ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (09/05/89)
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Volume 2, Number 32 September 4, 1989
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Editor: David Dodell, D.M.D.
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Telephone (602) 860-1121
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T A B L E O F C O N T E N T S
1. Medical News
Medical News for Week Ending September 3, 1989 ........................ 1
2. Center for Disease Control Reports
[MMWR 8-31-89] Motor Vehicle Crashes in Indian Community .............. 8
Measles Outbreak ..................................................... 11
Characteristics of Persons Who Died From Heart Diseases ............... 12
Rabies Surveillance,United States, 1988 .............................. 14
3. Dental News
Dental News from the American Dental Association ...................... 22
4. Columns
Black Bag Bulletin Board List ......................................... 27
5. Articles
International Diabetes Epidemiology Newsletter ........................ 38
Health InfoCom Network News Page i
Volume 2, Number 32 September 4, 1989
===============================================================================
Medical News
===============================================================================
Medical News for Week Ending September 3, 1989
Copyright 1989 -- USA TODAY/Gannett National Information Network
Reproduced with Permission
---
August 28, 1989
---
DIETERS SHOULD EAT ALONE:
People dieting to lose weight might be better off eating alone than in a
group, new research suggests. A study of 63 dieters at Georgia State
University found that meals eaten with other people contained 30 percent to 40
percent more calories and more fat. (From the USA TODAY Life section.)
SURVEY - COMPARE DRUG PRICE:
A new survey conducted by the American Association of Retired Persons found
that drug prices could vary widely, even within the same town. The association
asked 1,050 pharmacies in 42 states for prices of 15 prescription drugs. The
survey found that overall, shopping around for prescription drugs could save
up to 25 percent. (From the USA TODAY Life section.)
BRAND NAMES TWICE AS EXPENSIVE:
Brand name drugs cost about twice as much as generics, according to a new
survey. The American Association of Retired Persons polled 1,050 pharmacies in
42 states, asking them to provide prices for 15 common brand name and generic
prescription drugs. The poll also found that prices for the same generic drug
varied as much as 1,400 percent across the country. (From the USA TODAY Life
section.)
HORMONE LINKED TO DIABETES:
Researchers have uncovered a hormone that might be a key agent in the
development of diabetes, Thursday's New England Journal of Medicine reports.
The hormone, islet amyloid polypeptide, is commonly called IAPP. A team of
researchers found that it might impair insulin's ability to regulate blood
sugar levels, causing Type 2 diabetes, the disease's most common form.
ALLERGIES STILL TOP PROBLEM:
Despite advances in medicine, allergies remain one of the United States'
most common health problems, an expert said this week. Dr. M. Eric Gershwin of
the University of California, Davis, said one out of six U.S. children
suffered allergies to any of hundreds of everyday items. He said allergies
shouldn't be ignored and could be treated effectively.
JURY BELIEVES THE DETAILS:
Witnesses who remember details are often are more convincing to a jury than
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Volume 2, Number 32 September 4, 1989
those who don't. Two University of Washington psychologists found that study
participants who heard testimony from two witnesses to a store robbery sided
with the witness who remembered the candy a bystander brought to the counter,
weather the witness testified for the prosecution or the defense.
FOOD STRETCHES STOMACH:
Experiments might have proven the long-held belief that the stomach
literally stretches after large meals. Doctors at Roosevelt Hospital in New
York City inserted balloons into the stomachs of 11 patients, then filled the
balloons with water until patients said they felt full. The September
Hippocrates magazine reports that obese patients consumed 90 percent more
water than lean patients.
---
Aug. 29, 1989
---
DEPRESSION LINKED TO SEX ROLES:
Scientists cite two reasons to explain why teen girls are far more
depressed than boys: They feel fat and they participate in more "feminine"
activities, a new study suggests. Researchers at Princeton University studied
300 adolescents. (From the USA TODAY Life section.)
AGENCY WANTS PRIMATE'S BODY:
People for the Ethical Treatment of Animals want an independent
veterinarian to examine the body of one of the Silver Spring Monkeys to
determine the cause of death. The monkey, named Paul, was used in medical
testing and died Saturday at a Tulane University Laboratory in Louisiana. PETA
contends mistreatment by researchers led to his death.
PERSONAL STRESS TAKES TOLL:
Unexpected stress caused by strangers and uncontrolled situations causes
more toxic stress than extra work, family fights and a routine headaches, says
University of Michigan sociologist Ronald Kessler. Daily stress diaries kept
by 166 married couples for six weeks were used for the study.
VITAMIN C BATTLES DISEASE:
A team of researchers has found that ascorbate, better known as vitamin C,
appears to be the best way to neutralize dangerous "free radicals" in the
blood. Free radicals have been linked to the process which creates artery-
clogging plaque. The plaque build-up causes atherosclerosis. The vitamin C
neutralized 100 percent of the free radicals it encountered in lab tests.
DRUG FIGHTS DIABETIC PROBLEMS:
Researchers have found that the drug aminoguanidine shows promise in
stopping diabetic complications. Geritech Inc. of Northvale, N.J., signed an
agreement Monday forming an alliance with Yamanouchi Pharmaceuticals of Tokyo
to develop and commercialize biomedical technology to treat health effects of
diabetes and aging.
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Volume 2, Number 32 September 4, 1989
HOPKINS TESTS NEW EYE LASER:
Clinical tests of an experimental laser to remove scars and irregularities
from the corneal surface of the eye have begun at The John Hopkins Wilmer Eye
Institute. If the tests prove safe and effective, the laser surgery could
reduce the need for corneal transplants in an estimated 15 percent to 20
percent of the 33,000 U.S. residents each year who undergo transplants.
WHO RELEASES VACCINE UPDATE:
The World Health Organization announced that immunization against polio had
reached two-thirds of the world's population. WHO said Monday that 67 percent
of the world's children were now immunized against the disease by their first
birthday. WHO's update on other global vaccination efforts: diptheria, 66
percent; tetanus, 66 percent; and measles, 61 percent.
FEW BABIES CONTRACT HERPES:
New research indicates that less than one percent of infants born to
mothers with herpes simplex in their genital tract at the time of birth
actually get the disease. Doctors at the University of Alabama at Birmingham
said the study was good news for mothers who were concerned about passing the
disease to their children. Chance of a newborn getting the disease during
birth: 0.8 percent.
---
Aug. 30, 1989
---
MOST TEEN DEATHS PREVENTABLE:
A leading education official said that 77 percent of teen deaths were the
result of high risk behavior. Roseann Bentley, president of the National
Association of State Boards of Education, said changing risky teen behavior
would be the focus of a board formed to battle teen health problems.
Appointments to the board were expected Wednesday. (From the USA TODAY Life
section.)
OTC DIET PILLS MIGHT BE HARMFUL:
Many over-the-counter diet pills can be harmful to heart patients, a
pharmacist said this week. Some of the pills contain phenylpropanolamine, a
decongestant with a mild stimulant effect. They can cause blood pressure to
rise, increase heart rate, and cause heart palpitations, according to
pharmacist Judy Shinogle of Washington, D.C. (From the USA TODAY Life
section.)
PHARMACISTS GOING PRIVATE:
The American Society of Consultant Pharmacists reports a
growing trend in the industry: pharmacists are moving into private
practice. The organization represents about 3,000 independent
pharmacists across the nation. Typical fees: $35 to $75 for
initial consultation, including an interview with research. (From
the USA TODAY Life section.)
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Volume 2, Number 32 September 4, 1989
NEW PRODUCTS DEVELOPED:
Seven scientists and researchers were awarded Scientific Achievement Awards
of $10,000 from Schering-Plough Consumer Operations for developing new
products that range from water-resistant eyeliner pencil, new technology to
produce soft, chewable medicated squares, and highly protective sunscreens.
Patents are pending on some of the inventions.
LIVES SAVED WITH BELTS:
Traffic Safety Now, Inc., a non-profit organization promoting safety belt
use laws, estimates as many as 80 lives will be saved and 3,000 disabling
injuries will be avoided at current belt-use levels during Labor Day weekend.
Those numbers could be doubled if everyone buckled up, the agency said.
BEHAVIORS CAN HELP, HURT:
Teasing and ridicule among adolescents are two distinctly different
behaviors, a Cornell University psychologist contends. While the former
promotes self-esteem, the later destroys it. Psychologists said teasing among
teens showed they're accepted, and promoted a healthy attitude. Meanwhile,
spiteful ridicule can be damaging to young developing characters.
DOCTORS TREAT DISEASE EARLY:
Doctors at George Washington University are using a specialized technique
to find and treat diseases in human fetuses before they're born. Percutaneous
Umbilical Blood Sampling involves drawing blood from the umbilical chord - the
baby's life line to its mother - and testing it for evidence of various
diseases. If any are found, treatments to fight them could begin before birth.
PEDIATRICIANS CAN SPOT ABUSE:
A new survey by doctors at Johns Hopkins Children's Center indicates that
most pediatric training programs don't train physicians to recognize the
telltale signs of alcohol and drug abuse. The survey said pediatricians, who
often continue to see patients through adolescence, were in a position to
recognize changes that indicate abuse.
---
Aug. 31, 1989
---
PHARMACISTS CALM CALLERS:
Hundreds of callers phoned the USA TODAY hot line Tuesday inquiring about a
generic blood pressure drug replacement for Dyazide produced by Bolar
Pharmaceutical Co. under government scrutiny. The drug hasn't been proven
unsafe or ineffective and remains on the market for now, without the Food and
Drug Administration's recommendation. (From the USA TODAY Life section.)
BROCCOLI FIGHTS CANCER:
Broccoli and its related family of cruciferous vegetables - brussel spouts,
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Volume 2, Number 32 September 4, 1989
cauliflower and cabbage family - are considered to be anti-carcinogens. The
vegetables can be found year round in markets. Broccoli is best in the late
summer and early autumn, dietitians say.
STUDY TARGETS HELPFUL DRUGS:
Scientists at Biogen, Inc. in Cambridge, Mass., recently presented studies
on two new drugs to battle heart disease. The drugs are hirugen, an
anticoagulant, and applaggin, a protein that blocks clumping of platelets.
Studies say hirugen might be safer to use than conventional drugs, and
applaggin might lead to therapies for arterial thrombosis, a cause of heart
attacks.
LAB ANIMALS SPARED:
An artificial method of growing animal tissue is providing an effective
model for studying human diseases that once required live laboratory animals.
Researchers at Cornell University are using the process to study the
sometimes-fatal blistering skin disease pemphigus vulgaris and toxic shock
syndrome with artificially grown dog skin and baboon vaginal tissue.
SOVIETS AID U.S. PATIENT:
Joseph Kallu was the first U.S. resident to be treated in a new clinic for
foreigners near the Research Institute of Eye Microsurgery in Moscow. The
radial keratotomy surgery reshaped the surface of his eyes, correcting his
vision from 200/400 to 20/30. The technique is available in the United
States, but insurance coverage for it varies.
REFINING LIVER-TRANSPLANTS:
Members of the liver transplant team at the University of Chicago debated
the ethical issues of taking a lobe of liver from an adult living donor and
transplanting it into a child in the Aug. 31 issue of the New England Journal
of Medicine. The process could raise issues of risk-benefit, donor and
recipient selection and informed consent, they said.
PREVENT HEAT-RELATED INJURIES:
Athletes should drink at least one cup of liquid every 20 minutes during
strenuous practice to avoid heat-related injuries and practice during the
early morning or evening on hot and humid days. According to the American
College of Sports Medicine, symptoms of heat injury include: clumsiness,
stumbling, mental confusion, headache, nausea, dizziness, and lack of
sweating.
---
Sept. 1-3, 1989
---
ROUTINE TESTING QUESTIONED:
Routine "dipstick" testing of healthy peoplefor urinary problems results in
too many false positives to be useful, conclude two studies reported in
Friday's Journal of the American Medical Association. Dipstick urinalysis,
which has been available for about 40 years, costs about $3 a test; 50 million
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Volume 2, Number 32 September 4, 1989
are done in the United States each year. (From the USA TODAY Life section.)
CANCER-DEPRESSION LINK DISPUTED:
A new study, the first to be representative of the U.S. population, found
no extra risk of cancer for people who show signs of depression. Several
studies in recent years suggested the link. The study appears in Friday's
issue of Journal of the American Medical Association. (From the USA TODAY Life
section.)
DOCTORS FIND MUTANT GENE:
Doctors from two universities have discovered a mutant gene that spews out
a growth hormone, causing cancer and occasionally giving rise to giants.
Researchers at the University of California-San Francisco and the University
of Milan, Italy, report on their findings in Thursday's issue of the British
journal Nature.
GROUPS JOIN ON AIDS BOOKLET:
Fifteen major health and education organizations have joined in producing a
booklet of guidelines called "Someone at School Has AIDS." The book includes
recommendations administrators, teachers and parents should follow when a
child or staff member at their school is found to have the AIDS virus. The
booklet will be released Sept. 6.
BEST AND WORST TRAITS FOUND:
The best doctors are those who strive to help patients. The worst patients
are those with abrasive characters who can't accurately describe their ills.
These traits were drawn from a survey that examined how to improve difficult
doctor-patient relationships. Doctors were asked to list the traits of their
most difficult patients and their own motives for practicing medicine.
SEX ED CLASSES QUESTIONED:
School sex education classes have little or no effect on sexual behavior,
contraception or teen-age pregnancy, a new survey has found. Doctors at the
Harborview Medical Center in Seattle review five extensive studies on the
effect of sex education classes on students. Their findings appear in the
September issue of the journal Pediatrics.
NEW TECHNIQUE EXAMINES HEART:
Doctors at the National Heart, Lung and Blood Institute are using an
advanced imaging technique called nuclear magnetic resonance, or NMR, to
examine what happens to energy inside the cells of living things. They are
using NMR to learn more about how the heart uses its energy during certain
forms of exercise and to determine if stress tests could be used to find heart
ailments.
TEST PREDICTS LUNG TROUBLE:
A new study published in the Sept. 1 issue of Annals of Internal Medicine
shows that a test can predict an individual's risk of hypoxemia (trouble
Health InfoCom Network News Page 6
Volume 2, Number 32 September 4, 1989
extracting oxygen from aircraft cabins at high altitudes) during air travel.
Hypoxemia can result in irregular breathing and respiratory and cardiac
failure.
Health InfoCom Network News Page 7
Volume 2, Number 32 September 4, 1989
===============================================================================
Center for Disease Control Reports
===============================================================================
Morbidity and Mortality Weekly Report
Thursday August 31, 1989
Topics in Minority Health
Motor Vehicle Crashes and Injuries in an Indian Community -- Arizona
In 1985 and 1986, the Whiteriver Service Unit of the Indian Health Service
(IHS) investigated motor vehicle (MV) crashes* on the White Mountain Apache
Reservation in eastern Arizona (Figure 1). The reservation is located on 2600
square miles in a rural area with varied topography and climate. In 1986, the
population of the White Mountain Apaches was 9302 (3.6 persons per square
mile, compared with the 1980 U.S. average of 64.4 persons per square mile).
More than 3900 tribal members reside in the community of Whiteriver,
approximately 180 miles northeast of Phoenix. To determine the incidence of
injuries attributable to MV crashes and to identify risk factors amenable to
prevention strategies, the investigators reviewed White Mountain Apache Tribal
Police Department crash reports, Arizona Department of Transportation (ADOT)
data, and emergency department records at the Whiteriver IHS Hospital.
For the 2-year period, 571 MV crashes were identified. Serious injury or
death occurred in 120 (21%) crashes, resulting in 128 hospitalizations and 24
fatalities. The total annual MV-related fatality rate was 129 deaths per
100,000 population; the rate was four times higher for males (206 per 100,000)
than for females (53 per 100,000).
Two priority injury events were identified that were readily amenable to
prevention: 1) crashes involving pedestrians and 2) collisions with animals.
Pedestrians were involved in only 30 (5%) crashes, but accounted for seven
(29%) fatalities and 17 (13%) hospitalizations. Ten crashes involving
pedestrians occurred along a 1-mile stretch of highway with heavy pedestrian
traffic in the Whiteriver community. Although posted with a 25-mile-per-hour
speed limit, this section of road had inadequate lighting. Eighty (14%)
crashes involved animals; 63 of these involved domestic livestock. Nineteen
human injuries, but no fatalities, resulted from collisions with animals. Most
(63%) pedestrian injuries and most (77%) collisions involving animals occurred
at night. The 461 (81%) MV crashes not involving pedestrians or animals
accounted for 17 fatalities and 104 hospitalizations.
In addition, although most (73%) of the crashes occurred on state
highways, ADOT had records for only 58% of crashes recorded by tribal police.
Of 185 crashes that occurred on one state highway, ADOT received reports on 57
(30%). A third of all severe injuries and fatalities occurred along this
highway.
Reported by: A Kane, White Mountain Apache Tribal Police Dept, Whiteriver;
DR Olivarez, Arizona Dept of Transportation; SJ Englender, MD, State
Epidemiologist, Arizona Dept of Health Svcs. GL Rothfus, Office of Health
Program Research and Development, Tucson, C Alchesay-Nachu, Whiteriver Svc
Unit, Whiteriver, Arizona, D Akin, Div of Environmental Health, Indian Health
Svc, Rockville, Maryland. Program Surveillance Section, Program Development
and Implementation Br, Div of Injury Epidemiology and Control, Center for
Environmental Health and Injury Control, CDC.
Editorial Note: In 1985, the crude annual MV-related fatality rate for the
White Mountain Apaches (129 per 100,000) was three times higher than that for
Health InfoCom Network News Page 8
Volume 2, Number 32 September 4, 1989
all American Indians and Alaskan Natives (43 per 100,000) and nearly seven
times higher than that for the total U.S. population (19 per 100,000) (1).
Although American Indians and Alaskan Natives are younger than the overall
U.S. population, and MV-related fatalities occur disproportionately among the
young, age-adjusted fatality rates for American Indians and Alaskan Natives
for 1981-1985 have been greater than 2 times the rate for all U.S. residents
and other minority groups (1; IHS, unpublished data).
Because MV fatality rates correlate inversely with population density in
the United States, the tribe's rural location may account in part for the
elevated MV-related death rate. Some researchers have attributed higher MV
fatality rates in the rural western United States to greater driving distances
in those states, although one study found rural MV death rates to be elevated
even when the data were adjusted for distance traveled (2). Other factors that
may contribute to the elevated risk in rural areas include greater distances
between emergency facilities, reduced access to major trauma centers, travel
at higher speeds, and poor roads in rural areas where traffic volume is low.
In this study, reliable data were not available to assess the contribution of
alcohol and the use/nonuse of occupant-protection devices.
This investigation provided baseline information used to develop local
prevention measures. Intervention strategies developed in the community
focused on MV-related injury events identified as priorities. Because
inadequate lighting was identified as contributing to many pedestrian
injuries, the tribe, IHS, and ADOT provided funding for street lights, which
were installed in December 1988 along the route where pedestrians were most
frequently injured. To reduce the number of crashes involving domestic
animals, the White Mountain Apache Tribe is developing legislation to remove
domestic livestock from roadways, require penning of animals, and fine the
owners of stray livestock.
ADOT allocates funds for road maintenance and highway safety improvement
based on the frequency of MV crashes on state roads. Because MV crashes on
the Whiteriver reservation were underreported to ADOT, fewer state resources
had been allocated to make necessary environmental modifications. However,
ADOT administrators and design engineers are using data from this
investigation to review the priority status of planned Whiteriver highway
improvements. In 1990, some two-lane roads are scheduled for expansion to four
lanes, and traffic lights in high-risk areas are to be relocated to facilitate
safer pedestrian crossings. To more accurately document MV injuries on the
reservation and to evaluate highway safety interventions, the White Mountain
Apache Tribal Police Department has developed an improved system of reporting
MV crashes to ADOT.
The Whiteriver investigation has been used as a model for
MV-related injury prevention in the IHS Injury Prevention Program (3). Begun
in 1987, this community-action program trains selected IHS employees and
tribal representatives in injury surveillance, epidemiology, and intervention
strategies. Thirty graduates of the 1-year program are promoting injury
prevention in American Indian and Alaskan Native communities.
References
1. Indian Health Service. Chart series book. Washington, DC: US Department of
Health and Human Services, Public Health Service, 1988.
2. Baker SP, Whitfield RA, O'Neill B. Geographic variations in mortality from
motor vehicle crashes. N Engl J Med 1987;316:1384-7.
Health InfoCom Network News Page 9
Volume 2, Number 32 September 4, 1989
3. Smith RJ. IHS fellows program aimed at lowering injuries, deaths of
Indians, Alaska Natives. Public Health Rep 1988;103:204.
*A crash or collision involving an MV in motion, excluding events in public
parking areas.
Health InfoCom Network News Page 10
Volume 2, Number 32 September 4, 1989
Epidemiologic Notes and Reports
Measles Outbreak -- Chicago, 1989
As of August 23, 1989, 1123 confirmed cases of measles have been reported
to the Chicago Department of Health. Information is available for 1019 (91%)
of these cases; 799 (78%) have occurred in preschool-aged children ( less than
5 years old), including 340 (33%) children less than 16 months of age (i.e.,
too young for routine immunization). Blacks and Hispanics have accounted for
955 (94%) of the cases. Four measles-associated fatalities have been reported.
Outbreak-control activities have included intensified surveillance and
lowering of the recommended age for measles vaccination to 6 months during the
outbreak, with revaccination at age 15 months for children vaccinated before
the first birthday. Single-antigen measles vaccine is being used for children
before the first birthday, and measles-mumps-rubella vaccine (MMR) is
administered to older children. Seven new vaccination clinics have been
established and have administered approximately 21,000 doses of vaccine; door-
--- end part 1 of 5 cut here ---susans@seismo.css.gov (susans) (09/06/89)
In article <26876@shemp.CS.UCLA.EDU> ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) writes: >--- begin part 1 of 5 cut here --- >Volume 2, Number 32 September 4, 1989 Doesn't cross posting between sci.med.aids and sci.med defeat the purpose of creating a sci.med.aids group? I think these huge five part "articles" would be better off in the group where people would probably be most likely to read them with interest--sci.med.aids. -- Susan Scheide Just Another Friend of Bill's