make lemonade." That's kind of what our Special Correspondent Belle Waring did the last time she went to donate blood. Here she is with a special report.
Waring: Donating blood is cool. It's a low-key way of saving a life.
Sound Effects: [Blood pump purring]
Waring: That's the purr of an NIH Blood Bank pump, and if you're a regular donor, its soothing sound becomes part of your life. But the last time I came in to donate, something happened when the nurse took a drop of my blood for the screening test
Sound Effects: ["Snick" of the hemoglobin finger stick]
Waring: The test—which is painless, by the way—showed that my hemoglobin was too low for me to donate. Now, hemoglobin is the iron-containing protein that makes blood red and carries oxygen from the lungs to the tissues, so until my level came back up, I was to be deferred-temporarily turned away. I enjoyed coming around every eight weeks and being part of the Blood Bank family, but this time, my blood wasn't up to snuff.
Sound Effects: [Blood pump purr/alarm]
Waring: That's when I moved from writing about research to being in it, as a volunteer in the NIH study called Iron Replacement or Not. Dr. Barbara Bryant, the principal investigator, is tackling iron depletion in the blood-donor population, and this is the research effort she and her team invited me to join. As a clinical fellow in NIH's Department of Transfusion Medicine, Bryant is examining the safety and efficacy of giving donors oral iron supplements.
Bryant: We have an iron replacement study here at the NIH where we're looking at giving iron to blood donors that have low hemoglobins and low iron studies. To donate blood you have to have a 12.5 gram per deciliter hemoglobin level or higher. We like to confirm the low hemoglobin with a CBC and also check their iron studies, to see if they're iron deficient. And if they're iron deficient, we offer them over-the-counter iron replacement tablets. And then we follow up with them 30 to 60 days later to see if they're eligible to donate blood.
Waring: Prior to enrolling someone in the study, Bryant carefully screens them to rule out serious conditions that may be causing blood loss. But donors are, for the most part, healthy normal individuals, so if Bryant can determine if somebody is iron deficient and then determine the cause, she can help replace the iron. This is important, because recruiting new donors is expensive-as high as 500 dollars a head. The more donors the NIH Blood Bank can retain, the more patients it can help. And the Iron Replacement or Not Study is the first of its kind.
Bryant: Low hemoglobin in blood donors has been a subject of concern and discussion in the blood bank community for many years but there has not been a large study to take a look at giving iron to these donors. There have been some isolated studies about giving iron to pre-menopausal women but, for the most part, studies looking at giving iron replacement tablets to any donor who doesn't pass hemoglobin screening, regardless of age or sex, has not been studied. It is unique, because there are no other studies out there that have been published showing the safety and efficacy of giving iron replacement tablets to blood donors.
Waring: People can be iron deficient and not know it, Bryant says. They can feel fatigued, or crave unusual substances, such as large amounts of ice. They may even develop secondary restless leg syndrome due to low iron levels. But with iron replacement, their symptoms can go away and they become able to donate again.
Bryant: Donors are great people, they come in, they want to help people, they want to donate blood. Donating a unit of blood can help save three lives, and sometimes even more; it may go to several babies. So donating blood is such a good thing, and to have people who get deferred wanting to do this good thing but yet not having a way to fix the problem, I think this is a challenge to the blood bank community.
SFX: [Phone Rings]
Sparkle: Good afternoon, NIH Blood Bank, this is Sparkle, can I help you? Oh you mean as a new donor?
Waring: For NIH Radio, this is Belle Waring.
Schmalfeldt: May 18 will mark the 10th annual HIV Vaccine Awareness Day. It's an opportunity to reflect on the more than two decades of progress worldwide in the search for a safe and effective HIV vaccine. The National Institute of Allergy and Infectious Diseases initiated the first HIV vaccine clinical trial in 1987. Since then, the NIAID has worked with its partners to conduct a variety of vaccine clinical trials that have enrolled more than 26-thousand volunteers. Dr. Anthony S. Fauci, Director of the NIAID, commented on the importance of setting one day aside each year to focus on HIV Vaccine Awareness.
Fauci: First of all, HIV Vaccine Awareness Day is important for a number of reasons. First is to make people aware of the importance of vaccines in the broad approach towards the prevention of HIV. There will be no single modality that will be absolutely preventive of HIV infection, particularly in situations where there is risk behavior going on or in situations in which people aren't even aware that they are practicing risk behavior. There are so many modalities of prevention. Vaccine is key among them. So, the first objective is to get people to be aware that we have still not reached the point where we need to be in our comprehensive approach towards the prevention of HIV infection. The other importance of HIV Vaccine Awareness Day is to get people aware that they can contribute by participating as normal volunteers in any of a number of vaccine trials that will be rolling out over the next several years. We have had enormous success over the years, not only in HIV research, but in research in any discipline, in the careful and safe use of people who volunteer for clinical programs so that knowledge may be gained that might be helpful later on. So we're telling the public, "pay attention to what's going on, this is a very important component of the HIV infection prevention comprehensive plan. And if you see fit, if you have the opportunity, you should consider participating in a trial."
Schmalfeldt: Dr. Fauci said another reason for observing HIV Vaccine Awareness Day is to point out the importance of healthy volunteers in the search for safe and effective HIV vaccines. FAUCI: Well, first I would explain to them how important this is to global health. So if individuals want to make a contribution to the broad global health of which HIV infection is a major negative component of that - if you look at the global diseases that are killing so many people. There's HIV, there's malaria, there's tuberculosis, there's neglected tropical diseases. And then there's many of the diseases that we, ourselves, see—for example, among children in this country. So there are so many diseases for which we still have not gotten the final answer. So if an individual says, "I want to make a contribution to global health society. I want to feel that I have done something that is a contribution," why not consider taking part in a vaccine trial for HIV?
Schmalfeldt: The NIAID works closely with several organizations in the fight against AIDS. These organizations include the NIAID HIV Vaccine Trials Network, the US Military HIV Research Program, the US Centers for Disease Control and Prevention, the US Agency for International Development, the International AIDS Vaccine Initiative, the AIDS Vaccine Advocacy Coalition, the Bill and Melinda Gates Foundation, and other groups within and outside the United States. In addition, Dr. Fauci said local communities play a key role in HIV vaccine research.
Fauci: Well, sure, because we know that whenever we get action on things like clinical trials, it's the mobilizations in the local community—community leaders, community people who want to contribute to society, they're the ones that mobilize these drives to get people on studies. So it is so much better to get buy-in from the community level. You get a degree of credibility, you get people who understand what they're doing. They get well-educated into what they're getting themselves into because they're hearing it from people they trust - their community leaders.
Schmalfeldt: Dr. Peggy Johnston is the Director of the Vaccine Research Program at the Division of AIDS at the NIAID. She said there has already been significant progress made in HIV vaccine research, and that scientists believe it will be possible to develop an effective vaccine.
Johnston: We have learned a lot more from natural history studies how the immune system controls this virus, and we're now taking that information and applying it to new kinds of vaccines. Specifically, our classical vaccines mount an immune response so that when the virus comes in and begins to replicate that immune response can completely clear the virus and protect the person from infection. But HIV offers us many more challenges than the typical virus because when it comes in, it can get inside the host cell and get inside the DNA and remain there and stay hidden from the immune system, within probably weeks of exposure. So the window of opportunity we have for the immune system to clear the virus is very short, and much shorter perhaps than for other viruses for which we have more classic vaccines developed that completely prevent infection.
Schmalfeldt: Dr. Johnston said research has led to a better understanding of a specific type of immune response in the body known as "T Cells."
Johnston: We've learned about these T Cell responses and how they can help control the infection in infected people. So what we're testing now in trials are vaccines that induce strong T Cell responses that we will give to people before they become exposed. And then even if they become infected, we are hoping that these T Cells do what they did in animal models—which is help the body control the levels of virus down to low levels so the person remains disease-free for a longer period of time and lives longer without having to go on anti-retrovirals.
Schmalfeldt: Developing an effective vaccine depends on collaboration among academic, private sector and government researchers, non-government organizations, and thousands of volunteers who are committed to the fight against AIDS. For more information on how you can join the fight and be one of the generation that ends AIDS, visit www.BeTheGeneration.org.
Schmalfeldt: When we come back, we'll hear some suggestions from the National Eye Institute that could help you prevent the permanent damage caused by glaucoma. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT) (STORY: Early Detection Important in Preventing Vision Loss from Glaucoma)
Schmalfeldt: More than four million Americans have glaucoma - an eye disease that damages the optic nerve and destroys sight. About half of those people aren't even aware they have the disease - there are no symptoms, according to Dr. Anne Coleman, Chair of the Glaucoma Subcommittee for the National Eye Institute's National Eye Care Health Education Program.
Coleman: If you rely on a high eye pressure you're not picking up everybody because only one out of two has high eye pressures, and they may or may not have glaucoma. If you're relying on the visual acuity where you're reading along the chart, you're not going to pick it up because that's your central vision and glaucoma hits your side vision, your peripheral vision. And so they really need to go in and have someone look at their optic nerve. What they do, is they take special lenses and they can see the nerve when they look into the eye. And that's most often recommended to be done with a dilated eye exam where we put drops in to make the pupils big so we can see in better.
Schmalfeldt: The NEI encourages people at a higher risk for glaucoma to get a comprehensive dilated eye exam every one to two years. Those people would include African Americans over age 40, everyone over age 60, and anyone with a family history of the disease. Dr. Coleman said early detection and treatment is key in preventing permanent vision damage from glaucoma.
Coleman: We know that if we get the pressure down—if the pressure's normal we get it even lower - that we can slow down or prevent any vision loss. We can use medications to do that, which are eyedrops, sometimes pills. We can also do laser surgery. And we also have regular incisional surgery where we can make like a little trap door in the eye to let the fluid out. We can even put like a drainage device, which you could describe as like a hose that drains some of the fluid out of the eye and lowers the pressure.
Schmalfeldt: May is Healthy Vision Month, during which the NEI encourages all Americans to make vision a health priority.
(STORY: Study Links Faulty DNA Repair to Huntington's Disease Onset)
Schmalfeldt: Finally, Wally Akinso has this story about how insights into the body's healing mechanisms could lead to new ways to slow down the onset or progression of a serious disease.
Akisno: New insights into how cells repair their DNA could point the way to a possible way to stop or slow the onset of Huntington's disease according to a study funded by the National Institute of General Medical Sciences, the National Institute of Neurological Disorders and Stroke and the National Institute of Environmental Health Sciences. Huntington's disease is an inherited condition affecting roughly 30,000 Americans. It causes certain nerve cells in the brain to waste away causing such problems as uncontrolled movement, clumsiness or balance problems. Dr. Jeremy Berg, Director of the NIGMS, discusses the importance of this discovery.
Berg: What the paper reports is that a pathway involved in DNA repair seems to be responsible for genetic changes which are seen in Huntington's disease. What's most remarkable about it is it's one particular DNA repair enzyme that seems to be solely responsible which as has both implications for understanding the nature of these genetic changes but also has potential for therapeutic implications longer term.
Akisno: The study shows that the inserted segment grows when cells try to remove oxidative lesions which are caused by byproducts of the oxygen we breathe. DNA enzymes initially keep oxidative lesions in check, but over time, increasing numbers of lesions overwhelm the repair systems. Dr. Berg said while scientists have long suspected that oxidative lesions play a role in Huntington's disease, the specific role of the lesions had remained elusive till now. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, May 18th when episode 32 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address: email@example.com—once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0030 — April 20, 2007
Coming up on this edition, the most recent analysis of a long-term NIH-funded study found that children who received higher quality child care before entering kindergarten had better vocabulary scores in the fifth grade than did children who received lower quality care. A National Heart, Lung, and Blood Institute study shows that as rates of diabetes have risen in the U.S., the proportion of cardiovascular disease linked to diabetes has also increased. There's evidence that the ancient art of Tai Chi may help older adults avoid getting a painful condition known as shingles by boosting the immune response to the varicella vaccine. And we'll hear all about deep brain stimulation for the treatment of Parkinson's Disease from a neurosurgeon who may soon be performing the procedure on the host of this podcast. But first, some advice on how to help your children deal with the fears that may be caused by such traumatic events as the recent shootings at Virginia Tech.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland. this is NIH Research Radio.
Schmalfeldt: Welcome to episode thirty of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, the most recent analysis of a long-term NIH-funded study found that children who received higher quality child care before entering kindergarten had better vocabulary scores in the fifth grade than did children who received lower quality care. A National Heart, Lung, and Blood Institute study shows that as rates of diabetes have risen in the U.S., the proportion of cardiovascular disease linked to diabetes has also increased. There's evidence that the ancient art of Tai Chi may help older adults avoid getting a painful condition known as shingles by boosting the immune response to the varicella vaccine. And we'll hear all about deep brain stimulation for the treatment of Parkinson's Disease from a neurosurgeon who may soon be performing the procedure on your humble podcast host. But first, some advice on how to help your children deal with the fears that may be caused by such traumatic events as the recent shootings at Virginia Tech. That's next on NIH Research Radio.
(PUBLIC SERVICE ANNOUNCEMENT)
NIMH Offers Suggestions for Dealing with Emotional Impact of Virginia Tech Shootings
Schmalfeldt: In the aftermath of such shocking and tragic events as the recent shootings at Virginia Tech, it's only natural for people to suffer some residual emotional effects. Dr. Farris Tuma, chief of the National Institute of Mental Health's Traumatic Stress Research Program said it's important for people to acknowledge that they have been affected by tragic events like this in order to help them deal with the emotional impact.
Tuma: An event like this clearly has many ripple effects to the local community, to people who have known the young man who was involved, his family, those who knew the other victims as well as other people who were not directly impacted. We know from experience that all of these groups of people—there are consequence for them. And parents should surely be prepared to address their own feelings about what has happened, in addition to staying closely tuned in to their children's emotions and behaviors.
Schmalfeldt: Dr. Tuma said that events like the Virginia Tech massacre can also have a lingering effect on children and cause them to worry about their own safety. He suggested some ways for parents to deal with their children's fears.
Tuma: In general, and it sort of depends on the age of the child, it's probably a good idea for parents to be prepared to explain what has happened as best they are able, to encourage their children to express their feelings and to listen to them without sort of passing judgement and telling them that they're right or wrong about the way they feel. Children need to be reassured that it's OK to be upset after something bad happens. And generally things that parents can do, like maintaining home routines, are pretty reassuring to children—you know, like things are going on as they were before, even though something horrible has happened.
Schmalfeldt: Dr. Tuma said it's important for parents to deal with their own emotions after such a tragic event as well.
Tuma: We know pretty well now that children take a lot of their cues from how their parents are doing. If a parent is feeling distressed and sort of sitting on that and stewing in it is probably not going to be a good thing in the long run to help their children.
Schmalfeldt: You can find more information about post-traumatic stress online at www.nimh.nih.gov.
Tai Chi Boosts Immunity to Shingles Virus in Older Adults, NIH-Sponsored Survey Finds
Schmalfeldt: Historically,Tai Chi has been considered one of the Chinese martial arts. However, the practice of slow motion routines that groups of people practice every morning in parks across China and other parts of the world has developed a worldwide following for its perceived health benefits. Some have even called Tai Chi—"moving meditation." Now, there's evidence that this ancient art may help older adults avoid getting a painful condition known as shingles by boosting the immune response to the varicella vaccine. Research supported by the National Institute on Aging and the National Center for Complementary and Alternative Medicine suggests that a behavioral intervention like Tai Chi—used alone or in a combination with a vaccine—can help protect older adults from the varicella-zoster virus, which causes shingles. Dr. Andrew A. Monjan, Chief of the Neurobiology of Aging Program at the NIA, explains.
Monjan: Several other smaller studies have looked at exercise to help immunity and well-being. Certainly we know that the brain can modulate immunity, and this may be working through brain systems because Tai Chi is not only an exercise program but it also involves meditation and stress reduction.
Schmalfeldt: In the study, Tai Chi alone was found to increase participants' immunity to varicella as much as the vaccine typically produces in 30-to 40-year old adults. Tai Chi combined with the vaccine produced a significantly higher level of immunity, about a 40 percent increase, over that produced by the vaccine alone. The study also showed that the study participants participating in Tai Chi had an increase in immunity that was double that of the group of participants that took part in health education. Dr. Monjan said the impact of this study may go beyond protection from shingles alone.
Monjan: The interesting thing here is that the implications are that it may be not be limited to zoster, but it may be something that would be a behavioral adjudant—a way of boosting the immune response of older people to a number of other vaccinations such as for influenza since there was nothing specific in the Tai Chi related to shingles.
Schmalfeldt: The study appeared in a recent edition of the Journal of the American Geriatrics Society.
Schmalfeldt: When we come back, we'll hear all about a procedure known as deep brain stimulation from a neurosurgeon who may just be performing the procedure on yours truly. That's next on NIH Research Radio.
(BREAK FOR PSA)
Schmalfeldt: In the past couple podcasts, I've talked about how I'm taking part in a clinical research trial to test the safety and tolerability of a procedure known as deep brain stimulation on people in the early stages of Parkinson's Disease. I was diagnosed with PD more than seven years ago, and learned about this study by logging on to www.clinicaltrials.gov —a service of the National Institutes of Health developed by the National Library of Medicine. The study is being conducted at the Vanderbilt University Medical Center in Nashville, Tennessee. And twice, so far, I have been the guest of the General Clinical Research Center, which is funded by the National Center for Research Resources at the NIH. During one recent visit, I had the opportunity to sit down for a chat with Dr. Peter E. Konrad, Director of Functional Neurological Surgery and Associate Professor of Neurological Surgery and Biomedical Engineering at Vanderbilt. In Phase One of this clinical trial, 15 people will be selected to undergo deep brain stimulation, while 15 will be assigned to a control group and will continue their current regimen of medication. When I spoke to Dr. Konrad, I was still unaware of which group I would be joining. Dr. Konrad and I chatted as he visited me in my room at the General Clinical Research Center.
Schmalfeldt: Let's talk a little bit about deep brain stimulation. To put it simply, it's a pacemaker for the brain.
Konrad: Correct. Electronically, what's happening is that the unit only works for patients when it's in the high-frequency mode. So when it's in a low rate of stimulation—let's say under a hundred times a second or 100 hertz—the stimulation doesn't actually work well and, in fact, it drives the circuits into an abnormal pattern and not preventing them from being abnormal. So when it's put in the high frequency mode, this is what Dr. Benabid in Grenoble, France had pieced together along with a lot of other physicians and scientists back then that high-frequency stimulation effectively mimicked the old destructive lesions we used to do.
Schmalfeldt: The palidotomies.
Konrad: The palidotomies, the thalamotomies. And in fact for those of us who do those things, the way we know where to create that palidotomy lesion or injury is just before we turn on the heat probe —immediately before that to test it out - we put the unit into a high frequency stimulation mode and if we see the problem the person has go away, whether it's tremor or rigidity, then we know—"ah ha!"—the lesion's going to work there. And then we used to flip the unit over into a "heat mode" and then make a teeny, very precise little hole or burn there. So it wasn't too big of a leap of intellect to say, "Well, gee, instead of burning holes in people's brains, why can't we leave a high-frequency stimulator in there if it's going to do the same thing?"
Schmalfeldt: Now, basically what this does, it interferes with they hyperactive electrical signal that area of the brain is putting out which causes the symptoms, right?
Konrad: Correct. The recordings we get from the brains of patients in various states of the disease all indicate that the neurons in that region of the brain are revved up. They're firing at a rate higher than typical. In fact, we have an abstract coming out to show that as the disease gets in humans, just like in animals, the firing rates of this nucleus—STN—gets out of control. And that then leads to all the downstream effects of abnormal stiffness in muscles, tremor, a system that's sort of over-charged, so to speak. The stimulator basically brings that idling back down.
Schmalfeldt: You've done a lot of these.
Schmalfeldt: What's the feeling you get when you get that electrode in the right spot—you've hit the "money spot" and you know you're in there? What does that feel like to you?
Konrad: As a surgeon?
Schmalfeldt: As a surgeon.
Konrad: Oh, it's very gratifying. Because, actually, the patient will tell us, "Gosh, this feels just like my medication does," or, "I haven't seen my hand that steady in 10 years."
Schmalfeldt: When I talk to my friends about the possibility of my going through this, they're like, "Oh God! They keep you awake for this?" That's vital to this surgery, isn't it?
Konrad: Yes. Absolutely. We still don't have a nice little red dot or some marker on an MRI scan to say "put the electrode here and it's going to work 100 percent of the time." And part of it is because everybody's brain is a little bit different in shape and size. Just like no two pairs of glasses fits the same person—everybody's got just a little bit different anatomy in their brain, so in order to customize that implant to work well in a patient, we have to understand the micro-anatomy in that area, and there's no other way to do it except —right now—having the person awake and testing the device out and creating that micro map for that individual.
Schmalfeldt: Now, it's not like finding a needle in a haystack—the haystack being the brain—you have a general idea where you're going. You just showed me on my MRI the general area where the electrodes would go. So I understand that it's a matter of finding the—as I called it—the "sweet spot" in that narrow area.
Konrad: Yes. Our initial guess, so to speak, when we target for the initial implant, so for a patient coming into the operating room we know that, pretty much, if we target to a certain dimensional spec in the brain that we'll be within about five to seven millimeters of where we want that to be. But that isn't good enough to leave that implant there with that error. And, again, it's like throwing darts. We don't want to be in the 10 or 20 ring. We want to hit a bull's eye. Close just isn't good enough. Even as close as we get it.
Schmalfeldt: Now this isn't something you just show up and have done. There's a lot of prep work that needs to be done, from the patient's point of view and the doctor's point of view. You mentioned the brain mapping. There's the insertion of the bone markers—why don't you tell us a little bit about that.
Konrad: OK. Well, at Vanderbilt we've taken the surgery and broken it up into three shorter steps. I was never happy with putting somebody through an entire day of surgery. It gets to be pretty tiresome.
Schmalfeldt: That's a pretty big day.
Konrad: It's a long day. And the concept, again, of having a large frame put on your head and being locked to the bed is difficult for a lot of people. So, we've adopted a technology using a rapid-prototyping technology from the industry—and it's actually geared now into a medical device called the StarFix targeting platform—you can look at this on the website for the Fred Hare corporation. They make this as a commercially available product. It's approved by the FDA and it's a tool that I adopted four years ago that lets me get to the area of the brain with the same precision, or—I think—better than the big system. So, in a nutshell, basically the patient comes in for an outpatient scan—CT and an MRI—and placement of these teeny little bone markers.
Schmalfeldt: To me, they look like those wall anchors that you put into dry wall to hang a picture.
Konrad: Yes. And then scale it down to about 3 millimeters. And so then when a person's asleep for the scan, which is another huge advantage, because by putting someone to sleep for the studies I feel I'm able to get a motion-free picture, and a lot of Parkinson's or tremor or dystonia patients, if they have their pictures done in the morning because they have to be awake for the surgery, the scans can sometimes have a lot of "shake" to them. So by putting someone to sleep and getting the scan with them asleep, we get a very clear, crisp image. And then while they're asleep it's easy to just drop in these four little anchors. And these little anchors are basically attachment points for a yet-to-be-made customized platform that allows us to mount the instruments needed for the surgery the following week. So then, the patient wakes up and goes home with these little anchors installed in their skull and it's covered with a little staple. It's just a little puncture, a few millimeters. And then that allows me to take the pictures we get from that day and relate the target where we want to go with the little anchors. We send that information off to the company. And they then take the information and create a custom fixture for it. This has evolved from the industry of rapid prototyping where manufacturers take a drawing, basically, and they can create any three-dimensional object, much like a layered printing process.
Schmalfeldt: And you showed me one of these when we first met in February. You wouldn't know what it was to look at it, but to have it described to you—and there's some very good pictures of it in the booklet that you put together here at Vanderbilt. KONRAD: The company sends us back this platform within about three days and we have it waiting in the hospital. And then the patient can come in for the surgery and we don't have to perform scans and mounting of the halo and all that stuff the morning of surgery—we just walk into the operating room and this little platform is available. It's probably one-tenth the size of the big halo system and it basically then screws right into those little anchor points for the duration of the surgery. So the patients can turn their heads, sit up for the case, look around, tell us more about what's going on and not feel like they're sort of bolted down, unable to move which is always, again, an uncomfortable scenario for someone who's off their medication, who has Parkinson's Disease. It's very frightening to be locked to a table for several hours. And then at the end of the procedure, once we use this platform to basically put the electrodes in, the anchors are removed and the platform is given to the patient or discarded.
Schmalfeldt: Oh, I'll want mine!
Konrad: And it's allowed us to take about three-and-a-half to four hours off the front end of the surgery. So our surgery times are quicker. We generally get both implants done typically before noon. And for us at a major research center like this in which we also want to ask some questions, we don't want to waste time with unnecessary, inefficient parts of the procedure. We want to get the procedure done and make sure that implant's in the right spot. And the whole goal for that middle step is to basically map the area to a fine degree of precision and then implant the electrode and lock it into place in the skull and then that's all we do that day. We get both sides done. Typically most Parkinson's patients have to have one electrode on either side of the brain. Essentially at the end of that day we leave the electrodes in and the patient goes home the next day. The third step of the procedure, we bring the person back as an outpatient and put them to sleep for the parts they don't have to be awake for, which is basically the hookup of the brain electrodes with the little generator or computer. It's actually much more than a battery. People call it the little battery it's hooked up to. It's actually got a sophisticated computer inside of it—a programming apparatus, things that allow us as the clinicians to tell the device exactly how to run the electrodes and what frequencies and all of that. It's about, maybe, a quarter of an inch to a third of an inch thick, and maybe two to three inches long and an inch and a half wide.
Schmalfeldt: It's nothing huge.
Konrad: No. A lot of people can easily hide it underneath the skin, below the collarbone.
Schmalfeldt: And then, the step after that heals up, the patient comes back for the fine tuning.
Konrad: Yes. Unlike pacemakers for the heart which can be pretty well programmed right the moment they're put in—it's pretty well understood how the tissue will heal around that heart electrode— the brain electrode lead, the tissue can heal in with different electrical properties, so to speak, that would necessitate a different intensity of stimulation to get the same effect. And we don't have as much play room to just double or triple the juice coming out of the unit to control the person's symptoms. If we turn the implant up too high, there's no question we can capture structures we don't want—pretty much just results in undesirable tingling, tightness somewhere. So there's a window of therapy that we want to hit. And so we actually have to let that implant settle for a few weeks before it becomes real stable. Normally if we wait for about three weeks before the first program is tried on this, then the programming is pretty consistent. Be patient for a couple weeks, let the unit heal in, and then once the person comes in for programming, the programming's very predictable from that point. The electrode doesn't move. So if one of the electrodes is effective in stimulating the target then that one will be the effective electrode from then on.
Schmalfeldt: Now this clinical trial that I'm screening for now is to test the safety and tolerability of deep brain stimulation in early Parkinson's, and am I right in thinking that you've done a few of these surgeries in this study so far?
Schmalfeldt: Any surprises?
Konrad: Pleasant surprises so far. The first three patients we've done, implant-wise, actually have been easier, in my opinion, to find the target than the advanced Parkinson's patients. Part of it is because people get older and their disease progresses and thought processes also get bogged down and they have a harder time speaking exactly what they want them to. In other words, it's sort of like going to the eye doctor, getting fitted for glasses. And they put that thing in front of your eye and they say "better or worse." And we kind of do the same thing in the operating room. We test the point of stimulation and we really want to know was this better or worse than the last place we were at. And we rely on the patient to a fair degree to kind of help us tune that implant to their best point.
Schmalfeldt: I just want to thank you for everything you're doing for people in the Parkinson's community and for people throughout the entire spectrum of neurosurgical problems. Doctor Peter Konrad, neurosurgeon here at Vanderbilt University Medical Center, thanks again for everything.
Konrad: Thank you Bill. Appreciate the opportunity.
Schmalfeldt: As I mentioned, when I recorded this conversation with Dr. Konrad, I hadn't yet been assigned to either the surgery group or the control group in the study. Now, however, we've had the metaphorical flip of the coin. I've been randomized to the surgical group. So, sometime —probably in June or July—Dr. Konrad and I will become much better acquainted as I undergo bilateral deep brain stimulation as part of this clinical trial. Once again, taking part in a clinical research study is a very personal decision and only you and your health care provider can decide if such a step is right for you. However, clinical trials are a vital component in the never-ending search for cures and new treatments for a variety of diseases and conditions. Do you have the key that could unlock the vault of medical discovery? You can take the first step by logging on to www.clinicaltrials.gov.
Schmalfeldt: When we come back, Wally Akinso tells us how the proportion of cardiovascular disease cases related to diabetes has increased. That's next on NIH Research Radio.
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Study Shows Proportion of Cardiovascular Disease Related to Diabetes Increased
Schmalfeldt: More and more folks are being diagnosed with diabetes. Likewise, the rate of cardiovascular disease linked to diabetes is going up. Wally Akinso has this report.
Akinso: A National Heart, Lung, and Blood Institute study shows that as rates of diabetes have risen in the U.S., the proportion of cardiovascular disease linked to diabetes has also increased. The researchers compared risk factors for cardiovascular disease and cardiovascular events such as heart attacks among the study's participants from two different time periods. Dr. Caroline Fox, lead author and medical officer of the study, talked about what conclusions can be drawn from the findings.
Fox: So I think that overall the findings emphasize the need for more efforts to prevent diabetes as well as efforts to aggressively treat and control cardiovascular disease risk factors among individuals with diabetes. The findings also highlight the importance of understanding potential trajectories of cardiovascular disease due to risk factors because this knowledge is really helpful for efforts to predict trends of cardiovascular disease.
Akinso: A total of 9,540 individuals aged 45 to 64 were evaluated—one group between the years of 1952 to 1974, the second group from 1975 to 1998. Dr. Fox said most of the increased risk was observed among men. She added that the prevalence of diabetes among those with cardiovascular disease almost doubled between the earlier and later time periods and there was also an increase in the prevalence of obesity. For more information about this study, log on to www.nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Early Child Care Linked to Increases in Vocabulary and Problem Behaviors in 5th and 6th Graders
Schmalfeldt: The most recent analysis of a long-term NIH-funded study found that children who received higher quality child care before entering kindergarten had better vocabulary scores in the fifth grade than did children who received lower quality care. However, the study authors also found that the more time children spent in center-based care before kindergarten, the more likely their sixth-grade teachers were to report problem behaviors. Dr. James Griffin, the National Institute of Child Health and Human Development Science Officer for the study, explained a possible reason for this finding.
Griffin: There are some people that speculate that those who are in center-based care, because there's more children, there may be more opportunities for conflict and maybe some opportunities to learn some not-so-good behaviors. The other could be it's just a way of being socialized in a group versus a smaller setting, and that some of those behaviors persist.
Schmalfeldt: Researchers emphasized that this so-called bad behavior fell into the range of normal childhood shenanigans— like sassing back and getting into fights—and was not considered to be clinicially disordered. What's more, according to Dr. Griffin, the biggest influence on a child's behavior is still to be found at home.
Griffin: We found through sixth grade that parents are actually the biggest influence on children's lives and the best predictors of how they're going to do later in school and socially—much larger than any effects of child care.
Schmalfeldt: These are the latest findings in the NICHD Study of Early Child Care and Youth Development, the largest, longest running and most comprehensive study of child care in the United States. Families were recruited through hospital visits to mothers shortly after the birth of a child in 1991 in 10 locations in the U.S.
Griffin: And that's what makes them interesting. We've been studying these children since birth, and so while we can't draw causal conclusions, at the same time it's interesting to see these effects persist all the way into fifth and sixth grade.
Schmalfeldt: The study appears in the March/April 2007 edition of Child Development.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, May 4th when episode 31 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on nearly a thousand radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. If we use your comment, we'll send you something nice from the NIH gift shop! That e-mail address: email@example.com —once again, our e-mail address is firstname.lastname@example.org. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0029 — April 6, 2007
Coming up on this edition, Wally Akinso has a story about how MRI is being used to diagnose early disease in the opposite breasts of women diagnosed with breast cancer. Bill Schmalfeldt sits down with Dr. Griffin Rodgers, acting director of the National Institute of Diabetes and Digestive and Kidney Diseases to talk about what that institute has in mind for National Minority Health Month. A survey funded by the National Institute on Drug Abuse shows that fewer than 10 percent of drug-abusing offenders are getting the kind of treatment they need. Bill talks about his recent visit to an NIH-funded clinical research center at Vanderbilt University in Nashville where he's taking part in a clinical trial. But first, Wally tells us about a national study on addiction to prescription painkillers.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland. this is NIH Research Radio.
Schmalfeldt: Welcome to episode twenty-nine of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, Wally Akinso has a story about how MRI is being used to diagnose early disease in the opposite breasts of women diagnosed with breast cancer. I'll sit down with Dr. Griffin Rodgers, acting director of the National Institute of Diabetes and Digestive and Kidney Diseases to talk about what that institute has in mind for National Minority Health Month. A survey funded by the National Institute on Drug Abuse shows that fewer than 10 percent of drug-abusing offenders are getting the kind of treatment they need. And I'll tell you about my recent visit to an NIH-funded clinical research center at Vanderbilt University in Nashville where I'm taking part in a clinical trial. But first, Wally tells us about a national study on addiction to prescription painkillers. That's next on NIH Research Radio.
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NIDA Launches National Study on Addiction to Prescription Painkillers
Schmalfeldt: It's a nationwide study to look for solutions to a nationwide problem—prescription drug abuse. Wally Akinso has the details.
Akinso: In response to the growing national problem of prescription drug abuse, the National Institute on Drug Abuse has launched a national study evaluating a treatment for addiction to painkillers. Dr. Nora Volkow, NIDA's Director, discussed the problem.
Volkow: It's an addiction that has significantly increased over the past 5 years. It's actually the number one addiction; the number of new people becoming addicted to it. Last year in fact, it surpassed the number of new initiates to marijuana. It has surpassed the number of treatment admissions for addiction to that very much covered by heroin.
Akinso: The study will test the effectiveness of buprenophine in combination with naloxone tablets, along with different models of drug counseling in patients addicted to prescription painkillers. Buphrenorphine works by acting on the brain's own opiate receptors-targets heroin, morphine, and prescription painkillers-relieving drug cravings without prompting the same intense high or dangerous side effects. Dr. Volkow said when combined with naloxone, buprenorphine's abuse potential is further limited, since those who try to inject it to get high experience severe withdrawal symptoms, while no adverse effects occur when it is taken orally, as prescribed. She added that researchers must recognize the risk of addiction to pain medications and treatment for those who become addicted to them. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.
Interview with Dr. Griffin Rodgers
Schmalfeldt: This week on NIH Research Radio, we've taken the traveling microphone to the office of Dr. Griffin Rodgers, acting director of the National Institute of Diabetes and Digestive and Kidney Diseases. Thanks for taking some time to be with us today.
Rodgers: Pleasure to be here.
Schmalfeldt: So here we are in April—April is National Minority Health Month and I understand NIDDK, along with the National Diabetes Education Program is getting involved with a bunch of different outreach programs to sort of spread the word to the minority community about diabetes and other related disorders. What sort of things are you guys up to?
Rodgers: Certain ethic groups, such as African Americans, Hispanic, American Indians, Alaska Natives, Asian Americans and Pacific Islanders have an increased risk for developing both pre-diabetes and Type 2 diabetes. Current figures suggest that 54 million people over the age of 20 have pre-diabetes, a condition which increases the risk of developing diabetes.
Schmalfeldt: That's a lot of people.
Rodgers: It is. But not only that, but heart disease and stroke. People who have pre-diabetes, they have blood glucose levels that are higher than normal but they're not high enough yet to be considered frank diabetes.
Schmalfeldt: And a lot of these folks wouldn't even know they had this condition unless they actually went and got themselves checked.
Rodgers: It's estimated that perhaps up to one-third of people are unaware that they have diabetes and of course the number would be even higher than that for pre-diabetes. The National Diabetes Education Program promotes the finding of a major NIH study—that is, the Diabetes Prevention Program or DPP—which is that modest weight loss reduces the risk of these patients that have pre-diabetes to go on to develop diabetes.
Schmalfeldt: By modest weight loss, we're talking 10 percent?
Rodgers: Five to seven percent.
Schmalfeldt: That's even better than I thought.
Rodgers: .for someone that's 200 pounds, that would be 10 to 14 pounds. And these findings are true for all ethnic groups, including the ones that I just mentioned.
Schmalfeldt: What are some of the risk factors for diabetes? I don't think we can ever really talk about that enough. It's a message that I really do think we need to drill into people.
Rodgers: Absolutely. Well it turns out that the risk factors for diabetes are the same as those for pre-diabetes: a background of African American, Hispanic or Latino, American Indian or Alaska Native, or Asian or Pacific Islander. You're at increased risk for developing pre-diabetes or Type 2 diabetes. Being overweight or having what's defined as a body mass index—or BMI—greater than 25. Now, BMI is just a mathematical relationship between your weight and your height. Asian Americans actually develop a risk at a lower BMI—greater than 23. And if you're a Pacific Islander, it's around greater than 26. People over the age of 45 or people who have a family history of diabetes are at increased risk. And so if you fall into one of these categories, we are strongly urging the listeners—or if they have friends or relatives that fall into those categories.
Schmalfeldt: Everybody probably knows somebody who is in this category.
Rodgers: Absolutely. We encourage them to see their health care providers to be checked out. If you're a Medicare recipient, Medicare now covers tests to check for diabetes up to twice a year. And, in fact, if you develop diabetes, Medicare helps to pay for diabetes equipment, supplies, covers diabetes self management, training, medical nutrition therapy service, and other diabetes-related services.
Schmalfeldt: Now, NIDDK is doing more than just talking about this. There's a wealth of resources available to our listeners, both online and by calling a toll-free number. What are some of those resources?
Rodgers: The National Diabetes Education Program or NDEP—which is a partnership between the NIH and the CDC, and it also involves over 200 private and public partners offers free diabetes prevention resources that are tailored to specific ethnic groups through its "Small Steps, Big Rewards: Prevent Type 2 Diabetes" campaign. One example is the "More Than 50 Ways to Prevent Diabetes", coined after an old Simon and Garfunkel. "50 Ways to Lose Your Lover".
Schmalfeldt: Right. That's the first thing that comes to mind.
Rodgers: Exactly. Kind of humorous messages there, like "Snack on a Veggie, Reggie. Or, "Dance it Away, Faye" for example, to motivate people to take small steps to reduce their risk for diabetes. For the Hispanic and Latino population, we have the "Paso a Paso" tip sheet, available in English and in Spanish to help encourage Hispanics and Latinos to learn to reduce their risk for pre-diabetes. We have a "Power to Prevent Diabetes" tip sheet tailored to American Indians and Alaska Natives. You know, actually we have these materials in many, many different languages from Spanish to Samoan—over 15 languages that this information is provided. And the information is provided and tailored both at the level of the patients, the general public as well as providers. And if I can, if I could just give you some contact information.
Rodgers: For people interested in obtaining this information and more tips on how to lose weight and lower your risk for diabetes, you can call a toll free number—800-438-5383. Or you can visit us online at www.ndep.nih.gov.
Schmalfeldt: Excellent. And even though April is National Minority Health Month, we should be thinking about this all 12 months of the year.
Rodgers: We just want to highlight it this month, but you're absolutely right. This is something that is an ongoing effort.
Schmalfeldt: Dr. Griffin Rodgers, acting director of the NIDDK, thanks again for sitting in with us on NIH Research Radio.
Rodgers: It's been a pleasure. Thank you. (Transitional Music)
Schmalfeldt: When we come back, Wally tells us how doctors are using a state-of-the-art imaging technique to check for cancer in the opposite breast of women diagnosed with breast cancer. That's next on NIH Research Radio.
MRI Detects Cancers in the Opposite Breast of Women Newly Diagnosed with Breast Cancer
Schmalfeldt: As is true with all forms of cancer, the earlier breast cancer is discovered, the better the chances for a good outcome. Wally Akinso tells us how MRI is being used to look for cancer where it might not have been noticed before. AKINSO: MRI can be used to detect cancers in the opposite breast of women newly diagnosed with breast cancer, according to a study funded by the National Cancer Institute. MRI scans of women who were diagnosed with cancer in one breast detected over 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis. Dr. Constance Lehman, the principal investigator of the study, said given the established success rates of mammography and clinical breast exams for detecting cancer in the opposite breast, adding an MRI scan to the diagnostic evaluation effectively doubled the number of cancers immediately found in these women.
Lehman: We know that women who have a diagnosis of breast cancer in one breast are at risk for developing cancer in the other breast. We then learned that many of these cancers are actually in the breast right at the time of that initial cancer diagnosis. And if we use MRI added to mammography we can find many more of these cancers than we could before MRI.
Akinso: Researchers hope that with breast MRI's strong ability to predict the absence of a tumor, they could provide women with more reassurance that the breast is disease free. Dr. Lehman is optimistic that there may be a long-term savings to patients and to the health care system due to MRI's ability to detect cancer in both breasts prior to beginning therapy.
Lehman: I think this is important information to women and their doctors. Women when told that they have a breast cancer diagnosis have many difficult decisions to face. This study provides information they didn't have before to better guide those decisions. We want our patients to be able to make informed decisions and it's through these clinical research trials that we can provide the information so that they can make those informed decisions.
Akinso: For more information on this study, log on to www.cancer.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
NIDA Survey Shows Lack of Substance Abuse Treatment Options for Offenders
Schmalfeldt: Studies show that drug abuse treatment cuts drug abuse in half, drastically decreases criminal activity and significantly reduces arrests. Yet a recent survey funded by the National Institute on Drug Abuse shows that fewer than ten percent of drug-abusing offenders are getting the kind of treatment they need.
Bennett: I think that's exactly where you would want them to be available. That ten percent refers to people who are in community corrections, which includes parole, probation, community supervision. And those are the people who are at very high risk when they go back into the community from incarceration of using drugs again.
Schmalfeldt: That was Dr. Fletcher Bennett, the NIDA Science Officer on the National Criminal Justice Treatment Practices Survey, which provides a picture of existing treatment programs across all correctional settings—including jails, prisons, probation and parole offices, and local community correction agencies for juvenile and adult offenders. He said that the survey shows there are far too few programs and services in a correctional setting, and the ones that do exist are only offered to a handful of offenders.
Bennett: There are probably various reasons, the biggest one may be just simply resources. Often there's an assumption drug abuse treatment is available in the community when in fact it is not. It's under-funded and under-supported.
Schmalfeldt: In a published statement, NIDA Director Dr. Nora J. Volkow said that since offenders are four times as likely as the general population to have a substance abuse disorder, treating the offender population could measurably lower the demand for drugs in our society and reduce the crime rate. Dr. Bennett said NIDA is looking for ways to increase drug abuse treatment access for offenders.
Bennett: At this point we're simply trying to find the best way to integrate drug abuse treatment into correctional settings, including community corrections settings as well as jails and prisons. And so we're trying to find more effective ways of doing that so that the individual can have better outcomes when they go back into the community.
Schmalfeldt: The survey findings were published in a special issue of the Journal of Substance Abuse Treatment.
Schmalfeldt: When we come back, I'll tell you about my recent visit to an NIH-funded clinical research center in Nashville as I continue to be screened for participation in a clinical trial for a new use of deep brain stimulation in Parkinson's Disease. That's next on NIH Research Radio.
Schmalfeldt: DBS—Deep Brain Stimulation— the placement of electrodes deep into the brain as a treatment for Parkinson's Disease—was approved by the Food and Drug Administration in 1997. The technology was developed by scientists based on discoveries about brain circuitry supported by the National Institutes of Health. To put it simply, DBS acts as something of a pacemaker for the brain—interrupting the errant electrical activity of that portion of the brain caused by a deficiency of dopamine—a chemical produced by the brain that is necessary for smooth muscle movement. Patients who have undergone DBS generally report a reduced need for the drugs they previously took to control their symptoms—and a reduction in the side effects caused by those drugs. Do a search for "deep brain stimulation" at www.clinicaltrials.gov —a website sponsored by the National Library of Medicine— and you'll come back with several studies that either are or will be recruiting patients in the ongoing search for newer, better ways to use DBS to treat such conditions as epilepsy, dystonia, obsessive-compulsive disorder, depression, and—yes—Parkinson's Disease. As I've mentioned in a previous podcast, I am enrolled in such a clinical trial—a Phase I study to determine the safety and tolerability of DBS in early Parkinson's Disease, a condition I've been walking around with since being diagnosed in 2000. You may recall from that previous episode, I made my first visit to the site of the study—the Vanderbilt University Medical Center in Nashville, Tennessee, back in February. After a visit with the study coordinator, the lead investigator, the neurosurgeon who performs the implant surgery, and a biomedical ethicist, I signed the consent forms. Well, on March 25th, I returned to Vanderbilt where I was housed in the General Clinical Research Center—which is funded by a grant from the National Center for Research Resources at the NIH. The NCRR funds a national network of 59 of these GCRC's that provide settings for medical investigators to conduct safe, controlled, state-of-the-art, inpatient and outpatient studies of both children and adults. Dr. David Wilde is a program official in NCRR's Clinical Research Division, and he has oversight of 14 of these GCRC's—including the one at Vanderbilt. He talked about the purpose of the program. WILDE: This is a long-standing grant program, and Vanderbilt is one of the oldest. Some of these grants are in their 47th, 48th year so this is a continuous, ongoing effort. And at Vanderbilt, what the NCRR, the NIH really does is that we sort of buy a piece of the hospital that will later be dedicated to clinical research studies. And we buy the space or rent the space and we buy beds and put outpatient facilities in that space. And then we hire all the personnel that would be needed to run a clinical trial—the nurses, the core lab technicians, everything that you would expect to have in hospital care and we pay their salary and support primarily so that an investigator at Vanderbilt—should they discover something interesting or if they have a particular area of clinical research interest—can go to the GCRC and conduct that trial. And as you know, clinical trials are very expensive.
Schmalfeldt: So the GCRC provides a much-needed base of operations for investigators conducting clinical research. And they also provide many of the comforts of home for the person participating in the clinical trial. For myself, I was quite impressed with the staff at the GCRC at Vanderbilt. You might think the concept of "southern hospitality" is just one of those quaint concepts from days gone by. You'd be wrong. Although the room was small and clinically Spartan, it was cozy as any hospital room could ever be and the staff spared no effort to ensure that I was comfortable. And no wonder. Dr. Wilde at the NCRR told me it takes a special breed of nurse to work in an NIH-funded General Clinical Research Center.
Wilde: These nurses that we have are very special because they are trained not only as nurses, but they are trained as research nurses and actually some of them have further accreditation which allows them to monitor invasive procedures, to really be a tremendous assistant to the investigator who many times can't be on the spot every moment. And so these are very special nurses, and in fact sometimes in hospital surveys they will ask "where in the hospital did you get the best treatment?" Many times, the GCRC always came out on top so that the hospital started excluding the GCRC as part of their list of units when they were sending questionnaires around to the patients. These are such highly-trained nurses and—you're right—they're very friendly and yet they're highly-trained and they really enjoy their work. We have very little turnover in the GCRC unit and I think it's because it's a stimulating environment for them. Not only are they conducting nursing, but they're also integral —they're part and parcel of conducting these trials and they take a real sense of pride in that.
Schmalfeldt: No argument from this patient. Even though I actually didn't require a great deal of nursing care for this particular visit, beyond the taking of vital signs and the like, several times each shift, the duty nurse would come by to chat for a few minutes, to see how I was doing in general, to ask what appointments I had that day, and to just offer a welcome bit of human contact. The purpose of this visit? Screening. And to be properly assessed by the neurologist, it was necessary to stop taking my anti-Parkinson's medication for a couple days in advance of the appointment. By the time I visited with lead investigator, Dr. P. David Charles—associate professor and vice-chairman of Neurology at Vanderbilt—I was showing most of the cardinal signs of PD— rigidity, slowness, and problems with balance. Tremor, the symptom that most folks associate with PD, has never really been much of a problem for me. Dr. Charles put me through the paces of the "Unified Parkinson's Disease Ratings Scale" test—which in many respects, I suppose, resembles some of what you might see on one of those police reality shows on TV —"bring your fingers close together, but don't let them touch. Walk to the end of the hallway, turn around, and come back. Open and close your hand as quickly as you can. Now the other one." After the test, Dr. Charles asked me to go ahead and take my medication—something I was more than ready to do at that point—and he'd come back in an hour for a second look. When he returned to my little room at the CRC, I was—as they say in the parlance of Parkinson's—"On." And how! Dr. Charles repeated the testing and this time I breezed through with barely a twitch. Except for some minor rigidity in my right arm, my symptoms were non-existent an hour after taking my meds. This was important, as DBS only works as well as the medication, so if a person doesn't have a good reaction to the meds, there probably will not be a good result from the surgery. After the exam, I had a chance to sit down and talk with Dr. Charles about the study and what they hope to learn.
Schmalfeldt: First of all, thank you for everything you're doing for people with Parkinson's to bring the day closer to a cure for this thing. I asked you this when we met in February. What got you interested in Parkinson's?
Charles: Well, originally, I guess, when I finished my residency training in neurology, I began to think about the subspecialties of neurology that I'd like to do research in, and Parkinson's Disease —movement disorders and related conditions offered one of the greatest chances for advancements in the field of research for that area over the time of my career. So, I knew I wanted to do research in a subspecialty of neurology so Parkinson's Disease is one of the things that certainly posed a significant challenge to patients. But then, I thought, also had potential for significant advancements during my time in research.
Schmalfeldt:"The Safety and Tolerability of Deep Brain Stimulation in Early Parkinson's Disease." What are we trying to prove with this study?
Charles: This study is a first step. It's clearly a pilot study testing deep brain stimulation in the very early stages of Parkinson's Disease. Just to take a step back, DBS therapy has been widely accepted and is a proven therapy for advanced stage Parkinson's Disease, and—in fact—recently in Europe has now been tested in the middle stages of the disease—not FDA-indicated for that, but certainly has been tested and is proving to be helpful. What our study is doing here at Vanderbilt University is to test the device in the very earliest stages of Parkinson's Disease. They hypothesis of the underlying scientific question that we're hoping to get at is could the therapy slow the progression of the disease if it were applied early.
Schmalfeldt: That would be big time news.
Charles: It would be big news, it would be certainly. Because there's today there's no therapy that's clearly proven to slow the progression of the disease. Our study currently—the goal is to enroll 30 patients total in a pilot study of safety and tolerability to collect the preliminary data necessary to then begin a large-scale multi-center effort to test that hypothesis of could it slow the progression in Parkinson's long term.
Schmalfeldt: And what sort of patients are you looking for in this?
Charles: People with Parkinson's Disease, certainly in the very earliest stages, meaning they have to have been on medication less than four years, between the ages of 50 and 75, also not have any fluctuations in their response.
Schmalfeldt: No dyskinesias or any "on and off" times.
Schmalfeldt: Why that cut off? Why "four years"?
Charles: Well, typically people begin to experience motor fluctuations, if they're going to have them, within five to seven years of disease onset. So we're trying to get this study in the very earliest stages so less than four years of medication but also without any of those features if they were to develop earlier than expected.
Schmalfeldt: Thanks again for your interest in Parkinson's.
Charles: Thank you so much for participating and having us on.
Schmalfeldt: During our visit, Dr. Charles was accompanied by Ms. Chandler E. Gill, the study coordinator, the first person I contacted at Vanderbilt concerning my possible participation in this study. We talked about what it means to be the coordinator of a clinical trial.
Schmalfeldt: You're the coordinator for this clinical trial. Not just this clinical trial, you coordinate many here at Vanderbilt, right?
Gill: That is correct.
Schmalfeldt: That sounds like a hard job. That sounds like trying to keep a bunch of balls in the air at the same time— "herding cats" if you will. What's involved with being a coordinator for a clinical research trial?
Gill: It starts with putting all the regulatory paperwork through. There are things like the Institutional Review Board. And then, for this trial, because it's not a currently approved use of the device, we have to go through the FDA to get an investigational device exemption. And then, after all the regulatory aspects are completed, then there's patient recruitment, scheduling patients for appointments, and all the various stages of the study, for example for this one there are the four screening appointments then the baseline, six month, 12-month, 18-month and 24-month stays in the CRC.
Schmalfeldt: As somebody on the other end of this, you guys have been extremely accommodating. When you're looking for patients, are there many that you have to just turn away right at the outset?
Gill: There are many that we turn away just because you can see right off the bat that they don't qualify—they're too young for the study or they've been on medication too long or something like that.
Schmalfeldt: And what's your interest in neurology?
Gill: Well, I did an internship with Dr. Charles when I was in college and after I graduated he offered me a job. So I plan to work here for another two years and then apply to medical school.
Schmalfeldt: Are you going to be a neurologist?
Gill: Maybe. (Laughter)
Schmalfeldt: We'll hold out a good thought. (Laughter) Now, if folks are interested they contact you directly.
Gill: That's right.
Schmalfeldt: Why don't you give us that e-mail address?
Gill: OK. My e-mail address is email@example.com.
Schmalfeldt: Thank you, again, so much for everything you guys are doing.
Gill: Thank you.
Schmalfeldt: There was more screening, more testing to be done. Later that afternoon I visited with Dr. Michael G. Tramontana, assistant professor of psychiatry and neurology at Vanderbilt. It was his job to make sure that I wasn't suffering from any cognitive disabilities that would make me ineligible for the surgery or the study. Then on Wednesday, I chatted with Dr. Ronald M. Salomon, associate professor of Psychiatry. His business was to make sure I wasn't suffering from depression and was —in fact—entering into the study with a clear mind and for the right reasons. It wasn't on the official schedule, but I also had a very interesting conversation with Dr. Peter Konrad, Associate Professor of Neurosurgery and Biomedical Engineering. He's the gent who will become intimately familiar with my brain should I be randomized for the surgical portion of the study—you'll hear our chat in an upcoming podcast. Next step? On April 10, I'll return to Vanderbilt for the first of the eight day stays at the CRC that you heard Ms. Gill talk about. For eight days, I will be taken off my medication and each day I will be rated according to my performance in the Parkinson's Disease Rating Scale. I'll be videotaped for future reference. Then at the end of the eight days, it's a metaphorical flip of the coin. Heads? I'm scheduled for surgery. We'll talk about that next time. Tails? I go to the control group. That means I continue taking the same meds I'm taking now. and I go back to Vanderbilt twice a year, eight days at a time, for the next two years so my progress can be compared to the folks who were randomized to the surgical group. April 18. That's the day I'll find out which group I'm going to. And that will determine what direction my experience in this very important clinical trial will take. And I'll share the verdict with you in our next episode of NIH Research Radio. Now, choosing to participate in a clinical trial is a very personal decision. In my case, I'm excited about the possible neuroprotective effect of deep brain stimulation, meaning that if the theory is correct, it could slow down the inevitable advancement of this relentlessly progressive disease. DBS is not a cure for Parkinson's, but is has been shown to be an effective treatment. And it's completely reversible should the happy day arrive where an effective cure is discovered. Also, whether I'm in the surgical group or the control cohort, there's a sense of satisfaction in knowing that I'm contributing to research that could, someday, improve the lives of the more than 1-point-5 million Americans with Parkinson's Disease, with approximately 60-thousand new cases diagnosed each year. Now, if you're considering taking part in a clinical trial, talk it over with your family doctor or specialist and your loved ones. Then check out www.clinicaltrials.gov to see if there's a trial that fits your situation. There's a need for healthy volunteers, as well as for those diagnosed with a variety of conditions. The journey of discovery begins with a single step. You can make that step by logging on to www.clincialtrials.gov.
Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, April 20th when episode 30 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website: www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on nearly a thousand radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. If we use your comment, we'll send you something nice from the NIH gift shop! That e-mail address: firstname.lastname@example.org —once again, our e-mail address is email@example.com. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.
#0028 — March 23, 2007
Coming up on this edition, Wally Akinso shares a report about older mothers and Cesarean section births. Bill Schmalfeldt sits down for a chat with registered dietician Joanne Gallivan from the National Diabetes Education Program regarding National Nutrition Month. There's some interesting news from the Framingham Heart Study about cardiovascular risks to folks whose parents live long lives. Bill visits with Dr. Harrison Wein and talk about the online e-column he edits. But first, Wally has a report about some new insights into treatment of schizophrenia.
Transcript:Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.
Schmalfeldt: Welcome to episode twenty-eight of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, Wally Akinso shares a report about older mothers and Cesarean section births. I'll sit down for a chat with registered dietician Joanne Gallivan from the National Diabetes Education Program regarding National Nutrition Month. There's some interesting news from the Framingham Heart Study about cardiovascular risks to folks whose parents live long lives. And we'll visit with Dr. Harrison Wein and talk about the online e-column he edits. But first, Wally has a report about some new insights into treatment of schizophrenia. That's next on NIH Research Radio.
(PUBLIC SERVICE ANNOUNCEMENT)
New Studies Provide Additional Insight into Schizophrenia
Schmalfeldt: It's a chronic, severe and disabling brain disorder that affects about one percent of Americans. Wally Akinso has this report about some new insights into the treatment of schizophrenia.
Akinso: Two new studies provided additional insights into comparing treatment options and to what extent antipsychotic medications help people with schizophrenia learn social, interpersonal, and community living skills. The studies funded by the National Institute of Mental Health are published in the March 2007 issue of the American Journal of Psychiatry. Dr. Phillip Wang, director of the Division of Services and Intervention Research at the NIMH, said one study looks at the effects of newer antipsychotic medications given to patients when the older medications don't work.
Wang: The end result of that trial was that there were some differences. Patients who failed this older drug of the three newer ones that they were then offered, the one that they were able to remain on longest was called quetiapine. The one that they were able remain on for an intermediate length was olanzapine. And the one that they were able to stay on for the shortest period of time was risperidone. The take home message is that the response to these kinds of treatments is variable there's no one size fits all for patients with schizophrenia.
Akinso: Dr. Wang said the second study showed schizophrenia patients taking antipsychotic medications experienced only modest improvements in social, interpersonal and community living skills, regardless of which medication was prescribed.
Wang: The end result was that no matter what patients were prescribed the improvements in functioning were modest at best. And there were really no differences between the agents. What this tells us that antipsychotic medications probably are not going to be enough for most patients to have an improvement in their functioning in their lives, and probably some more intensive rehabilitation (or) other interventions are going to be necessary in order to really help people improve functioning in a substantial way.
Akinso: Dr. Wang said that over the long run patients are more likely to function better in the community if they are able to stay on their initial treatment, especially those who are the most impaired. Both studies were apart of the Clinical Antipsychotic Trials for Intervention Effectiveness better known as CATIE. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Interview with Dr. Harrison Wein, Editor of "NIH News in Health" and "NIH Research Matters"
Schmalfeldt: All right, here at the fabulous studio office of the NIH Radio News Service once again is my very excellent friend Dr. Harrison Wein. Good day to you, Dr. Wein.
Wein: Thank you, Bill.
Schmalfeldt: Usually when you're here with us we discuss the "NIH NIH"—the NIH "News in Health" which I understand is the "award winning NIH NIH." Can you tell us about that?
Wein: Yeah, we're winning an award from the National Association of Government Communicators. We won't know until April "what" award, but we know we're at least getting an award of excellence.
Schmalfeldt: Second time in two years, isn't it?
Wein: Exactly. We're very happy about that.
Schmalfeldt: You're a fabulous editor. But that's not what we're here to talk about today. We're here to talk about something else—something that's online.
Wein: It's called NIH Research Matters.
Schmalfeldt: NIH Research Matters. And before we go any further, do you have the website, a URL to share with us? Or can they go to the home page, click something and find it?
Wein: If you go to the home page.
Schmalfeldt: That's www.nih.gov...
Wein: On the left side, there's a section—"In the News"—and right on the bottom of that section there's a link, it says "e-column, NIH Research Matters." That's the easiest way.
Schmalfeldt: That's probably the easiest way, otherwise you have to remember some long, convoluted URL. So go to the home page, find the icon, and there it is.
Wein: The link's right on the left side of the NIH Home Page.
Schmalfeldt: So what's in this e-column?
Wein: Basically, every week we review some of the interesting things that NIH has funded. A lot of people don't know this, but NIH— most of our money actually goes out around the country to universities, to all kinds of research institutions that are doing basic research.
Schmalfeldt: That's right. Not all the research is done here in house, or "intramural" as we call it around here, a great deal of it is done in universities, in medical centers around the country or the "extramural". And this is what you're talking about.
Wein: That's actually the vast majority or research. Now this does cover some of the intramural research—the research on campus. But basically we just want to capture some of the most interesting things that are going on every week, and of course there are hundreds of papers being published all the time based on the research that's funded by NIH.
Schmalfeldt: So give us a slice of life—and it's going to be about a week after we record this—because it's hard to do a live podcast.
Schmalfeldt: But it will be the week after we record this that it hits the Internet. But give us a little slice of life. What will people find when they log on to NIH Research Matters?
Wein: Well, we usually have three stories every week. This week, for example, the first story is about a study finding a large number of cancer genes that we didn't know about before. This research team did a systematic study and got some real unexpected results. Our second story is about a study showing how long-lived parents actually seem to confer lower heart risk on their offspring.
Schmalfeldt: Right, that's from the Framingham Heart Study. We have a story about that on this very podcast.
Wein: Exactly. So a lot of people—you probably described a lot of researchers that suspected it, but this is really following people over a period of time. The third one is about a brain receptor that actually seems to play a role in alcohol pleasure and dependence and the problems. It seems that these monkeys with a particular variation in the receptor get a lot more pleasure from alcohol and there's an equivalent in humans. And a lot of the research looks like it's going to shed some light on what we're seeing in people and addiction. We try to cover a really broad range of studies to give an idea of all the things NIH is involved in.
Schmalfeldt: What do you think the value of something like NIH Research Matters is to the lay audience.
Wein: Well, I think a lot of people don't really realize how much research is going on that's actually feeding in to the stories you might hear in the mainstream press. Behind the big discoveries, the medications and the treatments, there's an awful lot of basic research that lays the foundation for that. And Research Matters really tries to give a picture of that. And also there are an awful lot of people who just like reading about science. We know that newspapers say that their health sections are among their most popular, and their science stories. And we just think all this is cool and interesting.
Schmalfeldt: And it's yet another way for the National Institutes of Health to get out the word.
Wein: Exactly. I mean, it's really hard to get a sense of how broad this effort is that NIH is behind. Research Matters really tries to at least give a sense of some of the things that we're supporting.
Schmalfeldt: And you go to the home page, that's www.nih.gov, and on the left-hand side of the page.
Wein: It says "e-column—NIH Research Matters." It's at the bottom of the section "In the News."
Schmalfeldt: And the next time we get together we'll talk a little more about NIH NIH—"News in Health" and maybe by then you can tell us what award you've won.
Wein: I should also mention that we've set up a listserv for NIH Research Matters. If you're interested in receiving e-mail alerts every week. There's also an RSS feed, which is probably the easiest way.
Schmalfeldt: Dr. Harrison Wein, thank you again for making the long trip down the hallway to sit in with us and tell us all about NIH Research Matters on NIH Research Radio.
Wein: It's always a pleasure to be here, Bill.
Schmalfeldt: When we come back, some interesting news about a long standing study into the risk of cardiovascular disease. That's next on NIH Research Radio.
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