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This week in the medical journals

By Peggy Peck
Managing Editor, MedPage Today

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



AIDS (Disease)
Medical Research
Centers for Disease Control & Prevention

Despite the Memorial Day holiday, there was no rest for obesity researchers in the major medical journals.

Researchers found that weight gain contributes to an increased risk of heartburn in women and that poverty is linked to teen obesity.

Added weight a burning problem

For women, any weight gain at all, even a few pounds for women in the "normal" range, can increase the risk of gastroesophageal reflux, (GERD), according to data from the Nurses' Health Study. The researchers tracked heartburn in more than 10,000 women. Writing in the New England Journal of Medicine, the Boston University team said that women with a body mass index (BMI) ranging from 22.5 to 24.9, which is considered normal, are 40% more likely to report frequent heartburn compared with thin women. The risk of GERD went up as BMI increased, so women with a BMI of 25 to 30, which is considered overweight, or those with BMIs of more than 30, considered obesity, were two to three times more likely to report frequent symptoms.

Gastroesophageal reflux in women parallels weight gainexternal link

Poverty linked to teen obesity

Poverty may play a crucial role in the battle of the bulge, say researchers at Johns Hopkins in Baltimore. They reported in the Journal of the American Medical Association that adolescents who are living below the poverty line are more likely to be overweight than kids in wealthier families. Data from the U.S. National Health and Nutrition Examination Surveys indicate that more than 23 percent of teens ages 15 to 17 were overweight versus about 14 percent of same-age teens from families not living in poverty. The weight differential was not observed in younger teens. The researchers think three factors may explain their findings: more impoverished teens don't exercise, drink too much sweetened beverage, and are likely to skip breakfast.

More older teens from poorer families are overweightexternal link

High-fat diets not suspect in skin cancer

A high-fat diet, meanwhile, is often cited as a risk factor for a number of conditions including obesity and coronary artery disease, but forget about blaming high-fat diets for skin cancer, say researchers from Australia. They reported in BMC Cancer that men and women with malignant melanoma skin cancer as well as basal-cell and squamous-cell skin cancers were actually less likely to eat high-fat diets than were healthy controls.

High-fat dietary link to skin cancer loses to scrutinyexternal link

Medicare set may need higher dose of flu vaccine

Increasing the dose of standard influenza vaccine, which is used to combat seasonal flu, increased the immune response in people ages 65 or older. Moreover, the higher dose didn't increase side effects, according to investigators from Baylor College of Medicine in Houston. They suggested that higher doses may be a good strategy for protecting the elderly, a group that is at high risk for serious complications of flu. The Baylor team tested doses that were up to four times the recommended dose and found that the higher dose nearly doubled the response, they wrote in the Archives of Internal Medicine.

High-dose flu vaccine boosts immunity safely in the elderlyexternal link

Taking a pass on an avian flu vaccine

But that finding didn't impinge on the lingering vaccinate-or-not-vaccinate question being debated by public health officials who are developing strategies to combat impending-or-not-impending bird flu. Avian flu vaccines are currently being developed to combat a feared pandemic, but many people say that even if that vaccine were "foolproof" they would still prefer taking their chances with the virus.

That was the answer when researchers at the Veterans Affairs Ann Arbor (Michigan) Healthcare System asked about 2,400 participants to consider this scenario: A deadly flu that carries a 10 percent risk of death is sweeping the nation. There is a foolproof vaccine against the virus, but the vaccine itself carries a 5 percent risk of death. Would you choose vaccination? The participants were asked to imagine themselves in the role of patient, parent, doctor or medical director, and answer the question from those perspectives. As patients, only 48 percent would choose the flu vaccine; as parents 57 percent said they would vaccinate their children; as medical directors 63 percent would recommend vaccination; and responding as physicians 73 percent said they would opt for vaccination.

Making theoretical avian flu vaccine choicesexternal link

Second look

Better imaging technology may improve the outlook for two conditions: breast cancer and emphysema, according to a pair of studies reported this week.

For women from 35 and 54 years old a second look with magnetic resonance imaging after screening mammography may be a cost-effective strategy that can detect early-stage breast cancers in women who have the so-called breast cancer susceptibility genes BRCA1 or BRCA2, according to a report in the Journal of the American Medical Association from Stanford researchers. The researchers calculated that adding the MRI screening would cost about $55,000 per life year gained for women with BRCA1 and about $98,000 per life year gained for women with BRCA2. Both cost estimates are less than the $100,000 cost per life year gained that it is associated with standard breast cancer treatments such as Nolvadex (tamoxifen).

MRI breast screening may be worth it for susceptible womenexternal link

Better look

The lung disease emphysema, meanwhile, causes disability and death in smokers, most of whom don't seek treatment until they are symptomatic. University of Wisconsin researchers reported that a new MRI technique -- two lung scans after patients inhale hyperpolarized helium 3 -- can spot emphysema before symptoms develop. Their report in Radiology described the new technique in 11 smokers and eight healthy volunteers. Earlier diagnosis may be helpful in convincing smokers to quit before they are gasping for breath.

Test spots emphysema before symptoms developexternal link

Ignoring the numbers

A picture may be worth a thousand words to smokers, but numbers alone fail to deliver the message to people with dangerously high cholesterol, according to Brown University researchers who reported their findings in Annals of Family Medicine. Focus groups with patients discovered that most people are not motivated by numbers or bar charts. A better way to drive home the true risk of high levels of LDL (bad) cholesterol is to use a HeartAge calculator to point out that risk factors like high cholesterol, high blood pressure, family history and current smoking "age" the heart and increase the risk of heart attack. With enough risk factors, a 42-year-old man can have the heart of a 70-year-old, which makes him much more likely to have a heart attack or stroke. That resonates.

Patients fail to grasp importance of cholesterol numbersexternal link

Bad math

Finally, here is a tale in which there is no substitute for numbers.

Number crunchers frequently try to come with a formula that can contain health care costs while maintaining quality. Researchers from Kaiser Permanente in Oakland said that putting a $1,000 limit on prescription drug coverage for Medicare patients added up to more hospitalizations, more emergency room visits, less adherence to recommended drug therapy for high blood pressure, high cholesterol and diabetes, and more deaths. And, this ostensible cost- saving plan didn't save any money. But the researchers, who reported their findings in New England Journal of Medicine, pointed out that their study assessed an older version of Medicare drug coverage, not the newly inaugurated Medicare Part D prescription drug coverage.

Endnote: Pennywise and pound foolish.

Cap on drug benefit doesn't add up to Medicare savingsexternal link

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