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 a follow-up colonoscopy after a screening sigmoidoscopy, but blacks were less likely to actually receive the follow-up.

Lower rates of follow-up could lead to delayed diagnosis and treatment and higher mortality. The results of this study were published online April 6, 2010, in the Journal of National Cancer Institute (JNCI) and will appear in the April 21, 2010, print edition.

“Our research suggests that the biology of colorectal cancer may not differ by race, at least in the early stages of tumor development,” said author Adeyinka O. Laiyemo, M.D., M.P.H., from NCI’s Division of Cancer Prevention. “Instead, health care utilization differences among races may play a more important role in colorectal cancer disparities.”

In the United States, colorectal cancer disproportionally affects blacks, who have higher incidence and mortality rates compared to whites. From 2002 to 2006, the average annual incidence rate for colorectal cancer was 48.6 per 100,000 for white men and women combined, compared to 59.9 per 100,000 for black men and women. The annual mortality rates for the same time period were 17.7 per 100,000 for white men and women, and 25.4 per 100,000 for black men and women. Several studies have found that blacks are more likely than whites to be diagnosed with advanced colorectal cancer, which is more difficult to treat and has worse survival outcomes.

Participants in this study were part of the ongoing Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a multi-center, randomized, controlled screening trial designed to evaluate the effect of screening on cancer mortality. At the start of the colorectal cancer part of the study, participants were offered a screening flexible sigmoidoscopy, which is used to examine the lower, or sigmoid, portion of the colon. Subjects who had polyps or lesions detected during the sigmoidoscopy were referred to their personal physician for follow-up colonoscopy, the cost of which was not covered by the study.
In a colonoscopy, the entire colon, which is about five feet in length, is examined. During a sigmoidoscopy, only about the last two feet of the colon closest to the rectum is viewed. The records of the follow-up colonoscopies were collected and reviewed to determine which subjects had received them. Those results were analyzed to determine whether utilization of follow-up colonoscopy and likelihood of adenomas (pre-cancerous lesions) or colorectal cancer varied by race. In their analysis, to reduce the possibility that other factors were influencing the outcome of the study, the researchers documented age, education, sex, body mass index, smoking, family history of colorectal cancer, colon cancer screening within the previous three years, personal history of polyps, and center where the participant was screened.
Of the 60,572 study participants who received flexible sigmoidoscopy (57,561 whites and 3,011 blacks) at the start of the study, 23.9 percent of the white participants and 25.5 percent of the black participants had abnormal results, such as polyps or lesions. Among those with abnormal results, 72.4 percent of whites and 62.6 percent of blacks received a follow-up colonoscopy to determine whether cancer was present. The researchers found no statistically significant differences in the presence of adenomas, advanced adenomas, or cancer by race. It should be noted, however, that black participants were more likely to have cancer in the upper part of the colon, which would not be viewed during a sigmoidoscopy.

Overall, a total of 156 colorectal cancers were diagnosed among the participants who received a follow-up colonoscopy. Most of the cancers (75.6 percent) were stage I or II tumors, which are considered early stage disease. There was no statistically significant difference in the risk of colorectal cancer by race.

Among white participants, women and people with a family history of colorectal cancer were more likely than men or those without a family history to undergo a follow-up colonoscopy. Among black participants, those with a personal history of colon polyps were more likely to undergo follow-up colonoscopy than those without such a history.

The reasons behind the lower follow-up rates among black men and women in this study are unknown. It is possible that lower socioeconomic status may have affected health care utilization due to the direct and indirect costs of care, such as copays and lost wages. Although the authors did not have direct information on the socioeconomic status of study participants, the overall educational level — an indicator of socioeconomic status — was lower in black participants than white participants. In addition, the need for multiple tests, including colonoscopy, following abnormal results of a screening sigmoidoscopy, and the cost and preparation required for those tests, could have deterred some people from receiving follow-up colonoscopies. Finally, a lack of knowledge about cancer prevention among patients and a lack of cultural competence on the part of the health care providers could be barriers to health care utilization.

When the authors analyzed the rate of follow-up colonoscopies by educational attainment, they observed differences at all educational levels, but the differences were only statistically significant among participants with a high school education or less. Because black participants in the PLCO study were, on average, more educated and health conscious than comparable members of the general population, the authors state that it is possible that their findings of lower health care utilization among blacks may actually be an underestimation of what would be seen in the general population.

“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,” said senior author Christine Berg, M.D., from the Early Detection Research Group in the NCI’s Division of Cancer Prevention.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

“Births: Preliminary Data for 2008,” based on an analysis of 99.9 percent of birth records for 2008, found there were 41.5 births per 1,000 teenagers aged 15-19 years, down from 42.5 in 2007 and 41.9 in 2006.

There was also a significant decline in the percentage of babies born preterm in 2008 (prior to 37 weeks of pregnancy). The preterm birth rate declined from 12.7 in 2007 to 12.3 in 2008. This marks the second straight year of decline in the preterm birth rate following a 20 percent increase between 1990 and 2006.

Other findings include:
The preliminary number of U.S. births in 2008 was 4,251,095, down nearly 2 percent from the preliminary number in 2007, which was an all-time high of 4,317,119.
The birth rate for older teenagers aged 18 and 19 declined by 4 percent to 70.7 births per 1,000. Only the youngest teenagers aged 10 to 14 saw no change in the 2008 preliminary birth rate compared to previous years (0.6 births per 1,000).
The birth rate for Hispanic teenagers fell to 77.4 births per 1,000, the lowest rate ever reported for this group in the two decades for which rates are available.
Birth rates fell by 3 percent among women aged 20-24 and by 2 percent for women aged 25-29. Rates for women in their thirties declined about 1 percent.
The preliminary birth rate for women aged 40-44 in 2008 increased 4 percent, to 9.9 births per 1,000 women, the highest rate since 1967. The rates for women aged 45-49 years also increased in 2008 from 0.6 births per 1,000 in 2007 to 0.7.
The preliminary birth rate for unmarried women aged 15 to 44 declined almost 2 percent from 2007 to 2008, to 52 per 1,000 in 2008 compared with 52.9 in 2007. The decline in the birth rate among unmarried women was the first reported since a slight decline during 2001-2002.
The other key measures of childbearing by unmarried women – total number of births and percentage of births to unmarried women – both increased to historic levels in 2008.
The cesarean delivery rate rose for the 12th straight year to 32.3 percent in 2008. Increases were seen among women of all age groups, and most race and ethnic groups.
The low birthweight rate remained unchanged between 2007 and 2008 at 8.2 percent; a small decline in low birthweight was reported for non-Hispanic black infants (from 13.8 to 13.7 percent).

The full report is available at www.cdc.gov/nchs.

DALLAS, April 6, 2010 — Women who walked two or more hours a week or who usually walked at a brisk pace (3 miles per hour or faster) had a significantly lower risk of stroke than women who didn’t walk, according to a large, long-term study reported in Stroke: Journal of the American Heart Association.

The risks were lower for total stroke, clot-related (ischemic) stroke and bleeding (hemorrhagic) stroke, researchers said.

Compared to women who didn’t walk:
Women who usually walked at a brisk pace had a 37 percent lower risk of any type of stroke and those who walked two or more hours a week had a 30 percent lower risk of any type of stroke.
Women who typically walked at a brisk pace had a 68 percent lower risk of hemorrhagic stroke and those who walked two or more hours a week had a 57 percent lower risk of hemorrhagic stroke.
Women who usually walked at a brisk pace had a 25 percent lower risk of ischemic stroke and those who usually walked more than two hours a week had a 21 percent lower risk of ischemic stroke — both “borderline significant,” according to researchers.

“Physical activity, including regular walking, is an important modifiable behavior for stroke prevention,” said Jacob R. Sattelmair, M.Sc., lead author and doctoral candidate in epidemiology at Harvard School of Public Health in Boston, Mass. “Physical activity is essential to promoting cardiovascular health and reducing risk of cardiovascular disease, and walking is one way of achieving physical activity.”

More physically active people generally have a lower risk of stroke than the least active, with more-active persons having a 25 percent to 30 percent lower risk for all strokes, according to previous studies.

“Though the exact relationship among different types of physical activity and different stroke
subtypes remains unclear, the results of this specific study indicate that walking, in particular, is associated with lower risk of stroke,” Sattelmair said.

Researchers followed 39,315 U.S. female health professionals (average age 54, predominantly white) participating in the Women’s Health Study. Every two to three years, participants reported their leisure-time physical activity during the past year — specifically time spent walking or hiking, jogging, running, biking, doing aerobic exercise/aerobic dance, using exercise machines, playing tennis/squash/racquetball, swimming, doing yoga and stretching/toning. No household, occupational activity or sedentary behaviors were assessed.

They also reported their usual walking pace as no walking, casual (about 2 mph), normal (2–2.9 mph), brisk (3–3.9 mph) or very brisk (4 mph).

Sattelmair noted that walking pace can be assessed objectively or in terms of the level of exertion, using a heart rate monitor, self-perceived exertion, “or a crude estimate such as the ‘talk test’ – wherein, for a brisk pace, you should be able to talk but not able to sing. If you cannot talk, slow down a bit. If you can sing, walk a bit faster.”

During 11.9 years of follow-up, 579 women had a stroke (473 were ischemic, 102 were hemorrhagic and four were of unknown type).

The women who were most active in their leisure time activities were 17 percent less likely to have any type of stroke compared to the least-active women.

Researchers didn’t find a link between vigorous activity and reduced stroke risk. The reason is unclear, but they suspect that too few women reported vigorous activity in the study to get an accurate picture and/or that moderate-intensity activity may be more effective at lowering blood pressure as suggested by some previous research.

Stroke is the third leading cause of death and a leading cause of serious disability in the United States, so it’s important to identify modifiable risk factors for primary prevention, Sattelmair said.

An inverse association between physical activity and stroke risk is consistent across genders. But there tend to be differences between men and women regarding stroke risk and physical activity patterns.

“The exact relation between walking and stroke risk identified in this study is not directly generalizable to men,” Sattelmair said. “In previous studies, the relation between walking and stroke risk among men has been inconsistent.”

The study is limited because it was observational and physical activity was self-reported. But strengths are that it was large and long-term with detailed information on physical activity, he said.
Further study is needed on more hemorrhagic strokes and with more ethnically diverse women, Sattelmair said.

The American Heart Association recommends for substantial health benefits, adults should do at least 150 minutes a week of moderate-intensity or 75 minutes a week of vigorous-intensity aerobic physical activity or a combination.

Co-authors are: Tobias Kurth, M.D., Sc.D.; Julie E. Buring, Sc.D.; and I-Min Lee, M.B.B.S., Sc.D. Individual author disclosures are on the manuscript.

The National Institutes of Health supported the study.

TachoSil is a ready-to-use surgical patch composed of a dry collagen sponge made from horse tendons, and coated with fibrinogen and thrombin. At the site of a wound, the two proteins, through a series of chemical reactions, produce fibrin, a stringy, white, insoluble protein that allows a clot to form.

The TachoSil patch is biodegradable and breaks down inside the body within four to six months. TachoSil is not intended for use within blood vessels.

“This approval provides an additional tool for surgeons to help control mild and moderate bleeding from blood vessels during cardiovascular surgery when standard surgical techniques are ineffective or impractical,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research.

The plasma used to manufacture TachoSil is collected from U.S. donors who have been screened and tested for diseases transmitted by blood. The fibrinogen and thrombin used in the surgical patch undergo additional manufacturing processes to remove impurities, including bloodborne viruses. The collagen taken from horse tendons undergoes a separate step to remove impurities, including equine viruses.

The effectiveness of TachoSil manufactured by Nycomed Austria GmbH of Linz, Austria was evaluated in a study of 119 cardiovascular surgery patients. Nearly three-quarters (74.6 percent) of those who received TachoSil, stopped bleeding within three minutes compared with 33.3 percent in the control group.

Hypersensitivity to product components or allergic reactions may occur with TachoSil. The adverse reaction rates were not statistically different between the study and control groups.

Research suggests, though, that lack of sleep can lead to memory problems, depression, cardiovascular concerns, cancer and increased risk of accidents.

“In the last couple of years, I’ve seen more overworked patients taking on extra shifts or second jobs,” Dr. Raman Malhotra, an assistant professor of neurology and director of the Sleep Disorders Center at Saint Louis University, said in a university news release. “For someone who is suffering from work-related sleep issues, changing jobs isn’t always an option. Instead, we’ve got to offer solutions to make the best of the current situation.”

Malhotra offered some suggestions for people who have sleep problems because of irregular work schedules.

For instance, if you work the night shift and sleep during the day, make sure your blinds are closed and reduce other sources of light in the bedroom. Being exposed to sunlight after a night shift can confuse the brain so you should find ways to reduce sunlight exposure before you go to bed.

“Wear sunglasses on the way home from work,” Malhotra said. “And, conversely, before work, spend time in a well-lit room.”

Among the other tips:
Avoid vigorous activity before you go to bed and stay busy before you go to work. Your activity level can tell your body whether it’s time for work or sleep.
Let your family and friends know about your sleep schedule and ask them not to phone or otherwise disturb you while you’re sleeping.
Consider seeing a sleep specialist if you notice that sleep deprivation is affecting your life. Perhaps you’re less productive at work or getting complaints on the job, losing your temper with your family or having difficulty staying awake at your child’s recital.

For some people, Malhotra said, medication can help with sleep difficulties.

SOURCE: Saint Louis University Medical Center, news release.

In 2009, close to 10 million cosmetic surgical and nonsurgical procedures were performed in the United States, down about 2 percent from the year before, the American Society for Aesthetic Plastic Surgery reports.

“Plastic surgery is feeling the effects of the recession, just like many other sectors of the marketplace,” Dr. Renato Saltz, president of the society, said in a news statement released Tuesday. “However, repeat patients and those putting off surgery are likely the reason for the small growth in non-surgical cosmetic procedures. Growth in demand will likely return as the recession eases and baby boomers’ offspring begin to explore surgical options.”

Men and women between the ages of 35 and 50 made up nearly half of the appearance-minded patients last year, racking up 4.4 million procedures. Next in line were 51- to 64-year-olds, representing just over a quarter of patients.

Breast augmentation was the most popular surgical procedure, with almost 312,000 such operations performed. Among men and women, the other top procedures were liposuction (nearly 284,000 operations); eyelid surgery (about 150,000 procedures); abdominoplasty (close to 128,000); and facelifts (more than 94,000).

Broken down by gender, after breast reduction, women most often opted for liposuction, eyelid surgery, abdominoplasty (tummy tuck) and breast reduction.

Men, on the other hand, sought liposuction most often, then rhinoplasty (nose surgery), eyelid surgery, male breast reduction and hair transplantation.

Many people seeking a more youthful look opted for nonsurgical services. Practitioners reported more than 2,557,000 Botox and Dysport treatments and more than 1,313,000 hyaluronic acid treatments (Hylaform, Restylane).

After the injectables, laser hair removal, microdermabrasion and chemical peels were most requested by men and women. For men, laser skin resurfacing was also a top seller.

In sum, Americans paid almost $10.5 billion for cosmetic procedures; $6 billion for various surgical procedures, and $4.5 billion for nonsurgical procedures, the society said.

SOURCE: 2010, news release, American Society for Aesthetic Plastic Surgery

Researchers recruited volunteers from 46 Canadian Hutterite religious colonies that have limited contact with surrounding, non-Hutterite populations. A total of 947 children between 36 months to 15 years of age participated in the trial; 502 children in 22 colonies received 2008-09 seasonal influenza vaccine, while 445 youth in the other colonies received hepatitis A vaccine. The hepatitis A vaccine served as a control vaccine for comparison.

In the six months after the children were vaccinated, 119 of 2,326 unvaccinated community members (who were of all ages) developed laboratory confirmed cases of influenza. Of these, 80 of 1,055 were from colonies where children received hepatitis vaccine, while 39 of 1,271 were from colonies where children received the influenza vaccine.

The researchers found that influenza vaccination was 61 percent effective at indirectly preventing illness — that is, protecting via herd immunity — in unvaccinated individuals if they lived in a colony where approximately 80 percent of the children had received flu vaccine. The findings, they write, “…offer experimental proof to support selective influenza immunization of school aged children…to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza.”

Mark Loeb, M.D., of McMaster University, Hamilton, Ontario, led the trial. The research was funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and by the Canadian Institutes for Health Research.

An illustration showing how vaccination generates herd immunity is available at http://www3.niaid.nih.gov/topics/communityImmunity.htm.

“In our small sample, there was a 10-fold increased risk among those taking Coumadin [warfarin],” said study author Dr. Shyam Prabhakaran, an assistant professor of neurological sciences and head of the stroke program at Rush University Medical Center in Chicago. “I think we have raised a doubt that hasn’t been looked at before and should make us be sure that tPA is safe for these patients before we move forward.”

Current guidelines say that tPA, or tissue plasminogen activator, should be used quickly to dissolve a clot that is blocking a brain artery — within three hours after the first symptoms, as late as four and a half hours in some cases. But they say that the drug should be used only when a measurement called the international normalized ratio, or INR, which measures the tendency of blood to clot, is 1.7 or lower. A higher INR means a greater tendency to bleed.

The study, published online March 8 in Archives of Neurology, reported on the use of tPA in 107 people who had ischemic strokes, those caused by a blocked artery, from 2002 to 2009. Among them, the incidence of excess bleeding in the 13 people who had been taking Coumadin before the stroke was 30.2 percent, compared with 3.2 percent for those who had not been taking the drug.

Prabhakaran was quick to point out the faults in the study. “It is a single-center, retrospective study and not large enough so that it could be affected by sample size,” he said. “We need a larger data set from more centers.”

That information should be forthcoming now that an alert has been sounded, Prabhakaran said. “Other centers should now start presenting their data bases,” he said. “If their data indicate it is safe, the guidelines should not be changed. I think we will find, in the next year or two, other centers will start publishing their findings.”

A large number of Americans, most of them elderly, take Coumadin for a variety of reasons, including to prevent problems caused by atrial fibrillation, an abnormal heart rhythm, and to prevent clots from forming on artificial heart valves.

“This is an important study that talks about the risks we are well aware of when we use tPA for ischemic strokes,” said Dr. Ralph Sacco, professor and chairman of neurology at the University of Miami Miller School of Medicine. Sacco, president-elect of the American Heart Association and the first neurologist to hold that post, was a member of the group that set the guidelines for tPA use.

“The new updated guidelines that extended use of tPA beyond the three-hour window did exclude all patients taking Coumadin [from being] treated after three hours, regardless of INR level,” Sacco said.

He echoed Prabhakaran’s list of the new study’s shortcomings. “This is a non-randomized study,” Sacco said. “All-case studies always raise concerns about some bias.”

But attention must be paid, he said. “This raises the alarm level and makes us pause, as we always should, when we consider treating ischemic stroke,” Sacco said. “But it should not make us deviate from the guidelines.”

SOURCES: Shyam Prabhakaran, M.D., M.S., assistant professor, neurological sciences, and director, stroke program, Rush University Medical Center, Chicago; Ralph Sacco, M.D., professor and chairman, neurology, University of Miami Miller School of Medicine, Miami; 2010, Archives of Neurology, online.

Heart failure, in which the heart weakens and can’t beat effectively, is the second most common diagnosis for people in hospice care, which is designed for people with only months to live. Only cancer sends more people to hospice.

Researchers found that blacks were 40 percent less likely to receive hospice care for heart failure than whites, and Hispanics were 50 percent less likely.

“Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization,” study author Dr. Jane L. Givens, a scientist at the Hebrew SeniorLife Institute for Aging Research, said in a news release from the institute.

Only about 30 percent to 50 percent of people who suffer from advanced heart failure live beyond a year. Researchers report that many people with advanced heart failure don’t go to hospice, even though it is frequently recommended.

The study appears in the issue of the Archives of Internal Medicin

The Indiana University study also found an association between high assault rates and stores that sell alcohol for off-premise consumption. These alcohol outlets appear to be associated with about 25 percent of simple assaults and about one-third of aggravated assaults, according to the researchers.

“A higher density of alcohol sales outlets in an area means closer proximity and easier availability to an intoxicating substance for residents,” study author William Alex Pridemore, a professor of criminal justice, said in a university news release. “Perhaps just as importantly, alcohol outlets provide a greater number of potentially deviant places. Convenience stores licensed to sell alcohol may be especially troublesome in this regard, as they often serve not only as sources of alcohol but also as local gathering places with little formal social control.”

Pridemore and colleague Tony Grubesic, a geography professor, compared Cincinnati crime statistics from January to June 2008 with the locations of alcohol sales outlets. The average density of assaults was 69 per square mile and the average density of alcohol outlets was 20 per square mile.

The researchers concluded that adding one off-premise alcohol sales site per square mile would create 2.3 more simple assaults and 0.6 more aggravated assaults per square mile. Adding one bar per square mile would lead to 1.35 more simple assaults, while adding one restaurant per square mile would lead to 1.15 more simple assaults.

“We believe that alcohol outlets, as a source of community-level variation in levels of interpersonal violence, deserve greater attention in the criminological literature,” Pridemore said. “The nature of our findings should encourage further investigation of the nature of the ecological association between alcohol, violence and other negative outcomes within communities.”

The study findings were scheduled to be presented at the annual meeting of the American Association for the Advancement of Science