Home  |  Patients  |  Physicians  |  In the News  |  Hours/Location  |  Contact
        Bio-Identical Hormones
             Hormones for Women
             Hormones for Men
             Hormone Drug Info
      • Erectile Dysfunction
      • HCG Weight Loss
      • NasoNeb & Sinus Meds
      • Pain Management
      • LDN, MS & Autoimmune
      • Sterile Clean Room
      • Veterinary Compounding

             Drug Shortages
             AMA Recognition
             Legal Information
             Insurance Services
        Nutritional Products
             Product Review Process
             Synergy Blends
        Veterinary Products
             Drug Shortages
        What is the Rose Garden
        Compression Hosiery
        Bras & Camisoles
        Swim Suits
        Hats & Turbans
        Lymphedema Garments

     • Rental, Repair, Sales
     • NasoNeb & Sinus Meds
     Breast Pumps & Nursing
     • Product List

        Product List
        Product Review Process
        Synergy Blends
        Veterinary Products
        •  Compounds
        •  Supplements

        PCAB Accreditation
        Legal Information
      • Staff Members
        History of Mark Drugs

Content 7


The Doctor and the Pharmacist

Radio Show Articles:
December 15, 2012

Back to Specialties button

Hormones Throughout the Life Cycle: Support for the Brain?
PCA3, a Relatively New Marker for Prostate Cancer
Low-Dose Aspirin and Dementia in Older Women
Health Insurance Premiums Rising Faster Than Income
Meta-Analysis of Epidural Corticosteroid Injections for Sciatica
Even a Little Smoking Heightens Sudden Death Risk in Women
Childhood Obesity on the Decline in Some Cities
Rapid Tests for Foodborne Illness Could Stymie CDC's Ability to Track Sources
A Little Sugar and Less Pain
Clostridium difficile Infection Now Ninth Leading Cause of Gastrointestinal Death
Probiotics Prevent Clostridium difficile–Associated Diarrhea
Does Early Otitis Media Lead to IBD?
Does Lack of Sunlight in Pregnancy Increase the Risk for Multiple Sclerosis?
Public Health Approach to Vitamin D Deficiency
Nonmedical Treatments for Breast Cancer Survivors' Menopausal Symptoms
Acupuncture for Breast Cancer–Related Fatigue
Overeating and Binge Eating in Youth Associated with Incident Drug Use
Using Technology for Weight Loss

MM: Use of Bio-Identical Estrogens, Progesterone and Testosterone have long been associated with effects on mood, cognitive function and energy levels. This data reinforces that premise and provides another reason to examine the potential benefits of these hormones. It will be interesting to see if the medical community decides to embrace this information as an adjunctive treatment for Alzheimer's.
J Womens Health (Larchmt) 2012 Sep 20
Hormones Throughout the Life Cycle: Support for the Brain?
Use of hormonal contraception was linked to certain cognitive benefits in later years.
The Alzheimer Association estimates that 5.4 million Americans currently have diagnosed Alzheimer disease (AD). Costs of care are estimated at US$200 billion annually; in addition, 15 million unpaid caregivers provide support services. However, data about effective preventive strategies are limited. Researchers conducted a cross-sectional review of 261 women (mean age, 52) in the Wisconsin Registry for Alzheimer's Prevention to determine if use of hormonal contraception influenced cognition later in life. Participants were evaluated with neuropsychological and genetic testing as well as a health history questionnaire based on that used in the Women's Health Initiative (WHI) Memory Study. Five domains were assessed: verbal ability, visuospatial ability, working memory, verbal learning and memory, and speed and flexibility. Participants were classified as never users or ever users of hormonal contraception and were stratified into years of hormone exposure (none, <5 years, 5 to <15 years, ≥15 years).
Both groups were similar in health characteristics, parental histories of AD, and the presence of the ApoE4 allele (a genetic risk factor for AD). After adjusting for age, socioeconomic status, education, and parity, ever use of hormonal contraception was associated with significantly higher scores in two domains: speed and flexibility, and visuospatial ability. Cognitive performance in all five domains improved, but not significantly, with increasing years of hormone exposure.
Comment: Despite its limited sample size and observational methodology (raising the possibility of a "healthy user" bias), this study of younger women lends support to the idea that use of exogenous hormones, whether for contraception or in the peri- and postmenopausal periods, might have certain long-term cognitive benefits.
Anne A. Moore, DNP, APRN, FAANP  Published in Journal Watch Women's Health November 29, 2012
Citation(s): Egan KR and Gleason CE. Longer duration of hormonal contraceptive use predicts better cognitive outcomes later in life. J Womens Health (Larchmt) 2012 Sep 20; [e-pub ahead of print].
Top of Page


MM: Increased use of this marker may be a good alternative or adjunct test to perform relative to PSA testing. It is becoming well agreed that PSA testing yields too many false positives and is falling out of favor in many circles.
J Urol 2012 Nov; 188:1726
PCA3, a Relatively New Marker for Prostate Cancer
This test might lower the number of biopsies driven by prostate-specific antigen testing.
Prostate cancer gene 3 (PCA3) is overexpressed in prostate cancer cells. Its product can be measured in urine specimens collected after digital rectal exams; FDA-approved assays are available for clinical use. To determine how PCA3 might help clinicians decide which patients with elevated prostate-specific antigen (PSA) levels should undergo biopsies, researchers conducted this study of 1913 men with PSA levels ≥2.5 ng/mL. All men underwent PCA3 testing before undergoing biopsies.
Biopsies were positive for cancer in 42% of patients. If only men with PCA3 scores ≥35 had undergone biopsies, about 1300 men would have avoided procedures, but about 400 of the 800 cancers would have been missed. In contrast, if the cutoff for a positive PCA3 score were lowered to 10, only about 100 of the 800 cancers would have been missed, but only about 500 men would have avoided biopsies.
Comment: Primary care clinicians should be aware of PCA3, which urologists are using increasingly to make decisions about prostate biopsy — especially for patients who are followed after previous negative biopsy results. The sensitivity and specificity of PCA3 vary considerably depending on the cutoff used; a cutoff of 25 (midway between the cutoffs discussed above) is suggested for a recently approved PCA3 assay. But whether PCA3 ultimately will do what its proponents hope — lower prostate cancer mortality and also lower the biopsy rate — remains unclear.
Allan S. Brett, MD Published in Journal Watch General Medicine December 13, 2012
Citation(s): Crawford ED et al. Diagnostic performance of PCA3 to detect prostate cancer in men with increased prostate specific antigen: A prospective study of 1,962 cases. J Urol 2012 Nov; 188:1726.
Top of Page


MM: This study relates to elderly women with a risk of cardiovascular disease greater than 10% ONLY! It cannot be extrapolated to the general population at the present time. Although low dose aspirin is relatively inexpensive, I would not, at this time, jump to the conclusion that its use will show significant benefits for the general population.
BMJ Open 2012 Oct 3; 2:e001288
Low-Dose Aspirin and Dementia in Older Women
Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk?
Several studies have examined the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the development of dementia (JAMA 2003; 289:2819 and BMJ 2003; 327:128). Now, researchers have conducted a prospective, observational study to examine whether low-dose aspirin could prevent cognitive decline. The Swedish population-based cohort included 681 women aged 70 to 92 at baseline. Comprehensive examinations at baseline and 5 years later included cognitive testing with the Mini-Mental State Exam (MMSE), category fluency, naming ability, and word memory tests. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third edition, revised, criteria.
Of the 681 women, 129 used low-dose aspirin at baseline (75–160 mg daily). Overall, 95% of the participants had a cardiovascular risk higher than 10%. The mean Framingham score (indicating 10-year cardiovascular risk) was significantly higher in the aspirin group. After 5 years, women taking regular low-dose aspirin had significantly less cognitive decline than those not taking aspirin, even after adjustments for age, APOE status, other NSAID use, and cardiovascular risk score. Development of dementia did not differ between the groups. The authors speculate that the thromboxane A inhibition of aspirin may produce an anticoagulant and anti-inflammatory effect, which other research suggests is a major component of neuritic plaques in Alzheimer disease. They concluded that low-dose aspirin treatment may have a neuroprotective effect in older women with high cardiovascular risk.
Comment: The strengths of this study include the population-based sample, the comprehensive exams, and the longitudinal design. However, the authors themselves indicate there may be a selection bias, as individuals with early cognitive dysfunction are less likely to take aspirin. In addition, the MMSE is not designed to detect small changes in mental function.
This intriguing study adds to the potential salutary effect of daily low-dose aspirin. Given aspirin's low cost and relative lack of side effects, those who tend to believe that low-dose aspirin may prevent dementia will take it. However, with all respect, it requires a leap of faith to believe this is so.
— Jon Brillman, MD, FRCPI  Dr. Brillman is Chairman Emeritus, Department of Neurology, Allegheny General Hospital, and Professor of Neurology, Drexel University College of Medicine, Allegheny Campus, Pittsburgh.
Published in Journal Watch Neurology December 11, 2012
Citation(s): Kern S et al. Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? A 5-year follow-up of a non-demented population-based cohort of Swedish elderly women. BMJ Open 2012 Oct 3; 2:e001288.
Top of Page


Health Insurance Premiums Rising Faster Than Income
Premiums for family health insurance plans sponsored by employers jumped more than 60% from 2003 to 2011, according to a report from the Commonwealth Fund released Wednesday.
The report, which tracked state trends in private employer–based health insurance, shows that over the same period:

Top of Page


Ann Intern Med 2012 Nov 13
Meta-Analysis of Epidural Corticosteroid Injections for Sciatica
No long-term benefit was found for leg pain, disability, or back pain.
Published data and guidelines are mixed about whether epidural steroid injections benefit patients with sciatica. Researchers performed a meta-analysis of 23 randomized trials (>2000 patients) in which steroid injections were compared with placebo injections. The placebo arms included injection of inert substances (such as saline) or short-acting anesthetics. Both acute and chronic cases were included in the trials; patients with histories of surgery or potential spinal canal stenosis were excluded. Short- (>2 weeks but ≤3 months) and long-term (>12 months) efficacy was measured on a scale from 0 to 100 points (difference of 10–30 points is clinically significant).
Epidural steroid injections were associated with less short-term leg pain (mean difference, –6.2 points) and disability (mean difference, –3.1 points) but not with less back pain relative to placebo. In the long term, no significant differences were found in leg pain, disability, or back pain.
Comment: This meta-analysis of trials of epidural steroid injections for sciatica showed a small, clinically insignificant benefit in the short term (leg pain and disability) but failed to identify benefit beyond 12 months. The finding supports using conservative measures and avoiding epidural steroid injections in patients with sciatica.
Jamaluddin Moloo, MD, MPH  Published in Journal Watch General Medicine December 13, 2012
Citation(s): Pinto RZ et al. Epidural corticosteroid injections in the management of sciatica: A systematic review and meta-analysis. Ann Intern Med 2012 Nov 13; [e-pub ahead of print].
Top of Page


Even a Little Smoking Heightens Sudden Death Risk in Women
Long-term data from the Nurses' Health Study reveal that even light-to-moderate smoking is associated with an increase in the risk for sudden cardiac death.
Published in Circulation: Arrhythmia & Electrophysiology, the results from 30 years' follow-up of some 100,000 predominantly white women include the following:

Top of Page


Childhood Obesity on the Decline in Some Cities
Obesity rates among school-age children have dropped in some U.S. cities, reports a front-page story in the New York Times.
Declines ranging from about 3% to 6% have been reported in New York City, Los Angeles, and Philadelphia, mostly among higher-income, white children.
Although the declines are small, the Times says, "experts say they are significant because they offer the first indication that the obesity epidemic ... may actually be reversing course."
Top of Page


Rapid Tests for Foodborne Illness Could Stymie CDC's Ability to Track Sources
New rapid tests designed to identify foodborne pathogens a few days earlier than those currently available could actually hamper the ability of government agencies to track outbreaks, the Associated Press reports.
Although faster, the new tests do not require labs to grow a bacterial culture, the first step in identifying DNA patterns that the CDC uses to identify outbreaks of foodborne illnesses. The new tests, which identify a pathogen on the basis of its DNA, could be available to labs as early as next year.
To aid in outbreak detection, the CDC is requesting that clinicians send samples to labs to be cultured even when performing the rapid tests.
Top of Page


Pediatrics 2012 Nov; 130:918
A Little Sugar and Less Pain
A small amount of oral sucrose is widely recommended for routine use during painful procedures in young infants.
The Prophet Mohammed seemed aware of the calming effect of oral sugar when he started the custom of giving newborns a well-chewed date in 632 AD (http://www.islamicvoice.com/april.2001/quran.htm). The first report in the pediatric medical literature documented a significant nonsedating calming effect of oral sucrose in infants (Pediatrics 1991 Feb; 87:215). Medical progress moves slowly as the effect of sucrose in infants continues to be studied (JW Pediatr Adolesc Med Sep 29 2010). A recent review on oral sucrose for procedural pain management examines existing evidence and practice recommendations.
Sucrose is sweeter and more effective than glucose or lactose. Evidence of the calming and analgesic effect of sucrose is limited to infants younger than 12 months. Most studies have examined a 24% sucrose solution in small amounts (0.2–0.5 mL/kg). In a meta-analysis of 44 randomized, controlled trials in infants, oral sucrose reduced behavioral responses to pain (e.g., cry duration and facial actions) and composite pain scores during painful procedures (e.g., heel stick and circumcision) compared with placebo, no treatment, or a less-sweet solution (e.g., breast milk). Administering oral sucrose throughout a painful procedure provides a sustained analgesic effect, and the effect is enhanced when combined with nonnutritive sucking. Evidence is limited on the use of oral sucrose in preterm and sick infants.
The mechanism of the effect of oral sucrose appears to be the release of β-endorphin in response to the sweet substance. This theory is based on evidence that oral sucrose was not effective in infants who were exposed to antenatal methadone (a substance that depresses endogenous opioids).
Recommendations for the use of oral sucrose include the following:

Comment: I asked a primary care pediatrician in my community to comment on the use of oral sucrose. She wrote, "We use oral sucrose routinely for circumcisions in addition to the dorsal penile block. If a parent is present, they usually administer the sucrose on their finger or with a pacifier and hold their baby's hand. My assistant usually holds the baby's other hand. I no longer restrain the baby's arms. The direct skin-to-skin contact through the hand holding in addition to oral sucrose augments the effect of the block."
Martin T. Stein, MD Published in Journal Watch Pediatrics and Adolescent Medicine December 5, 2012
Citation(s): Harrison D et al. Sucrose for procedural pain management in infants. Pediatrics 2012 Nov; 130:918.
Top of Page


MM: This phenomenon can be attributed directly to antibiotic misuse, overuse, and resultant resistance coupled with a host of causes of diminished immune systems ranging from rampant low vitamin D levels to excessive high glycemic foods in our common diet. Irrespective of the vaccine issue that is in constant debate, some answers to these other problems may include Vitamin D3 supplementation, decreased use of or elimination of high fructose corn syrup and a focus on daily supplemental probiotics to restore the appropriate flora mix in the gut.
Gastroenterology 2012 Nov; 143:1179.
Clostridium difficile Infection Now Ninth Leading Cause of Gastrointestinal Death
The latest data on the public health burden of GI diseases in the U.S.
A recent study examining data from multiple large, national databases in the U.S. reports that C. difficile colitis is now the ninth leading cause of death from gastrointestinal (GI) and liver diseases — exceeding GI hemorrhage, chronic hepatitis C, acute pancreatitis, diverticular disease, and cholecystitis. The number of deaths from C. difficile infection increased from 2195 in 2002 to 7251 in 2009 — a 230% increase.
Other findings from 2009 data sources are highlighted below.

Comment: This survey of multiple databases provides an informative overview of the relative frequencies of GI complaints that lead to outpatient visits, hospital admissions, and deaths in the U.S.
Douglas K. Rex, MD Published in Journal Watch Gastroenterology November 30, 2012
Citation(s): Peery AF et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012 Nov; 143:1179.
Top of Page


MM: This is pretty dynamic information. Imagine such an economical and easy approach to reducing the 9th leading cause of GI associated death in the U.S? Why would any health care provider or third party payer balk at this approach?
Ann Intern Med 2012 Nov 13
Probiotics Prevent Clostridium difficile–Associated Diarrhea
In a meta-analysis of 20 randomized, controlled trials, probiotics reduced risk by 66%.
Clostridium difficile–associated diarrhea (CDAD) is increasing in incidence and severity in North America and Europe. Some studies have suggested that probiotics taken in combination with antibiotics can reduce the risk for antibiotic-induced CDAD.
The current meta-analysis identified 20 eligible trials including 3818 patients. The investigators were interested in the protective effect of any probiotic at any dose. Probiotic species included were Bifidobacterium, Lactobacillus, Streptococcus, and Saccharomyces. The pooled relative risk for CDAD in patients receiving probiotics was 0.34 (95% confidence interval, 0.24–0.49). Probiotic use was not associated with increased risk for adverse events and was effective in both adults and children. The risk reduction was greater in trials that used multiple species (relative risk, 0.25).
Comment: Given the high incidence and severity of CDAD in Western countries as well as the low cost and low risk for probiotic administration, these data present a strong rationale for administration of probiotics to patients receiving antibiotics who are at significant risk for CDAD. Exceptions include patients unable to take medicines by mouth, neutropenic patients, and perhaps patients with central lines, in whom probiotics have been suggested to increase the risk of line sepsis. Although patients with inflammatory bowel disease were not specifically evaluated in this study, they should also be considered for prophylactic probiotics when antibiotics are prescribed.
— Douglas K. Rex, MD Published in Journal Watch Gastroenterology December 7, 2012
Citation(s): Johnston BC et al. Probiotics for the prevention of Clostridium difficile–associated diarrhea: A systematic review and meta-analysis. Ann Intern Med 2012 Nov 13; [e-pub ahead of print].
Top of Page


J Pediatr 2012 Oct 19
Does Early Otitis Media Lead to IBD?
Another potential long-term consequence of indiscriminate antibiotic use
Rates of inflammatory bowel disease (IBD) in children are rising. One etiologic hypothesis is that early use of antibiotics causes alterations in gastrointestinal flora that contribute to the development of IBD (JW Pediatr Adolesc Med Oct 31 2012). Researchers examined the association between an early diagnosis of otitis media (by age 5 years) — the most common diagnosis associated with antibiotic treatment — and IBD using population-based data from Manitoba, Canada. They compared 294 children (mean age, 13 years) diagnosed with IBD between 1989 and 2008 and 2377 matched controls.
By age 1 year, 50% of IBD cases and 48% of controls had at least one diagnosis of otitis media. By age 5 years, only 11% of IBD cases and 18% of controls did not have at least one diagnosis of otitis media. In logistic regression, compared with cases and controls without a diagnosis of otitis media, those with a diagnosis of otitis media by age 5 years were 2.8 times more likely to have IBD, 2.7 times more likely to have Crohn disease, and 3.0 times more likely to have ulcerative colitis. Penicillins were the most common antibiotics prescribed for both cases and controls with otitis media (on the basis of available drug data since 1995).
Comment: The authors of this population-based analysis found a strong statistical association between early diagnosis of otitis media and IBD. They propose that otitis media serves as a proxy for antibiotic prescription and that antibiotic treatment alters the flora in the gastrointestinal tract early in life, thereby contributing to the development of IBD. Although these retrospective data do not prove a causal link between otitis media and IBD, they serve as a reminder of the long-term potential consequences of indiscriminate antibiotic use in young children.
F. Bruder Stapleton, MD  Published in Journal Watch Pediatrics and Adolescent Medicine November 7, 2012
Citation(s): Shaw SY et al. Association between early childhood otitis media and pediatric inflammatory bowel disease: An exploratory population-based analysis. J Pediatr 2012 Oct 19; [e-pub ahead of print].
Top of Page


MM: The pending studies on this phenomenon promise to be quite interesting. With the seeming rise in the incidence of MS in recent years it would be uplifting to discover that simple vitamin D supplementation could curb this debilitating condition. I would not be at all surprised to this conclusion based on many earlier studies that have shown benefit of Vitamin D3 and MS patients.
J Neurol Neurosurg Psychiatry 2012 Nov 14
Does Lack of Sunlight in Pregnancy Increase the Risk for Multiple Sclerosis?
Two recent studies come to divergent conclusions on maternal vitamin D in pregnancy and MS in offspring.
Low serum vitamin D levels have been associated with increased risk for multiple sclerosis (MS). Because people with MS are more likely to be born in the spring, maternal winter ultraviolet light exposure and serum vitamin D levels during gestation have been suggested as contributing factors to MS risk in offspring. Two recent studies assessed this issue.
Dobson and colleagues evaluated whether month of birth affected risk for MS among a total of 172,918 participants with MS, in a meta-analysis combining 10 studies. Among 89,059 participants considered by geographic location, significantly more people with MS than expected had been born in April, May, or June (odds ratio range, 1.06–1.11) and significantly fewer than expected had been born in October or November. The seasonal birth effect did not appear in the three studies performed at a latitude of <52°N, where exposure to sufficient ultraviolet radiation for vitamin D synthesis occurs year-round.
Salzer and colleagues evaluated serum vitamin D levels in 192 individuals prior to MS diagnosis (out of 291,500 samples from 164,000 individuals) and in 37 mothers of people with MS (from 124,000 serum samples taken during pregnancy decades earlier, typically during the first trimester). Comparing the 192 MS cases with two controls each (without MS), high vitamin D levels (≥75 nmol/L), in samples drawn a median of 9 years before diagnosis, were associated with a significantly decreased risk for MS (4% of cases vs. 8% of controls; OR, 0.39). For the analysis of gestational vitamin D levels, vitamin D in the mother was not associated with MS risk in the offspring.
Comment: The seasonal birth effect for MS has been attributed to an environmental exposure during gestation, whether infectious, toxic, or metabolic. The Dobson study lends circumstantial credence to the role of sunlight and vitamin D by suggesting an effect by latitude. However, few studies were conducted at latitudes <52°N, and other confounders were not available for inclusion in the models. Salzer's findings confirm the role of serum vitamin D in the individual prior to MS diagnosis, but they could not show an association with maternal vitamin D serum levels, possibly because of the relatively small number of cases or sampling too early during pregnancy (in late summer/early fall for those born in the spring). For our patients with MS, a trial of vitamin D supplementation is under way (ClinicalTrials.gov Identifier: NCT01490502) and remains highly anticipated.
Robert T. Naismith, MD Published in Journal Watch Neurology November 27, 2012
Citation(s): Dobson R et al. The month of birth effect in multiple sclerosis: Systematic review, meta-analysis and effect of latitude. J Neurol Neurosurg Psychiatry 2012 Nov 14; [e-pub ahead of print].
Salzer J et al. Vitamin D as a protective factor in multiple sclerosis. Neurology 2012 Nov 20; 79:2140.
Top of Page


MM: This is great news and extremely welcome. The Vitamin D dose administered to infants and children under five is a promising starting dose but the dose to pregnant and lactating moms is still insufficient. The good news is the recognition of the problem. Now we need to have a paradigm shift in the way that we look at the problem and look at acquiring a healthy status rather than simply avoiding a deficient and clinically disastrous state. At least we seem to be heading in the right direction.
Arch Dis Child 2012 Nov; 97:952
Public Health Approach to Vitamin D Deficiency
A British universal campaign reduced symptomatic vitamin D deficiency and increased public awareness.
Vitamin D deficiency has increased in frequency in recent years in the U.S. (JW Pediatr Adolesc Med Nov 4 2009) and other developed countries. In 2005, a British public health intervention began in an inner city with a high proportion of ethnic minority groups. The campaign provided free vitamin D supplements to children younger than 5 years (300 IU daily) and pregnant or lactating women (400 IU daily) who received state benefits. Home health visitors provided the first bottle of vitamin D–containing drops when infants were 2 weeks old. Education on the importance of vitamin D supplementation was provided to health professionals, and a public awareness campaign conveyed messages about vitamin D to the target population.
Symptomatic vitamin D deficiency (serum 25-hydroxyvitamin D levels <10 ng/mL) was detected from laboratory records and confirmed by chart review as a case of rickets or infantile hypocalcemic seizure. Between 2005 and 2010, the annual incidence of symptomatic vitamin D deficiency decreased from 120 to 49 cases per 100,000 children younger than 5 years. Between 2007 and 2011, surveys of public awareness among mothers showed an increase in knowledge that vitamin D is essential for bone health (from 21% to 79%) and that sunlight is the main source of vitamin D (from 20% to 85%). The proportion of children and mothers who received the vitamin D supplement increased from <4% in 2005 to 17% in 2010.
Comment: The increase in vitamin D knowledge and supplement use and decrease in symptomatic vitamin D deficiency demonstrate the power of a well-conducted public health intervention that pairs universal treatment with widespread education. A cost-effective analysis would have been interesting. These results apply to high-risk children, typically those of ethnic minority. Current U.S. daily vitamin D supplement recommendations are 400 IU for all infants, 400–600 IU for toddlers and older children (depending on the guideline), and 600 IU for pregnant and lactating women.
CorneliusW. Van Niel, MD Published in Journal Watch Pediatrics and Adolescent Medicine December 12, 2012
Citation(s): Moy RJ et al. Successful public health action to reduce the incidence of symptomatic vitamin D deficiency. Arch Dis Child 2012 Nov; 97:952.
Top of Page


J Clin Oncol 2012 Nov 20; 30:4124
Nonmedical Treatments for Breast Cancer Survivors' Menopausal Symptoms
Both cognitive-behavioral therapy and physical exercise improved endocrine and urinary symptoms and physical function but did not decrease frequency of hot flashes.
Younger breast cancer survivors' quality of life can be adversely affected by treatment-induced menopausal symptoms. Hormone therapy is often contraindicated, and nonhormonal pharmacologic treatment is available but less effective. Nonpharmacologic interventions offer an alternative approach. Dutch investigators randomized 422 disease-free breast cancer survivors (aged <50; premenopausal at cancer diagnosis) who were experiencing menopausal symptoms to one of four groups: cognitive-behavioral therapy (CBT; 6 weekly 90-minute group sessions followed by one refresher 6 weeks later), physical exercise (PE; 12 weeks of individually tailored 2.5–3.0-hour weekly home sessions), CBT plus PE, or no structured intervention. General menopause-related endocrine and urinary symptoms (i.e., incontinence and its consequences) and specific hot-flash symptoms (including perception that they interfered with daily life) were measured with standardized scales.
Fewer than half the women in each intervention group adhered to minimal protocol requirements; many cited scheduling conflicts as a factor. Nevertheless, results of per-protocol and intent-to-treat analyses were similar: At 12 weeks and 6 months, women in all three intervention groups showed small but significant mean improvements in endocrine and urinary symptoms and in physical function. The CBT and CBT plus PE groups also reported decreased impact of hot flashes and night sweats on quality of life, although the symptoms themselves did not abate.
Comment: Low adherence and lack of a placebo intervention in the comparison group limit the reliability of these results. However, they agree with the growing literature demonstrating that cognitive-behavioral therapy, physical exercise, and other nonpharmacologic interventions (JW Womens Health Dec 13 2012) can improve quality of life for women with chronic health conditions, alone or in conjunction with other treatment. We need to broaden our awareness of the evidence for (or against) all modalities that might benefit our patients, not just the ones we were trained to provide.
Diane E. Judge, APN/CNP  Published in Journal Watch Women's Health December 13, 2012
Citation(s):Duijts SFA et al. Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: Results of a randomized, controlled, multicenter trial. J Clin Oncol 2012 Nov 20; 30:4124.
Top of Page


J Clin Oncol 2012 Oct 29
Acupuncture for Breast Cancer–Related Fatigue
A short course of acupuncture significantly improved measurements of fatigue in women who had been treated for breast cancer.
Persistent posttreatment cancer-related fatigue (CRF) and its adverse effects on breast cancer survivors are common; effective treatment is not. Some studies suggest that complementary and alternative strategies may offer some relief. U.K. investigators enrolled women who had completed therapy for stage I to IIIA breast cancer 1 month to 5 years before and who screened positive for significant fatigue. Patients were randomized to usual care plus a fatigue information booklet or usual care plus acupuncture (weekly 20-minute, standardized, protocol-based sessions). Assessment of CRF was made with the Multidimensional Fatigue Inventory (scale, 0–20) at baseline and after 6 weeks of treatment. Mean duration of fatigue was 18 months for the usual care and 15 months for the acupuncture group; mean time since cancer diagnosis was 20.5 months for both.
Of the 75 women (mean age, 53) in the usual care group, 65 provided data at completion of the trial, compared with 181 out of 227 (mean age, 52) in the acupuncture group; dropouts were assumed to have experienced no improvement. Patients in the acupuncture group had greater mean reduction in general fatigue score than patients in the usual care group (mean difference, –2.5 points). Acupuncture also showed beneficial effects on secondary outcomes including mental fatigue, activity, and motivation; anxiety and depression; and quality of life.
Comment: An editorialist notes that the improvement demonstrated in this study might not be long lasting and might not have returned participants to their pretreatment energy levels; furthermore, studies that include active controls would be helpful. In the meantime, breast cancer survivors would probably welcome even short-term relief from cancer-related fatigue. Establishing referral relationships with acupuncture practitioners (including discussing the specific protocol used here) can facilitate the process.
Diane E. Judge, APN/CNP  Published in Journal Watch Women's Health December 13, 2012
Citation(s): Molassiotis A et al. Acupuncture for cancer-related fatigue in patients with breast cancer: A pragmatic randomized controlled trial. J Clin Oncol 2012 Oct 29; [e-pub ahead of print].
Bower JE. Treating cancer-related fatigue: The search for interventions that target those most in need. J Clin Oncol 2012 Oct 29; [e-pub ahead of print].
Top of Page


Overeating and Binge Eating in Youth Associated with Incident Drug Use
Overeating in adolescence is a predictor for future use of marijuana and other drugs, according to a cohort study in the Archives of Pediatrics and Adolescent Medicine.
Researchers periodically surveyed over 14,000 9- to 15-year-olds for overeating, binge eating, and adverse outcomes over 11 years. Both binge eating and overeating were associated with increased risk for incident marijuana and other drug use. Binge eating was associated with increased risk for incident symptoms of depression, and was also associated with being overweight or obese, whereas overeating was not.
The authors conclude: "Given that binge eating is uniquely predictive of some adverse outcomes and because previous work has found that binge eating is amenable to intervention, clinicians should be encouraged to screen adolescents for binge eating."
Top of Page


Using Technology for Weight Loss
Two small studies in the Archives of Internal Medicine point to a modest, emerging role for widely available technologies in weight loss.
In one study, some 35 patients self-monitored their diet and exercise using PDAs, a technology now largely supplanted by smart phones. They also received supportive phone calls every 2 weeks. The 35 controls received standard-of-care group treatment. After a year, the PDA group lost an average of 4 kg more than the controls.
The other study randomized roughly 250 patients with prediabetes or metabolic syndrome into three groups: a 3-month coach-led group intervention; a self-directed intervention using a DVD of the coach-led sessions; or usual care. During a 12-month maintenance phase, patients in both interventions had access to additional support through e-mail. At 15 months, both coached groups lost significantly more weight than controls: BMI changed –2.2 units in the coach-led group; –1.6 units in the self-directed group; and –0.9 in controls.

Top of Page

Home | Contact | Roselle (630) 529-3400 | Deerfield (877) 419-9898 | Careers | Sitemap