February 12, 2010
NIH Podcast Episode #0103
Balintfy: Welcome to episode 103 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 Joe Balintfy. Coming up in this episode: new research showing a strong lung-heart link; the question of less therapy for a breast lesion; reducing risky behaviors in middle-schoolers; and making a deposit, to a blood bank. But first, this news update.
Balintfy: An NIH-funded study finds that sudden infant death syndrome, or SIDS, is linked to abnormalities in the brain-region that regulates breathing and sleep. Researchers report that the brains of infants who die of SIDS produce low levels of serotonin, a brain chemical that conveys messages between cells and plays a vital role in regulating breathing, heart rate, and sleep. SIDS is the death of an infant before his or her first birthday that cannot be explained after a complete autopsy, an investigation of the scene and circumstances of the death, and a review of the medical history of the infant and of his or her family. According to the National Center for Health Statistics, SIDS is the third leading cause of infant death, claiming more than 23-hundred lives in 2006. The researchers theorize that this newly discovered serotonin abnormality may reduce infants' capacity to respond to breathing challenges, such as low oxygen levels or high levels of carbon dioxide. These high levels may be a result of re-breathing exhaled carbon dioxide that accumulates in bedding if an infant sleep face down. The findings appear in the February 3 issue of The Journal of the American Medical Association.
A panel is calling for barriers to screening for colorectal cancer be struck down, adding that colorectal cancer deaths could be reduced. Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Despite evidence and guidelines supporting the value of screening for this disease, rates of screening for colorectal cancer are consistently lower than those for other types of cancer, particularly breast and cervical. Although the screening rates in adults over age 50, the target population for screening, have increased from 20-30 percent in 1997 to nearly 55 percent in 2008—the rates are still too low. An NIH state-of-the-science panel was convened recently to identify ways to further increase the use and quality of colorectal cancer screening in the United States. The panel found that the most important factors associated with being screened are having insurance coverage and access to a regular health care provider. Their recommendations highlighted the need to remove out-of-pocket costs for screening tests.
Researchers have discovered the first genes for stuttering. Findings suggest that the common speech problem, in some cases, may actually be an inherited metabolic disorder. Metabolic disorders affect the way your body gets or makes energy from the food you eat—diabetes is one example. A study published in the February 10 Online First issue of the New England Journal of Medicine says stuttering may be the result of a glitch in the day-to-day process by which parts of cells in key regions of the brain are broken down and recycled. Researchers at the National Institute on Deafness and Other Communication Disorders have identified three genes as a source of stuttering. Mutations in two of the genes have already been implicated in other rare metabolic disorders also involved in cell recycling, while mutations in a third, closely related, gene have now been shown to be associated for the first time with a disorder in humans.
And, in recognition of American Heart Month, the National Heart, Lung, and Blood Institute and its heart disease awareness campaign—The Heart Truth—is reminding all American women that heart disease prevention remains critically important, despite that fact that awareness is at an all time high. More women than ever know that heart disease is their leading killer, yet millions of women are at risk, at increasingly younger ages. Even with increased awareness, 80 percent of midlife women, ages 40 to 60, still have one or more of the modifiable risk factors—for example high blood pressure, high cholesterol, obesity, and smoking. Sixty percent of younger women, ages 20-39, have one or more risk factors. Statistics show that heart disease risk factors are subject to a multiplier effect. This means that having even one risk factor, such as high blood pressure, can double a woman’s chance of developing heart disease. Two risk factors, such as overweight and high blood pressure, increase risk fourfold, and having three or more risk factors increases risk tenfold.
News updates are compiled from information at www.nih.gov/news. Now, coming up after this break, reports on lung disease impacting the heart, too much treatment for breast lesions, and reducing risky behaviors in kids. Stay tuned.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
COPD, Even When Mild, Limits Heart Functions
Balintfy: Now for our first story. A common lung condition called chronic obstructive pulmonary disease—or COPD—reduces the heart's ability to pump blood even when the disease has mild symptoms or no symptoms at all. This is according to research published in the January 21 issue of the New England Journal of Medicine. The research was funded by the National Heart, Lung, and Blood Institute. Wally Akinso reports that this is the first time researchers have shown strong links between heart function and mild COPD.
Akinso: Even with a mild case, COPD still diminishes the heart's ability to pump effectively.
Dr. Kiley: We've known for many years that there’s been some relationship between this serious lung disease and cardiovascular disease.
Akinso: Dr. James Kiley is the Director of the National Heart, Lung and Blood Institute's Division of Lung Diseases.
Dr. Kiley: COPD stands for chronic obstructive pulmonary disease, it's also known as emphysema and chronic bronchitis. It's a very serious lung disease that where parts of the lung becomes partially blocked making it particularly difficult to breathe.
Akinso: Results from an NHLBI study suggest that changes in the heart occur much earlier than previously believed in mild cases, and before COPD symptoms appear. Using breathing tests and imaging studies of the chest, researchers measured heart and lung structure and function in 2,816 healthy adults. Dr. Kiley explains the findings of the study.
Dr. Kiley: The primary finding from this study is that the degree of emphysema was related to reductions in heart function which led to reduce stroke volume cardiac output and things that have a significant impact on the ability of the heart to pump blood. What we’re now learning from this study, the main outcome from this, is that we really need to look more closely at cardiovascular function in patients even with very mild emphysema or chronic obstructive pulmonary disease.
Akinso: Dr. Kiley says COPD is one of the big killers in the U.S., yet it's unknown to many.
Dr. Kiley: COPD is a very serious lung disease. It’s on the rise. It's the fourth leading cause of death. So it's a very prevalent condition. We know that about 12 million Americans have COPD, and we guess or estimate that about another 12 million may have it but they don’t even know they have it. So this calls into question how well do people understand this disease.
Akinso: Dr. Kiley says these results raise the intriguing possibility that treating lung disease may, in the future, improve heart function. He adds that further research is needed to prove whether treating mild COPD will help the heart work better. For more information on COPD, visit www.nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Panel Urges Further Research to Determine Which DCIS Patients may be Candidates for Less-Invasive Therapy
Balintfy: In this next report, we learn about ductal carcinoma in situ—or DCIS—the most common non-invasive lesion of the breast. DCIS presents unique challenges for patients and health care providers largely because the natural course of the untreated disease is not well understood. Because most women diagnosed with DCIS are treated, it is difficult to figure out the benefits of different treatment strategies versus active surveillance, meaning systematic follow-up. A panel of experts is urging more research to determine which DCIS patients may be candidates for less-invasive therapy. The independent panel convened by the NIH is urging the scientific community to identify appropriate diagnostic factors to better predict the risk of developing breast cancer in women with DCIS.
Dr. Allegra: DCIS represents a spectrum of abnormal cells that happen to be confined to the breast duct.
Balintfy: Dr. Carmen Allegra, panel chair and Chief of Hematology and Oncology at the University of Florida, explains DCIS.
Dr. Allegra: The disease is a risk factor for evasive breast cancer but it’s important to understand that it is not evasive breast cancer. It’s totally confined to the duct system.
Balintfy: DCIS, the most common non-invasive lesion of the breast, presents unique challenges for patients and health-care providers largely because the natural course of the disease if left untreated is not well understood.
Dr. Allegra: Despite having had a century of knowledge about the disease, we do not understand the natural history of DCIS, and probably never will. And that’s primarily because just about every one who is diagnoses with DCIS undergoes some form of therapy in general that leads to surgical intervention.
Balintfy: Dr. Allegra recommends determining which individuals are likely to develop invasive breast cancer and which will not. He adds that being able to predict this might save some women from undergoing unnecessary invasive treatments while achieving the same positive outcomes.
Dr. Allegra: Given that the outcomes in women treated with the available therapies is truly excellent with survivals in the 98 percent survival range, the primary question for future research we felt, had to focus on the accurate identification of patient subsets diagnoses with DCIS who may be managed with less therapeutic intervention that we currently use. But at the same time, without sacrificing the excellent outcomes presently achieved with available therapeutics.
Balintfy: The panel also emphasized the importance of patient preferences, and recommended improved communication between patients and providers. Serious consideration was also given to giving DCIS a new name that more closely reflects the excellent survival rates for this condition. For more information on panel's state-of-the-science statement visit the website consensus.nih.gov.
Innovative Community-Based Prevention System Reduces Risky Behavior in 10-14 Year Olds
Balintfy: We turn back to Wally Akinso for this next report. He explains that a randomized trial of Communities That Care: That’s a an evidence-based, substance-use, community-focused prevention system; it showed significant reductions in the initiation of alcohol use, tobacco use, binge drinking, and delinquent behavior among middle schoolers as they progressed from the fifth through the eighth grades. The four-year trial, called the Community Youth Development Study, began in 2003 and has been supported by the National Institute on Drug Abuse.
Akinso: A community based prevention system reduces risky behavior in 10-14 year olds.
Dr. Sims: The Communities That Care operating system is not a specific prevention program. It’s a system.
Akinso: Dr. Belinda Sims is a Health Scientist Administrator in the Prevention Research Branch of the Division of Epidemiology, Services and Prevention Research, at the National Institute on Drug Abuse.
Dr. Sims: And it was designed to help communities identify specific risk and protective factors for the target populations they wanted to work with. And identify and implement evidence- based preventive interventions that address those elevated risk factors in those communities.
Akinso: A trial of Communities That Care, a substance use community-focused prevention system, showed significant reductions in the introduction of alcohol use, tobacco use, binge drinking, and delinquent behavior among middle schoolers as they progressed from the fifth through the eighth grade. The four year trial, Community Youth Development Study, began in 2003 and has been supported by NIDA.
Dr. Sims: The purpose of the study was to conduct a randomized control trial to examine the efficacy of a system for community wide implementation of evidence based drug abuse prevention and related to behavioral health prevention programs. And these are programs that are designed to reduce substance use and related health risking behaviors among youth.
Akinso: To evaluate the CTC program, researchers studied a group of 4,407 fifth graders from 24 communities in Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington. Twelve communities were randomly assigned to undergo CTC training and implementation, and 12 served as the control communities that did not implement CTC. Dr. Sims explains how researchers saw fifth graders with slower risk growth in these communities.
Dr. Sims: What they found in terms of the overall risk profile, is that risk exposure in the control communities went up significantly faster than risk exposure in the CTC communities. So this delay growth in risk exposure in the intervention communities was associated with the significant decrease in both the incidence and prevalence of substance abuse and delinquency.
Akinso: In the CTC communities, stakeholders, including educators, business and public leaders, health workers, religious leaders, social workers and other community volunteers received six training sessions over a year to help them identify the dominant risk and protective factors for substance use in their areas. Dr. Sims says the results of this trial confirm that tools do exist that give communities the power to reduce risk for multiple problem behaviors across a community.
Dr. Sims: The significance of this study is that it’s showing that by implementing evidence based approaches in a very systematic way we can have a community wide impact on youth health risking behaviors.
Akinso: Dr. Sims added that this study shows that a coalition of community stakeholders armed with tools solidly grounded in prevention science can prevent middle schoolers from starting to use tobacco, starting to drink, and starting to engage in delinquent behavior. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: When we come back, some insight on donating blood at the NIH Clinical Center. Stay tuned.
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NIH Blood Bank
Balintfy: Welcome back. January was National Blood Donor Month. But just because its February now, doesn’t mean the need for donors is over. For an upcoming "I on NIH" video, Jilliene Mitchell talked to some experts at the NIH Blood Bank. Here, we’ll go over the questions and answers they gave about donating blood. We start with Phyllis Byrne who explains why the NIH Blood Bank is unique:
Byrne: I don’t know if a lot of people realize that, that we are a self-supporting blood bank, so—we’re not—we’re different from any other blood bank in that we are responsible for supporting all of our Clinical Center patients.
Balintfy: The NIH Clinical Center is where clinical biomedical research occurs and includes a hospital, the Mark O. Hatfield Clinical Research Center.
Byrne: We get our orders from the doctors who are treating the patients in different protocols, who are having surgeries, who are out-patients and they’re coming in as out-patients to be transfused. We do sickle cell exchanges here, so we have to do matched to the person’s blood type and the certain antigens that they have in their blood. So if you get transfused over a period of time, say you’re here for a couple of years and you’re coming in every couple of months to get a red cell exchange, you would need to have a match because your own body builds up antibodies to any different antigens that you might have separate from the person that would be the donor to you. So we have a list of people that we call in special, and we ask them if they would come in as a match. And so, that means that their antigens and the patient’s antigens are matching. So that’s something very different that the blood bank here does at NIH. We do, also, matched platelets the same way, so we’re unique.
Balintfy: Byrne adds that another reason the NIH Blood Bank is different is because if you donate at the Clinical Center, your blood is going to stay at the Clinical Center.
Decot: The donated blood is used to support the many patients that come to NIH to get treatment for anemia, immune disorders and cancer.
Balintfy: Al Decot is the marketing coordinator for the NIH Blood Bank.
Decot: And with a unit of blood, it expires every 42 days, so there’s always a constant need for replacement.
Balintfy: But how does the process work if you want to donate? Decot points out some requirements.
Decot: You need to be a minimum of 17 years of age, weight 110 pounds or more, and be in general good health.
Balintfy: Byrne adds there are some travel requirements as well. Donors are asked where they have been, if they have lived in Europe or abroad, which may mean they can’t donate for patient care because of conditions like VCJD—often called mad cow disease.
Byrne: But you can donate for research, so the research protocols are different than going to patient care, but we certainly can use people that have been in malaria area or have been in VCJD areas in Germany and Great Britain, those areas. So we could use those for research.
Balintfy: Both Byrne and Decot explain that a typical blood donation is about a pint. It doesn’t take long. And after effects are mild.
Byrne: Well, the one thing that we want to tell our donors is, when you come in, make sure you have something to eat, and make sure you’re well-hydrated, that you’ve taken plenty of fluids. We don’t want someone to come in not having eaten, not having had a lot of fluids. But if you eat well and you have taken adequate fluids, you should find minimal—the most common thing, I would say, is you might feel dizzy and you might feel a little tired. And that’s why we take you to the Canteen and feed you and give you nice treats. You have juices, you have snacks that are very wholesome. We have some fresh fruit in there. So the effects are transient; they don’t last very long, but we want you to stay about 20 minutes or so in the Canteen, sit down. We’ll observe you, make sure that you’ve had a good reaction to your donation. And there will be a nurse very close by. So that’s what we want to make certain, that you’ve had a good experience when you come to donate blood.
Decot: Blood donation doesn’t cost you a thing. It takes about 45 minutes to an hour. And overall, you get a good feeling of helping to save lives.Balintfy: Thanks to Al Decot and Phyllis Byrne at the NIH Blood Bank. For more information about blood donation, or if you are nearby and would like to donate at the NIH Clinical Center, visit www.bloodbank.nih.gov. And be sure to keep an eye out for more on this story with Jilliene Mitchell in the "I on NIH" vodcast.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, February 26 when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
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