May 07, 2010
NIH Podcast Episode #0109
Balintfy: Welcome to episode 109 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 colorectal cancer concerns for African-Americans; careers in genetics and genomics—that’s work with genes and DNA; also a couple topics related to May being Older American’s Month: a new on-line resource for cancer survivors, and how older adults can combat type 2 diabetes. But first, this news update.
Balintfy: Some depressed patients who don't respond to or tolerate antidepressant medications may have a new option. A new study suggests benefits from a non-invasive treatment that stimulates the brain with a pulsing electromagnet. This first industry-independent, multi-site, randomized, and tightly controlled trial of the treatment found that it produced significant antidepressant effects in a subgroup of patients, with few side effects. The treatment accounted for remissions in 14 percent of antidepressant-resistant patients actively treated, compared to about 5 percent for a simulated treatment. Researchers say the treatment has not yet lived up to early hopes that it might replace more invasive therapies. But the study suggests that the treatment may be effective in at least some treatment-resistant patients.
Scientists report that they have identified two human genes that may play a role in causing cleft lip or palate. By working as a consortium and through the consent of more than 1,900 affected families from eight countries, scientists were able to detect variations close to specific genes. The variations suggest that altered forms of these genes may be related to clefting. Scientists say the finding pulls together past work, while the potential new genes help to move the science forward.
And researchers have found that Latinos have higher rates of developing visual impairment, blindness, diabetic eye disease, and cataracts than non-Hispanic whites. These are the first estimates of visual impairment and eye disease development in Latinos, the largest and fastest growing minority population in the United States. Researchers found that over the four-year interval of a recent study, Latinos developed visual impairment and blindness at the highest rate of any ethnic group in the country. Overall, nearly 3 percent of Latinos developed visual impairment and 0.3 percent developed blindness in both eyes, with older adults impacted more frequently. Of Latinos age 80 and older, 19.4 percent became visually impaired, and 3.8 percent became blind in both eyes. Researchers say these data have significant public health implications and present a challenge for eye care providers to develop programs to address the burden of eye disease in Latinos.
News updates are compiled from information at www.nih.gov/news. Now coming up next colorectal cancer rates, resources for students, and reports for Older Americans Month. Stay tuned.
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New Study Implicates Healthcare Utilization Rates, More than Biology, in Colorectal Cancer Disparities
Balintfy: Higher rates of colorectal cancer incidence and mortality experienced by African-Americans may be driven largely by differences in health care utilization, and less by biology. This is according to a new study led by researchers from the National Cancer Institute. Elizabeth Goers files this report.
Goers: In a study involving more than 60,000 people who were screened for colorectal cancer, researchers found that blacks and whites were equally likely to need follow-up after a screening, but blacks were less likely to actually receive it.
Laieymo: It has long been documented that blacks in the United States they have a higher incidence of colorectal cancer and they also have a mortality that is death, from colorectal cancer.
Goers: Dr. Adeyinka Laiyemo is a researcher with the National Cancer Institute and a faculty member at Howard University. He says studies have shown that for blacks, colon cancer is more likely to be diagnosed at later stages.
Laieymo: And since screening by itself is generally not covered if you do not have insurance, it has long been debated all the higher incidents and mortality from colorectal cancer that is seen in blacks is it because they don’t have access and probably do not utilize access even if they have it to health care resources or is it because they have a different susceptibility to colon cancers.
Goers: The participants in this study were part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or PLCO, a multi-center, randomized, controlled screening trial designed to evaluate the effect of screening on cancer mortality funded by the NCI. Dr. Laieymo explains that there are about 150,000 people in the PLCO trial, half of them randomized to have some screening.
Laieymo: One of the screening tests that was done at baseline for these participants was what you would call flexible sigmoidoscopy. Flexible sigmoidoscopy is a screening test for colon cancer in which a short video camera is used to look in the initial part of the colon from below. Now if any polyp was found in this trial, the patient is referred to his or her doctor so that they can get follow-up which generally should be a full colonoscopy to take a look in the entire colon. Now PLCO covered the cost of the flexible sigmoidoscopy screening, but the follow-up for it if an abnormality is found was not covered by PLCO which means the individual and their physician they have the task of going ahead and following up on those abnormal results.
Goers: Researchers realized that roughly 25% of both groups had abnormal polyps. Dr. Laieymo adds that the PLCO continued to contact these participants in the trial on a regular basis to ensure that they received necessary follow-up, and every follow-up was expected to be conducted within one year.
Laieymo: However, what we realized was after one year from that deadline in this trial, only about 72 percent of whites that had abnormal findings went on to have a colonoscopy, but only that was 62 percent of blacks. However, when we now collected the results of their colonoscopy performed on what was found we did not see any significant differences. Our study making us believe that this is probably more because they do not have equal access to care or they are not utilizing access to care.
Goers: NCI scientists say this research suggests that targeting interventions toward increasing the use of screening among minority populations might go a long way toward reducing disparities in colorectal cancer. For more information on colon screenings, visit the NCI home page at www.cancer.gov and search "colorectal cancer." This is Elizabeth Goers, National Institutes of Health, Bethesda, Maryland.
NHGRI Launches Genomics Careers Resource for Students
Balintfy: It’s almost graduation time—do you know a student planning their professional career? To help those interested in the fields of genetics and genomics, the National Human Genome Research Institute has launched the Genomic Careers Resource on the institute’s Web site. The goal is to help students understand career opportunities in the field through video interviews, career profiles, and tools to rate potential career choices, plus a game. Wally Akinso has the details.
Akinso: The National Human Genome Research Institute has launched a website to help students plan their professional careers in genomics.
Easter: The name of the website is the NHGRI Genomic Careers website.
Akinso: Dr. Carla Easter is a NHGRI science education specialist.
Easter: This is really meant for just about anybody who is interested in a career that has to do with genetics and genomics. And mainly our focus has been on students, so high school students, middle school students, community college students, college students—anybody who’s looking to find out what it is they’d like to do in the field.
Akinso: NHGRI staff unveiled the Genomics Careers Resource Web Site at the annual National Science Teachers Association in Philadelphia. Science teachers were encouraged to share the resources with other educators and school counselors.
Easter: The site was designed mainly because there really was nothing really cool or interactive out there. And we wanted to make something that students would look at that wasn’t considered bland or pretty much what was out there already. So we really put a lot of effort into making it video driven and interactive.
Akinso: On the website students and visitors can find nearly 50 career opportunities through various resources.
Easter: So besides the interactive videos we also have a database with 50 careers that provides an overview of career including how much does this person make. What are the job outlooks for this individual who might pursue this career? What are the educational requirements? And then resources if you’re interested in this career—what are the types of places you need to be finding information out more about this. We also have what I think is the coolest part of this site, which is an interactive game where you can guess what people are going to be when they grow up. The final part of the website, is actually a way for students to create their own website and keep track of careers and individual videos and database entries that their most interested in.
Akinso: Dr. Easter hopes that this website excites the next generation of students about careers in genetics and genomics and shows them how they can contribute to improving human health. If you would like to check out this Web site, visit www.genome.gov/GenomicCareers. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Information on Life after Cancer Now Available on NIHSeniorHealth.gov
Balintfy: Now we’re turning our focus on older adults—again, May is Older American’s Month. First, a report for those who have survived cancer. Life after Cancer, the newest topic on the NIH Senior Health Web site, shares what to expect once treatment ends. Wally Akinso is back and explains how the site and new topic area is designed to provide health and wellness information to older people.
Akinso: There are more than 11 million cancer survivors in the U.S. and about 60 percent of them are age 65 and older.
Rowland: These figures reflect the progress we've been making in diagnosing earlier and treating more effectively individuals who develop cancer.
Akinso: Dr. Julia Rowland is the director of the Office of Cancer Survivorship at the National Cancer Institute.
Rowland: This is a disease that is very prominent in our older population and one therefore great attention to this group.
Akinso: These and many other issues related to cancer survivorship are addressed in Life after Cancer a new topic on the NIHSeniorHealth website.
Rowland: And one of the reasons that we've developed that is because realized that for many individuals who were diagnosed and treated for cancer many questions arrive as treatment ends. What we are trying to do with this site is provide information that will be helpful to individuals in making that transition from being an active patient to picking up their lives and recovering after that history of care.
Akinso: Although many people are living longer following cancer due to better diagnostic tests and treatments, life after cancer can be challenging. Dr. Rowland says the site covers a variety of different topics.
Rowland: So in that site we cover a variety of different topics. For example, who is a cancer survivor, what should follow up care look like after treatment ends, what are some of the physical changes that people experience in the wake of cancer. And also changes in their emotional psychological feelings about having had this disease and its impact on various relationships in their lives. Also included in this site are frequently asked questions and links to more information.
Akinso: The NIH Senior Health website was jointly developed by the National Institute on Aging and the National Library of Medicine for older adults and their families. If you would like to read up on this topic, visit www.NIHSeniorHealth.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: More for older Americans up next: managing type 2 diabetes. Stay tuned.
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Managing the ABCs of Diabetes in Older Adults
Balintfy: A year ago, I talked to Dr. Judith Fradkin, director of the Division of Diabetes, Endocrinology and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases. We discussed pre-diabetes and preventing type 2 diabetes. This time in time for Older Americans Month, we’re talking about the management of the ABCs of diabetes in older America. First, welcome back Dr. Fradkin.
Fradkin: Thank you. It’s great to be here.
Balintfy: And let’s talk about that—what is the prevalence of diabetes among older Americans in the United States? How many new cases of diabetes have been diagnosed in this group recently?
Fradkin: Diabetes is very, very common as people get to be 60 years and older. In fact, one in four people who are over 60 have diabetes, predominantly type 2 diabetes, and that’s about a half a million new cases every year or almost 1,500 cases a day. And as we talked about last year, the good news is that there are steps that people can take to prevent type 2 diabetes, and I think what we’re going to focus on now is the steps that people who have type 2 diabetes can take to prevent themselves from developing the complications of type 2 diabetes.
Balintfy: Yeah, last time we talked, we talked about pre-diabetes and about how about 57 million Americans have that condition. I’ll refer listeners back to that May 15th of 2009 episode for more on that. But maybe something to touch on now are what are some of the problems that are associated with diabetes?
Fradkin: So, diabetes overall doubles the risk of death, and that’s predominantly because it doubles or even more increases the risk of cardiovascular disease. So that’s heart attacks and strokes, and particularly for older people with diabetes, those are the major complications to be worried about. In addition, people with diabetes are more likely to get infections, to get pneumonia, to have problems with periodontal disease, so they need to get flu vaccines, make sure they take care of their teeth to prevent some of the infectious complications. People with diabetes also are at increased risk for blindness. So it’s really important to get an annual eye exam in which they dilate your pupils and look at your retina. Kidney disease is more common in people with diabetes, and amputation can occur as a result of losing sensation in your feet and then injuring your feet and developing a sore that doesn’t heal.
Balintfy: It seems that there are a lot of complications, but these can be prevented and delayed, can’t they?
Fradkin: Absolutely. That’s one of the wonderful things that research has done, is that very well-done studies have proven that there are a number of steps that people with diabetes can take to improve their outcomes. And one thing that just came out last year is the importance of making healthy choices about diet and physical activity. So, for example, when we talked last year, we talked about the importance of controlling your weight in terms of preventing type 2 diabetes. Now more recently a major NIH study of people with type 2 diabetes has shown that after four years, losing just about 7 to 10 percent of body weight can dramatically improve your control of blood sugar, and blood pressure, and lipids, which is very important for preventing the cardiovascular complications, and people had better control of their sugar, and their blood pressure, and their lipids even though they were taking fewer medications to control those factors.
Balintfy: Those are basically the ABCs of diabetes that you mentioned, the blood glucose, the blood pressure, and the cholesterol —
Balintfy: —and that’s the plan to work out with a health professional?
Fradkin: Yes, and the reason that we call the blood glucose the "A" is because the test that measures it is something called the A1C test, and that’s a test that tells you what your average blood sugar has been over the past three months. So, the general goal for people with diabetes is to have an A1C level of seven, but that goal needs to be individualized.
Balintfy: And the "B" for blood pressure, what are the targets there for older Americans?
Fradkin: So, again, the general target is 130 over 80, but that’s for everybody with diabetes, and sometimes for older people it’s a little bit harder to control that top number without getting the bottom number so low that a person is at risk of feeling dizzy. So the treatment needs to be individualized.
Balintfy: And I guess the same for cholesterol, the “C” target?
Fradkin: Yes. So, with cholesterol we’re basically talking about your LDL cholesterol, the so-called bad cholesterol, and there are very well-established clinical trial results that show that lowering your LDL cholesterol with a statin drug to a target of 100 will reduce your risk of heart attack and stroke.
Balintfy: And you’ve said these measurements need to be personalized. Are there any particular questions that you would recommend an older individual ask their health care team about managing their ABCs?
Fradkin: I think people should look at whether they already have complications, and so what they’re looking at is trying to slow the progression of those complications, or whether they're early in the course of diabetes and they’re trying to prevent the development of complications.
Balintfy: You mentioned earlier in the program about how Medicare coverage is—may actually be helping older adults with diabetes. Are there some specifics that they should know about?
Fradkin: So, Medicare covers a wide variety of things that can help people with diabetes, and one thing is both medical and nutrition therapy, seeing a dietician, as well as diabetes education from a certified diabetes educator, and these kinds of interactions with trained health care professionals, in addition to your physician, can really help you understand diabetes and understand what steps you need to do to take care of your diabetes, because most of the care of diabetes is actually not provided by a health care professional. It’s actually a person with diabetes taking care of themselves, taking steps to be physically active, to eat a good diet, to take their medications regularly, and so it’s really important to develop a plan for controlling your diabetes. And these kind of health care professionals, diabetes educators as well as dieticians and nutritionists, can play a huge role in helping people take care of themselves.
The really important thing for people with diabetes to remember is you don’t have to do everything absolutely right, but setting some goals and taking some small steps in the right direction can have a huge impact on your health, and so you can talk with your health care provider about what’s the most important goal for you to set. It might be, you know, walking for 30 minutes a day. That’s a really important goal for people. It might be losing 10 pounds through eating more fruits and vegetables and eating less high-calorie, dense foods. It might be taking your medications more regularly, getting your eye exams, getting your flu shots. Every one of those things has been proven to have huge benefits for people with diabetes, and we know that people with diabetes nowadays are doing much better than they did even 10 or 20 years ago, and that’s because all of this research-proven treatment can dramatically reduce your risk of having a heart attack or stroke and thus dying from a complication of diabetes.
Balintfy: Dr. Judith Fradkin with NIDDK is also a leader of the National Diabetes Education Program, a joint program of NIH and Centers for Disease Control and Prevention. She recommends visiting the website: www.YourDiabetesInfo.org. Or you can call toll-free 1-888-693-NDEP. That’s 1-888-693-6337.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, May 21 when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is firstname.lastname@example.org. I'm your host, Joe Balintfy. Thanks for listening.
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