Saturday, September 30, 2006

Guide to Quitting Smoking

Why Quit? Your Health

Health concerns usually top the list of reasons people give for quitting smoking. About half of all smokers who continue to smoke will end up dying from a smoking-related illness. Nearly everyone knows that smoking can cause lung cancer, but few people realize it is also a risk factor for many other kinds of cancer as well, including cancer of the mouth, voice box (larynx), throat (pharynx), esophagus, bladder, kidney, pancreas, cervix, stomach, and some leukemias.
Smoking increases the risk of lung diseases such as emphysema and chronic bronchitis. These progressive lung diseases – grouped under the term COPD (chronic obstructive pulmonary disease) – are usually diagnosed in current or former smokers in their 60s and 70s. COPD causes chronic illness and disability and is eventually fatal.
Smokers are twice as likely to die from heart attacks as are nonsmokers. And smoking is a major risk factor for peripheral vascular disease, a narrowing of the blood vessels that carry blood to the leg and arm muscles, as well as cerebrovascular disease that can cause strokes.
Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, and yellow fingernails and hair, yellow fingernails and increased risk of macular degeneration, one of the most common causes of blindness in the elderly.
For women, there are unique risks. Women over 35 who smoke and use birth control pills are in a high-risk group for heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or to be permanently impaired.
Based on data collected in the late 1990s, the US Centers for Disease Control (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.
No matter what your age or how long you've smoked, quitting will help you live longer. People who stop smoking before age 35 avoid 90% of the health risks attributable to tobacco. Even those who quit later in life can significantly reduce their risk of dying at a younger age.
Ex-smokers also enjoy a higher quality of life with fewer illnesses from cold and flu viruses, better self-reported health status, and reduced rates of bronchitis and pneumonia.
For decades the Surgeon General has reported the health risks associated with smoking. Regardless of your age or smoking history, there are advantages to quitting smoking. Benefits apply whether you are healthy or you already have smoking-related diseases. In 1990, the Surgeon General concluded:
Quitting smoking has major and immediate health benefits for men and women of all ages. Benefits apply to people with and without smoking-related disease.
Former smokers live longer than continuing smokers. For example, people who quit smoking before age 50 have one-half the risk of dying in the next 15 years compared with continuing smokers.
Quitting smoking decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease.
Women who stop smoking before pregnancy or during the first 3 to 4 months of pregnancy reduce their risk of having a low birth weight baby to that of women who never smoked.
The health benefits of quitting smoking far exceed any risks from the average 5-pound weight gain or any adverse psychological effects that may follow quitting.

When Smokers Quit – What Are the Benefits Over Time?
20 minutes after quitting: Your heart rate drops. (US Surgeon General's Report, 1988, pp. 39, 202)

12 hours after quitting: The carbon monoxide level in your blood drops to normal. (US Surgeon General's Report, 1988, p. 202)

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. (US Surgeon General's Report, 1990, pp.193,194,196,285,323)

1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. (US Surgeon General's Report, 1990, pp. 285-287, 304)

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's. (US Surgeon General's Report, 1990, p. vi)

5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5-15 years after quitting. (US Surgeon General's Report, 1990, p. vi)

10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease. (US Surgeon General's Report, 1990, pp. vi, 131, 148, 152, 155, 164,166)

15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's. (US Surgeon General's Report, 1990, p. vi)

American Cancer Society

Cancer Statistics Presentation

Cancer Facts & Figures 2006

Presents data on cancer incidence, mortality, survival, cancer risk factors, and annual estimates of expected new cases and deaths. Special section on Environmental Pollutants and Cancer. Also available: the most-requested graphs and figures and the Cancer Statistics Presentation 2006 in PowerPoint.

File Format: Adobe Acrobat File Size: 500k

American Cancer Society

Thursday, September 28, 2006

Lung tumours in children

Lung tumours in children

Emma McCahon
The Children's Hospital at Westmead, Department of General Medicine, Locked Bag 4001, Westmead, Sydney 2145, Australia

Primary lung tumours in children are rare and metastatic lung disease is uncommon. The majority of children who present with a primary or secondary pulmonary malignancy will present co-incidentally while seeking attention for another medical problem, or with non-specific abnormalities such as cough with collapse or consolidation on the chest radiograph. With improved techniques of medical imaging for diagnostic and therapeutic purposes and improved outcomes of childhood malignancies, the role of the respiratory paediatrician in the ongoing care of oncology patients is likely to increase.
Keywords: lung tumours; medical imaging; metastatic lung disease

Paediatric Respiratory Reviews Volume 7, Issue 3 , September 2006, Pages 191-196

Scientific Conferences

Welcome to the American Heart Association's Scientific Conferences

The American Heart Association sponsors accredited scientific conferences and professional development seminars to disseminate new and emerging scientific knowledge and stimulate discussion on future research and the application of knowledge.

Click on the events below to find registration and program information, and more!
Conferences and WorkshopsSeptember 2006 – February 2007
Full listing

Wednesday, September 27, 2006

Henoch-Schönlein Purpura

Risk Factors for the Development of Nephritis in Henoch-Schönlein Purpura

Shin JI, Park JM, Shin YH, et al.

Henoch-Schönlein purpura (HSP) is one of the most common vasculitides in childhood. In addition to palpable purpura, patients often have abdominal pain, arthritis, and renal disease, including nephritis, proteinuria, nephrotic syndrome, and hypertension. Most will recover without sequelae, but up to 7% can develop end stage renal disease (ESRD). Few studies have analyzed risk factors for developing nephritis, relapse, or proteinuria
The authors from South Korea carried out a retrospective study of 206 children with HSP (age at onset 7.2 ± 2.8 years, duration of follow-up 3.1 ± 2.2 years) who were seen at Yonsei University, Seoul from 1996 to 2001, to identify factors associated with developing nephritis, relapse, or proteinuria. They excluded patients with <1>20mg/m2/hr, relapse as flare of disease following an asymptomatic period of 1 month or more, and nephritis as hematuria (>5 red blood cells per high-power field in a centrifuged specimen) with or without proteinuria.
In univariate analyses, age >10 years, persistent purpura, severe bowel angina, and relapse were associated with developing nephritis. Arthritis was less common in those developing nephritis. Age >10 years, persistent purpura, relapse, and severe bowel angina were associated with significant proteinuria. In the multivariate analysis, only age >10 years, persistent purpura, and relapse remained associated with an increased risk of developing nephritis, while relapse and severe bowel angina were associated with significant proteinuria. Multivariate analysis showed that age >10 years, persistent purpura, and severe bowel angina were associated with relapse. The authors demonstrated a predictive model for developing nephritis or significant proteinuria based on those variables that had a P<.05 on univariate analysis (age >10 years, persistent purpura, severe bowel angina, and relapse). When applied to their patients’ data, the risk effect from these factors was additive (as suggested by the multivariate analysis). The greater the number of factors present, the higher the risk for developing nephritis or significant proteinuria. For example, children with no risk factors for nephritis developed nephritis 20% of the time; with 1 risk factor, it was approximately 45%; with 2 risk factors, about 65%; 3 risk factors carried a nephritis risk of 80%; and those with 4 risk factors all developed nephritis (total of only 5 patients in this group).

Scand J Rheumatol. 2006;35:56–60;


In vivo measurement of synthesis rate of multiple plasma proteins in humans

Abdul Jaleel,1 Vandana Nehra,2 Xuan-Mai T. Persson,1 Yves Boirie,1 Maureen Bigelow,1 and K. Sreekumaran Nair1

1)Division of Endocrinology, Diabetes, Metabolism, and Nutrition, 2) Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota

Advances in quantitative proteomics have facilitated the measurement of large-scale protein quantification, which represents net changes in protein synthesis and breakdown. However, measuring the rate of protein synthesis is the only way to determine the translational rate of gene transcripts. Here, we report a technique to measure the rate of incorporation of amino acids from ingested protein labeled with stable isotope into individual plasma proteins. This approach involves three steps: 1) production of stable isotope-labeled milk whey protein, oral administration of this intrinsically labeled protein, and subsequent collection of blood samples; 2) fractionation of the plasma and separation of the individual plasma proteins by a combination of anion exchange high-pressure liquid chromatography and gel electrophoresis; and 3) identification of individual plasma proteins by tandem mass spectrometry and measurement of stable isotopic enrichment of these proteins by gas chromatography-mass spectrometry. This method allowed the measurement of the fractional synthesis rate (FSR) of 29 different plasma proteins by using the same precursor pool. We noted a 30-fold difference in FSR of different plasma proteins with a wide range of physiological functions. This approach offers a tremendous opportunity to study the regulation of plasma proteins in humans in many physiological and pathological states.

Am J Physiol Endocrinol Metab 291: E190-E197, 2006. First published January 31, 2006;

Pediatric Brain Tumors

Presenting Symptoms of Pediatric Brain Tumors

Source: Wilne SH, Ferris RC, Nathwani A, et al.
The presenting features of brain tumors: a review of 200 cases.

Arch Dis Child. 2006;91:502–506

The presenting features of brain tumors in 200 children diagnosed between 1988 and 2001 were determined by retrospective chart review at the pediatric and neurosurgical services of the Wessex Neurology Centre and Southampton General Hospital, UK. Mean age at presentation was 7.4 years (range 15 weeks to 17 years). The male/female ratio was 4:3. The first symptoms in order of frequency were headache in 41%, vomiting (12%), ataxia (11%), visual problems (10%), educational or behavioral disorders (10%), and seizures (9%). Headaches were nocturnal or occurred in early morning in 43 (61%) and were continuous in 13 (18%). A diagnosis of migraine was made in 14 (13%) and tension headache in 8 (7%). Of 38 children with school problems, 12 had impairments in reading, writing, memory, and concentration, and poor attendance. Visual disturbances were present in 76 (38%) patients and included diplopia in 30 and blurred vision in 27. Seizures occurred in 30 (15%) patients; in 19 children the seizures were focal in nature.

One or more abnormal neurologic signs was found in 175 (88%) children at presentation and included papilledema in 66 (38%), cranial nerve abnormalities in 86 (49%), cerebellar signs in 84 (48%), long tract signs in 47 (27%), and impaired consciousness in 21 (12%). Of 24 children with no neurologic findings at diagnosis, 17 (71%) had seizures (focal in 14). Of the remaining 7, 4 were >3 years of age. Two had nocturnal or early morning headache and 2 had headache with vomiting or visual symptoms. Three of these children had abnormal endocrine function (and underlying craniopharyngioma) and the remaining child had "clumsiness" secondary to hydrocephalus (and underlying tectal glioma). Of the 3 children between 2–3 years of age, 1 child with neurofibromatosis type 1 presented with vomiting and behavior change, 1 had unsteadiness for 1 month’s duration, and 1 was under evaluation for a shunt malfunction. In the 42 children who were <3> and seizure were less common than in older patients (12% vs 68% and 7% vs 17%, respectively), whereas behavioral problems such as lethargy were more common (48% vs 30%). The median duration of symptoms before diagnosis was 2.5 months (range 1 day to 120 months). Children aged <3> symptom interval prior to diagnosis than older patients (1 vs 3 months). High-grade tumors were diagnosed more rapidly after onset of symptoms than low-grade tumors (median, 1.5 vs 4 months), and infratentorial tumors sooner than supratentorial tumors (median, 2 vs 4 months).

Tuesday, September 05, 2006

Pediatric Antipsychotic Prescription Rates Soar

Pediatric Antipsychotic Prescription Rates Soar

Olfson M, Blanco C, Liu L, et al.
National trends in the outpatient treatment of children and adolescents with antipsychotic drugs.
Arch Gen Psychiatry. 2006;63:679–685;

To characterize the use of antipsychotic drugs in children and adolescents, authors from the Columbia University College of Physicians and Surgeons in New York and The National Institute of Mental Health in Bethesda, Md analyzed National Ambulatory Medical Care Survey (NAMCS) results from 1993 to 2002. The NAMCS is conducted annually and includes a nationally representative sample of visits to non-federally employed physicians in office practice. For trend analysis, population-based estimates were determined using NAMCS data and US Census Bureau population estimates for the same years.

The estimated number of US office visits that included prescription of antipsychotic medication for children under 21 years old skyrocketed from approximately 201,000 in 1993–1995 to 1,224,000 in 2002. In that time period, annual estimated office visits that included antipsychotic medication for patients under age 21 years increased from 274.7 to 1438.4 per 100,000 population.

Further scrutiny of 2000–2002 data reveals that psychiatrists provided care at 83.5% of visits that included antipsychotic treatment. Overall, only 9.2% of all mental health visits and 18.3% of visits to psychiatrists included antipsychotic treatment. Second generation antipsychotics were prescribed in 92.3% of the visits that included antipsychotic treatment. Diagnoses for youth in the antipsychotic-prescribed group included disruptive behavior disorders (37.8%), mood disorders (31.8%), pervasive developmental disorder or mental retardation (17.3%), and psychotic disorders (14.2%). Antipsychotic treatment rates were significantly higher for male youths than female, for white non-Hispanics than other racial/ethnic groups, and for those having public health insurance (Medicare, Medicaid, and other government insurance) than those privately insured. When compared with youth mental health visits that did not result in antipsychotic treatment, visits with prescribed antipsychotic medication were more likely to involve patients with more than 1 mental disorder and to include treatment with a mood stabilizer.

AAP Grand Rounds 16:25-26 (2006)
© 2006 American Academy of Pediatrics