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This week in the medical journals

By Peggy Peck
MedPage Today Managing Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.



Centers for Disease Control & Prevention
Flu Season

Marital strife and healing

Diarrhea epidemics in hospitals was the top story in the major medical journals this week. But the winner of the week's MFS (most fascinating study) focused on marital strife and wound-healing.

Killer bug

First, the bacteria hunters from the Centers for Disease Control and Prevention gave a detailed description of a super bug that has triggered outbreaks of serious, and sometimes lethal, diarrhea in hospitals across the United States and Canada. Writing in the New England Journal of Medicine, the CDC team said that the bacteria, Clostridium difficile, are resistant to fluoroquinolone antibiotic drugs.

They advised treating the infection with Flagyl (metronidazole) or oral Vancocin (vancomycin). And the CDC said it is time to crank up standard infection-control measures such as isolating the patient, use of barrier agents, and fastidious hand-washing with real soap rather than alcohol wipes.

Virulent strain of C. difficile called cause of diarrhea outbreaksexternal link

Guidelines for major disease

Two journals, the Journal of the American College of Cardiology and Circulation, Journal of the American Heart Association, joined forces to publish a massive new guideline on ways to prevent, diagnose, and treat peripheral artery disease. Also known as PAD, this is a catchall term for the disease that attacks all the arteries and blood vessels outside the heart and brain.

PAD affects an estimated 20 million Americans and is a leading cause of limb amputation when it attacks the blood supply to the legs and feet. It is also the cause of abdominal aortic aneurysms, the condition that killed Albert Einstein and actor George C. Scott, among others, and the aneurysms that attacked the blood vessels behind Vice President Dick Cheney's knees.

Peripheral arterial disease guidelines push early diagnosisexternal link

Thumbs up for vaccine safety

For those who worry about vaccine safety, there was good news in a pair of Journal of the American Medical Association reports.

The aerosol flu vaccine, FluMist (LAIV-T) is safe, and the smallpox vaccine, which has been given to about 40,000 "first responders," also has a low risk of major adverse events.

The take-home message was that the benefit -- in both cases -- outweighs the risk.

Low rate of adverse events after smallpox vaccinationsexternal link

FluMist vaccine safety affirmedexternal link

Doing as the doctor says

In heart news this week was the puzzling report that patients with chronic heart failure will improve if they faithfully take their medicine -- even if that medicine is a placebo (sugar pill).

The study randomized 7,600 patients to either the drug Atacand (candasartan) or to placebo on top of standard therapy for heart failure. Patients who regularly took their assigned study drugs -- active or placebo -- had a 35 percent lower mortality risk than patients who were not adherent.

The researchers, who reported the finding in The Lancet, conclude that patients who faithfully take study drugs are also likely to follow directions for other medications, which is why they live longer.

Faithful adherence to placebo is predictive of outcomeexternal link

Exercise builds strong hearts

Children born with heart defects are often regarded as fragile, but a team of researchers from Children's Hospital in Boston reports that exercise is actually good for many of these kids.

Writing in Pediatrics the authors reported that a regular exercise program will make these damaged hearts work better. And the exercise can include activities ranging from ranging from jumping jacks to jumping rope, as well as square dancing and games like capture the flag.

Exercise helps children with congenital heart defectsexternal link

Heavy loads for small backs

And speaking of kids, what about those backpacks they lug around?

Researchers at the University of California, San Diego, reported that kids are regularly shouldering 22 percent of their body weight on their backs. That's too much and causes too much shoulder pain, they wrote in the Archives of Pediatrics & Adolescent Medicine.

But solving the problem isn't easy since even first graders are likely to think that pulling a wheeled backpack is too dorky.

Children stagger under painful backpack loadsexternal link

No more pizza parties

The same teachers who are assigning the homework that weighs down kids' backpacks, may be handing out rewards that are weighing down the kids themselves.

University of Minnesota scientists reported that middle schools that rely on food rewards like pizza parties, or fundraisers like bake sales, are contributing significantly to childhood obesity.

Their report in the Archives of Pediatrics found that the body mass index of 8th graders goes up in direct proportion to the use of "food practices" like handing out pizza coupons to spelling bee champs or raising money for a class trip by selling candy.

Middle schools flunking in basic foodexternal link

Blame Mom

School is not the only culprit when it comes to childhood obesity. Look to mom as well.

This new "mom's fault" theory suggests that mothers who are overweight or obese before pregnancy are twice as likely to have children that become overweight or obese.

That's the word from researchers at Ohio State University who reported the findings in the December issue of Pediatrics.

Mom's prepregnancy weight can affect childhood obesityexternal link

Happy, honey?

And finally, the MFS winner.

There was evidence reported this week that marital strife can be hazardous to both partners. When married couples argue -- even couples who usually exhibit blissful harmony -- it can generate stress that interferes with wound healing, according to a report in the Archives of General Surgery

And really hostile spouses will take about a day longer to heal.

Endnote: Remember The Honeymooners? It's a good thing that Ralph Cramden never needed emergency surgery.

Marital strife can delay surgical wound healingexternal link

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