October 22, 2010
NIH Podcast Episode #0120
Balintfy: Welcome to the 120th episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health - the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode, how the diets of American youth have a lot to be desired, in part because they're filled with empty calories; how children, men and blacks have higher rates of food allergy; an alternative asthma treatment may be an existing drug; and our series continues on the History of Medicine. But first, this news update. Here’s Craig Fritz.
Fritz: The National Heart, Lung, and Blood Institute has launched the first large-scale study to investigate the effectiveness of body cooling treatments in infants and children who have had cardiac arrest. Body cooling, also known as therapeutic hypothermia, has been successfully used in adults after cardiac arrest and in newborn infants after lack of oxygen at birth. It has not yet been studied in infants or children who have had cardiac arrest. Researchers note that this study is important because children who experience cardiac arrest can suffer long-term neurological damage or death. During body cooling treatments, participants lie on mattresses and are covered with blankets. Machines circulate water through the blankets and mattresses to control the participants' body temperatures. The cooling system will lower the patients’ temperature to between 89.6 and 93.2 degrees Fahrenheit. Patients will be removed from the cooling system after two days and results will be measured against patients that did not receive the cooling treatment.
The National Institute on Aging is expanding the Alzheimer’s disease neuroimaging initiative. This groundbreaking study will recruit hundreds of new volunteers to help define the subtle changes that may take place in the brains of older people many years before overt symptoms of Alzheimer’s disease appear. Over the next five years, participants aged 55 to 90 will be enrolled at 55 sites in the United States and Canada. Researchers will be looking for changes in brain structure and function as people transition from normal cognitive aging to mild cognitive impairment to Alzheimer’s dementia. The study will use imaging techniques and biomarker measures in blood and spinal fluid specially developed to track changes in the living brain. Researchers hope to identify who is at risk for Alzheimer’s, track progression of the disease and devise tests to measure the effectiveness of potential interventions. According to researchers the study expansion will build upon the successes of this ongoing effort to identify the earliest signs of Alzheimer’s disease, when damage to the brain may begin well before symptoms appear. The study is seeking 550 new participants for the expansion.
The National Institute of Allergy and Infectious Diseases has announced four large-scale clinical trials that will address the problem of antimicrobial resistance. Over the next five to six years, these new clinical trials will evaluate treatment alternatives for diseases for which antibiotics are most commonly prescribed. These include middle ear infections, community-acquired pneumonia and diseases caused by gram-negative bacteria, which include E. coli, salmonella, gonorrhea and meningitis. Gram-negative bacteria are frequently resistant to first-line antibiotics. Each trial will enroll at least 1,000 participants who have been diagnosed with these illnesses and diseases. Scientists say that many infectious diseases are increasingly difficult to treat because bacteria and other microbes have developed resistance to commonly used antimicrobial drugs. Research to preserve the effectiveness of antibiotics is a critical priority for NIH.
For this NIH News Update – I’m Craig FritzBalintfy: News updates are compiled from information at www.nih.gov/news. We’ll have more about the body cooling story in our next episode. And for information on a clinical trial, like the Alzheimer’s study or antimicrobial resistance trials, visit the website www.clinicaltrials.gov. And later in this program, images and archives available to the public, plus allergy and asthma stories. Coming up kids are filling up on empty calories. That’s next on NIH Research Radio.
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Flow of empty calories into children's food supply must be reduced
Balintfy: About 17 percent of children and adolescents in the US are obese. Childhood obesity can increase risk for a wide array of health problems. With an additional 15 percent of kids and teens considered overweight, researchers are calling for the flow of empty calories into children's food supply to be reduced. What are empty calories?
Reedy: That includes things like cakes, cookies, pies...
Balintfy: That's Dr. Jill Reedy, a nutritionist with the National Cancer Institute.
Reedy: Nearly 40% of total calories consumed by 2-18 year olds were in the form of what we call empty calories, empty calories from solid fats and from added sugars. More specifically, sugar-sweetened beverages, which include soda and fruit drinks combined, provided almost 10% of total calories.
Balintfy: Dr. Reedy has published a paper in this month’s Journal of the American Dietetic Association. The article describes how she and colleagues looked at data from the National Health and Nutrition Examination Survey, called NHANES.
Reedy: So this research identifies the major sources of overall energy and empty calories in the diets of American children. So for 2-18 year olds the top sources of energy were grain deserts, pizza and soda.
Balintfy: Energy is another word for "calories." Dr. Reedy adds that children of different ages get their energy from different sources, and there are differences by race-ethnicity as well. But she emphasizes the importance of reducing the flow of empty calories into the food supply.
Reedy: It's unreasonable to expect people to be able to change their eating behaviors when so many forces in the environment conspire against them to make healthy choices. So most experts agree that the solution will involve changes in both diet and physical activity, in order to affect this energy balance.
Balintfy: Energy balance is the balance of calories consumed through eating and drinking compared to calories burned through physical activity. Dr. Reedy says the paper provides context for dietary guidance.
Reedy: The epidemic of obesity among children and adolescents is now regarded as one of the most important public health problems in the United States. And these findings are very consistent with other research from our group here at the National Cancer Institute, as well as others, really adding another piece to the rather disturbing picture that emerging about the nation’s diet in crisis.
Balintfy: To learn more about managing an energy balance to help children maintain a health weight, visit the website wecan.nhlbi.nih.gov.
Children, Males and Blacks are at Increased Risk for Food Allergies
Balintfy: From obesity to allergy: A new study estimates that 2.5 percent of the United States population, that’s about 7.6 million Americans, have food allergies. Food allergy rates were found to be higher for children, non-Hispanic blacks, and males, according to researchers. The odds of male black children having food allergies for example, were 4.4 times higher than others in the general population. Study authors note more research is needed to understand why certain groups are at increased risk for food allergy. But this study is the first to use a nationally representative sample. Wally Akinso reports it is also the first to quantify allergic sensitization to common foods.
Akinso: In a National Institute of Environmental Health Sciences study food allergy rates were found to be higher for children, African Americans, and males.
Zeldin: Specifically we found that children, males, and African American individuals were more likely to have food allergy.
Akinso: Dr. Darryl Zeldin is the NIEHS Acting Clinical Director and author of the study.
Zeldin: If you were black you were about three folds more likely to have food allergy than if you’re not black. If you were a male your about two folds more likely to have food allergy than if you’re female. And if you’re a child you’re about two folds to have food allergy than if you’re an adult.
Akinso: The study is the first to use a nationally representative sample, as well as specific immunoglobulin E or antibody levels to quantify allergic sensitization to common foods, including peanuts, milk eggs, and shrimp. In addition to the identification of race, ethnicity, gender, and age as risk factors for food allergies, the researchers also found an association between food allergy and severe asthma.
Zeldin: We also found an interesting relation between food allergy and asthma. Compared to people without asthma, individuals with asthma were much more likely to have food allergy. Individuals with asthma and symptoms of their asthma that were active were much more likely to have food allergy and if you had severe asthma severe enough to cause a visit to an emergency room for that asthma within the last year, you were extremely likely to have food allergy. Those individuals were between six and seven fold more likely to have food allergy than individuals without asthma. And so what this means is that there's a very close relationship between food allergy and asthma. The more severe and the more persistent the asthma the more likely you are to have food allergy.
Akinso: The data used for this study comes from the National Health and Nutrition Examination Survey 2005-2006. It's a large nationally representative survey conducted by the National Center for Health Statistics, a part of the Centers for Disease Control and Prevention. For more information, visit www.niehs.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Possible Alternate Therapy for Adults with Poorly Controlled Asthma
Balintfy: Dr. Zeldin mentioned in that last report an interesting relationship between food allergy and asthma. Wally Akins files this next story about how a drug commonly used for the treatment of chronic obstructive pulmonary disease or COPD successfully treats adults whose asthma is not well-controlled on low doses of inhaled corticosteroids. COPD by the way is a serious lung disease which makes it hard to breathe. Also known by other names, such as emphysema or chronic bronchitis, COPD is now the 4th leading cause of death in the United States and also causes long-term disability. The number of people who have COPD is on the rise — more than 12 million are currently diagnosed with it. And it is estimated that another 12 million may have COPD but not realize it. But back to the asthma story: here’s Wally...
Akinso: A drug commonly used for the treatment of chronic obstructive pulmonary disease, or COPD, successfully treats adults whose asthma is not well-controlled on low doses of inhaled corticosteroids according to a study by the National Heart, Lung, and Blood Institute. Dr. Gail Weinmann, deputy director of the Division of Lung Diseases at the NHLBI, explains how an existing drug has new potential.
Weinmann: This study shows that this drug tiotropium, which is the drug that’s already been approved for use in COPD, may provide another option for patients with asthma in controlling and preventing asthma symptoms.
Akinso: Conducted by the NHLBI's Asthma Clinical Research Network, the study compared three treatment methods.
Weinmann: This study compared three treatments added to inhale corticosteroids for control of asthma. The three treatments added to the inhaled corticosteroids were: doubling the doses of inhaled corticosteroids, adding inhaled tiotropium, or, adding long acting beta agonist all of the patients received all three add-on treatments. The study found that tiotropium was superior to doubling the dose of the inhaled corticosteroids and controlling asthma. And tiotropium was as good as adding long-acting beta-agonist.
Akinso: The results of the study have been published online in the New England Journal of Medicine and presented at the Annual Congress of the European Respiratory Society in Barcelona.
Weinmann: We hope that this study provides proof of principal to further evaluate the role of tiotropium in the management of asthma.
Akinso: Dr. Weinmann says the Asthma Clinical Research Network is designed to address exactly these kinds of practical and important management questions, with the ultimate goal of helping asthma patients. For more information, visit www.nhlbi.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Balintfy: More than just books in the History of Medicine Division. That’s next on NIH Research Radio.
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The History of Medicine series - part 2 of 3
Balintfy: Welcome back to NIH Research Radio. In out last episode, we started a series on the History of Medicine Division, which is part of the National Library of Medicine – one of the 27 different institutes and centers here at the National Institutes of Health. This time, we’ll be talking about some of the interesting images and archives that are kept here, but first Dr. Jeffery Reznick, deputy chief of the History of Medicine Division is back with a little perspective on the library as a whole:
Reznick: So, the NLM, the National Library of Medicine, is, in fact, the world’s largest medical library, and it houses one of the world’s largest history of medicine collections. And the collections trace their origins to the early 19th century, specifically in 1818. In that year, Dr. Joseph Lovell, who was the first surgeon general of the Army, filled his office full of books and journals and pamphlets to begin to serve as a reference collection for the Army surgeons under his command. And several years later, in the 1830s, this growing collection was officially named the Library of the Office of the Surgeon General of the United States Army. So, it’s from this early library, in particular the efforts of the medical officer and book lover, Dr. John Shaw Billings, that the National Library of Medicine traces its own roots. So, under the stewardship of Dr. Billings, the Library’s roughly 2,300 medical volumes grew to a collection of nearly 125,000 volumes. By the end of the 19th century, the Surgeon General’s Library was, in fact, the world’s largest—the largest medical library in the Americas and possibly in the world. And today, the National Library of Medicine includes more than seven million items, including books and journals, technical reports, manuscripts, photographs, images, and microfilms.
Balintfy: Dr. Reznik says seven million items, not books. So we’re continuing our conversation with Dr. Paul Theerman, head of the images and archives section in the History of Medicine Division. Now this brings to mind something different than just volumes of books. Dr. Theerman, can you tell me a little bit about the section and what it has?
Theerman: It is a very different from books. Actually, one of the best ways I know to think about is the title that the section used to have which was non-book collections, which I like because there’s a lot of stuff in the world that’s not books and we can collect any of it. More specifically, we cover three different types of materials: modern manuscripts, prints and photographs, and historical audiovisuals. So we try to pick up on things and in some ways, can be a little bit more ephemeral, a little bit closer tied to their creator, and sometimes they lack the formal status of a publication which makes it for very interesting and very challenging.
Balintfy: Can you share a couple of examples Dr. Theerman?
Theerman: Well, one of the focuses that we’ve had for collecting is—has been here on campus—on the NIH campus—we’ve been trying to collect papers of prominent and NIH scientists, especially those that have the Nobel Prize, although by no means limited to that. So one of the largest collections we have, actually, is the Marshall Nuremburg collection and it’s a collection started when Dr. Nuremburg was still with us and still alive and it also formed part of our profiles and science project which is a separate project. But it’s a collection of his papers related to the discovery of the genetic code. Some of the other collections we have are the Joshua Lederberg Papers. Dr. Lederberg was on the NLM board of regents and a prominent geneticist and founder of the field of artificial intelligence and medical informatics.
Balintfy: Neat. What sort of caught my ear was that some of this wasn’t even in print, it’s photos. It’s maybe audio and video. What are some examples of that?
Theerman: Well most of the manuscript collections we have are not published materials and a large portion of our prints and photographs collection is also non-published or has not been published. So we focus on the manuscripts—correspondence memos, lab notebooks, grant applications. One really nice collection we have, actually, is C. Everett Koop’s speeches, that is his typewritten speeches that he gave on at a number of public occasions and we were fortunate enough that he also—after the collection came to us, he would annotate them—that is, he would let us know the context in which he would take a fairly standard speech and tailor it for the audience or what was particularly on his mind or his audience’s mind at the time. So it adds a dimension of behind the scenes.
We are just in the infancy of putting our film collection online for a variety of reasons, but we have a few up there now. We plan to have some more and again, one of the more interesting films we have had have been public health films from around the world that were produced in the 1950’s and 1960’s. Because of the origins of the library—it used to be the Armed Forces Medical Library—actually, the earlier film collections have a good number of World War II health films in there and they’re fascinating.
Balintfy: Who are the people that are interested in these and access these kinds of images and archives?
Theerman: It’s a wide variety of people. Mostly we focus on history researchers. That is, professional historians who come in to use our materials to try to give us a good and accurate chronicle and development of the medical science of the twentieth century, or earlier centuries—but my collection has been predominately twentieth century. The film and still image photograph collection are also widely used as illustrations, as part of a documentary filmmakers work. We’re trying to focus more as the field changes, of getting people who are interested in visual culture as a research topic to come in and use our materials, and we’ve been fairly successful with that recently.
Balintfy: How do they access the materials? Do they actually have to come to Bethesda or are there ways to get them online?
Theerman: Most of the time, just because of the volume of the materials, you do come and use our reading room. A big exception with that is most of the collection of prints and photographs is available online in our database called Images from the History of Medicine. Beyond that, we have selected manuscripts online as well. The biggest project for that is a project called Profiles in Science, which relates to late twentieth century science and now also cardiac surgery and public health. We have also released a nineteenth century collection of physicians’ letters from the Shenandoah Valley relating to the records—correspondence mostly, letters of an extended family of physicians in New Market, Virginia.
Balintfy: If I’m not a documentary film maker or I’m not a researcher doing a biography or something like that, I’m just maybe a student or just someone in the public interested in historical images and documents, what do you think would be most interesting to me?
Theerman: We’ve done a number of collaborations and profiles in science with very, very famous biomedical scientists such as Frances Crick and Linus Pauling, and looking online at some of those materials is just fascinating because these were stellar intellects. These were people who were probably in the top dozen or two dozen scientists of the twentieth century. Looking at their scribbles, their notes, their published papers in some cases, that’s a fascinating topic.
Another really good collection we’ve taken in recently is a large collection of Chinese public health materials. We probably have the best collection outside of mainland, China in posters and other kinds of ephemera. A number of those are online and of course, you can come to the library and see them as well.(THEME MUSIC)
Balintfy: Thank you Dr. Paul Theerman. Visit the History of Medicine Division online at www.nlm.nih.gov/hmd. And we’ll have one more interview from the History of Medicine Division in our next episode:
North: In our collection we have really most of the important high points in medical publishing over the last 500 years.
Balintfy: For now, that’s it for this episode of NIH Research Radio. Please join us again on Friday, November 5th when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is firstname.lastname@example.org. I'm your host, Joe Balintfy. Thanks for listening.
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