November 19, 2010
NIH Podcast Episode #0122
Balintfy: Welcome to episode 122 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 investigating the effectiveness of body cooling in infants and children who have had cardiac arrest; evidence is in on a drug used for treating lead poisoning as an alternative therapy for autism—it’s not recommended; another alternative therapy for fibromyalgia patients that does appear to help; and more details on diabetes risk and awareness. But first, this news update. Here’s Craig Fritz.
Fritz: Researchers funded by the National Institute of Alcohol Abuse and Alcoholism have found effective strategies to reduce college drinking. According to the study, highly visible cooperative projects, in which colleges and their surrounding communities target off-campus drinking settings, can reduce harmful alcohol use among college students. Conducted at 14 large, public universities in California, policy and enforcement interventions were implemented at half of the universities, with the other half monitored for comparison. Interventions included increased efforts to control unruly parties, surveillance to prevent alcohol sales to minors, drunken driving checkpoints, and use of campus and local media to increase the visibility of interventions. Researchers found significantly greater reductions in the incidence and likelihood of intoxication at off-campus parties, bars and restaurants for students at the intervention universities. Students at these universities also reported a lower likelihood of drinking to intoxication the last time they attended an off-campus party, bar or restaurant. The greatest reductions were found at universities with the highest intensity of intervention activities, achieved through heavy publicity and highly visible enforcement.
Researchers funded by the National Institute on Aging have discovered that a drug used decades ago to treat high blood pressure may slow the progression of Alzheimer’s disease. The study in mice found that the drug, diazoxide, stabilized nerve cells in the brain and prevented their destruction. The drug also improved blood flow in the brain and prevented the harmful accumulation of two proteins, which are hallmarks of Alzheimer’s. Widely used in the 1970s and '80s to treat patients with severe hypertension, diazoxide is currently used to treat low blood sugar. According to scientists these findings open new avenues of basic research of how regulating the electrical activity of nerve cells may slow Alzheimer’s damage. They also note that more research will be needed before it can be determined whether this may be a potential therapy for the disease.
For this NIH news update - I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Later in the program, alternative therapies: one not recommended for autism, another shows promise for fibromyalgia; also November is National Diabetes Awareness Month. Coming up next a clinical trial on body cooling.
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NHLBI launches temperature regulation study for pediatric cardiac arrest
Balintfy: Researchers are starting a new study to see if infants and children who have cardiac arrest – whose hearts stop – can be helped with therapeutic hypothermia.
Pemberton: Therapeutic hypothermia – it’s a big word – but really just means body cooling.
Balintfy: Victoria Pemberton is a clinical trials specialists and program officer at the National Heart, Lung and Blood Institute.
Pemberton: We've probably all heard a story of a child who had fallen into an icy pond and who has come out remarkably intact.
Balintfy: Therapeutic hypothermia is cooling done on purpose. She adds that it has been successful in adults after cardiac arrest and in newborns after birth asphyxia, or lack of oxygen. In those cases it improves survival and outcomes; but therapeutic hypothermia has not been studied in infants or children who have had cardiac arrest.
Pemberton: And so I think the next step now is for us to test this treatment in children. Children don't always respond the same way that adults do and so it would really be not ethical or fair to apply this treatment to children where it’s never been tested and proven effective.
Balintfy: With $21-million in funding over six years, it is the first large-scale, multicenter study to explore the use of therapeutic hypothermia in infants and children after cardiac arrest. Participants in the study must be older than 48 hours and younger than 18 years and must be enrolled within six hours of suffering cardiac arrest.
Pemberton: So one of the very important parts of this study is to get the therapy instituted very quickly. So from the time that a child has been noted to have cardiac arrest and the heart starts beating again—after CPR or whatever resuscitative measures have been given—there's about six hours before we want to put the child on the cooling mattress and have the cooling blankets on.
Balintfy: Roughly 16-thoudand children suffer cardiac arrest each year in the United States. Cardiac arrest in infants and children has many causes, such as strangulation, drowning, or trauma. It can also be a complication of many medical conditions. Again NHLBI’s Pemberton.
Pemberton: Cardiac arrest in children outside of the hospital is a particularly devastating event. Many children do not survive after a cardiac arrest or they survive with really impaired neurologic abilities and cognitive abilities.
Balintfy: Pemberton says it’s important for both healthcare providers and the public to know and understand the scope of this new study, called Therapeutic Hypothermia Aafter Pediatric Cardiac Arrest or THAPCA. But she adds of the treatment:
Pemberton: We would like to caution the public against thinking that this is a magic cure or the silver bullet. But we do think that it’s a reasonable therapy to consider and to test in this patient population to see if whether it will improve survival and cognitive intactness in children after cardiac arrest.
Narrator: For more information on THAPCA, visit the website, www.nhlbi.nih.gov.
Succimer found ineffective for removing mercury
Balintfy: Succimer is a drug used for treating lead poisoning in children. Dr. Walter Rogan, a senior investigator in the epidemiology branch at the National Institute of Environmental Health Sciences, says the drug has been studied and is approved by the Food and Drug Administration to reduce lead in the blood of children.
Rogan: Back in the 90’s we had done a large scale clinical trial of the drug to treat lower level lead exposure in children in the hopes of reversing the IQ deficit that comes from exposure to lead. And although we decreased their blood leads by about 40% in the short term, we weren’t able to have any effect on their IQ.
Balintfy: Dr. Rogan explains that about 780 kids participated in the clinical trial¯which included taking blood samples—and that they were followed for five years.
Rogan: What we did was, since we had done the clinical trial in kids with excess lead exposure, we had blood samples left over from that trial and we were able with the collaboration of the lab folks at CDC to analyze blood samples left over from that clinical trial for mercury. And what it let us do essentially was a clinical trial of succimer for background exposure to mercury without enrolling any patients. We simply analyzed the blood samples. And so we didn’t have to do a study in new kids at background exposure to mercury with all of the expense and difficulty that that entails. We simply did the trial in the blood samples.
Balintfy: Dr. Rogan reports that although succimer is not approved by the FDA to reduce mercury, in the belief that conditions like autism and autism spectrum disorders are caused, in part, by mercury poisoning, some families are turning to the drug as an alternate therapy.
Rogan: It is a kind of a general purpose metal chelator. By which I mean it makes metals that you stored in your body more soluble in urine.
Balintfy: With blood samples left over from that earlier lead trial, researchers were able to analyze them for mercury. Although researchers found that succimer lowered blood concentrations of mercury after one week, continued therapy for five months only slowed the rate at which the children accumulated mercury.
Rogan: So it’s not as effective a chelator for mercury as it is for lead.
Balintfy: Dr. Rogan emphasizes that while succimer reduced lead levels by about 40%, it lowered mercury levels by less than 20%. He adds that the practice of using succimer for conditions like autism is not supported by data.
Rogan: We hear stories, newspaper reports, websites that say it’s used in kids with autism and autism spectrum disorders. And there is some belief that those disorders may have something to do with mercury exposure. And so if you’re contemplating using this drug for any reason that has anything to do with mercury, the take-home message form this is in a large formal trial, it’s not very effective at lowering blood mercury.
Balintfy: Most mercury exposure in the United States is from methylmercury, found in foods such as certain fish. Thimerosal, a preservative once more commonly used in vaccines, contains another form of mercury, called ethylmercury.
Tai Chi May Benefit Patients with Fibromyalgia
Balintfy: People with fibromyalgia may benefit from practicing tai chi, according to a study published in the New England Journal of Medicine. Fibromyalgia is a disorder characterized by muscle pain, fatigue, and other symptoms. People with fibromyalgia have chronic widespread pain, as well as "tender points" on areas of the body, which hurt when slight pressure is applied. Wally Akinso files this report.
Akinso: A new study shows that people with fibromyalgia may benefit from practicing tai chi.
Briggs: Tai Chi is an ancient meditative form of exercise.
Akinso: Dr. Josephine Briggs is the Director of the National Center for Complementary and Alternative Medicine.
Briggs: It’s very commonly practiced in China. It's a mind-body practice. It combines slow movements, deep breathing, relaxation and meditative components.
Akinso: Dr. Briggs says that fibromyalgia is a common disease.
Briggs: Fibromyalgia is more common in women than men, that's characterized by diffuse musculoskeletal complaints and pain. One of the characteristics of fibromyalgia is enhanced sensitivity pain. People with fibromyalgia also often suffer from sleep disturbances, disturbed appetite, and depression and enhanced stress.
Akinso: Researchers evaluated the physical and psychological benefits of tai chi in 66 people with fibromyalgia. Dr. Briggs explains the scope of the study, which was funded in part by NCCAM.
Briggs: This was a small study in which the investigators took 66 patients with fibromyalgia and half of them were put into a control group. The control group was given stretching exercises and some support. The tai chi group received regular instruction in tai chi principles and techniques and were urged to practice tai chi at home. The people who did tai chi had a significantly greater improvement in their symptoms—measured by something called the fibromyalgia impact score. They also reported better sleep quality, better mood, and better quality of life. The investigators were quite enthusiastic about the potential of this study and we certainly are too.
Akinso: Dr. Briggs believes that this study is promising because people are actively treating this condition by taking tai chi themselves. For more information, visit www.nccam.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up, an interview with the director of NIDDK about diabetes. That’s next on NIH Research Radio.
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National Diabetes Awareness Month Interview
Balintfy: In our last episode, we had some highlights from Dr. Griffin Rodgers, Director of the National Institutes of Diabetes and Digestive and Kidney Diseases. It’s still National Diabetes Awareness Month, so we’re talking more with him. Dr. Rodgers, what is the prevalence of diabetes in the U.S. and what should people know about this disease?
Rodgers: At least 24 million adults in the U.S. which is about 8 percent of the U.S. population, have diabetes. Almost one-fourth of them, or nearly 6 million people, do not know they have the disease. If left untreated, diabetes can lead to serious complications such as heart disease, stroke, kidney disease, blindness, and amputation. Another 57 million Americans are estimated to have pre-diabetes, a condition that places them at increased risk for developing type 2 diabetes and heart disease.
Balintfy: What are the risk factors for developing type 2 diabetes?
Rodgers: There are a number of factors that increase your risk for developing type 2 diabetes. While there are some risk factors that you can’t change, such as genetics, age, and race, ethnicity, there are risk factors associated with a person’s lifestyle that they can change, such as being more physically active and maintaining a healthy weight.
Risk factors for diabetes include: having a family history of diabetes, being overweight or obese, and having pre-diabetes. These are all risk factors.
Balintfy: Dr. Rodgers, why is it important for people to know if they have a family health history of diabetes?
Rodgers: Well it’s important to know if you have a family history of diabetes because family health history is an important risk factor for developing a number of serious diseases, including type 2 diabetes. In fact, most people with type 2 diabetes have a family member—such as a mother, father, brother, or sister—with the disease.
If you have a family history of diabetes, it’s important to share your family’s health history with your health care team and learn what you can do to prevent or delay the development of chronic diseases like type 2 diabetes.
Now while you cannot change your family’s health history, knowing about it can give you the information you need to work with your health care team to take action on the things you can change.
To help your family members talk about their health history of diabetes, we recommend asking the following questions: Does anyone in the family have type 2 diabetes? Who has type 2 diabetes? Has anyone in the family been told they might get diabetes? Has anyone in the family been told they need to lose weight or increase their physical activity to prevent type 2 diabetes?
If the answer to any of these questions are yes, you may be at an increased risk for developing type 2 diabetes.
Balintfy: If someone is concerned that they may be at risk for diabetes, what can they do to prevent or delay the onset of type 2 diabetes?
Rodgers: If you have a family history of type 2 diabetes or are concerned that you are at risk, you should talk to your doctor.
The good news is that research has shown that people at high risk for developing type 2 diabetes can prevent or delay this disease by making important lifestyle changes, such as losing a small amount of weight – about 5 or 7 percent or approximately 10 to 14 pounds if you weigh 200 pounds – and becoming more physically active.
And the whole family can benefit from making healthy food choices and being more active.
Balintfy: How can people make a family plan for a more healthy lifestyle?
Rodgers: Your family plan to have a healthy lifestyle can include: making healthy food choices such as fruits and veggies, fish, lean meats, poultry without skin, dry beans and peas, whole grains, and low-fat or skim milk and cheese; choosing water to drink; eating smaller portions. Make half your plate veggies and/or fruit, one-fourth a whole grain, such as brown rice, and one-fourth a protein food, such as lean meat, poultry or fish, or dried beans.
Balintfy: Should the plan also include a goal of being active 30 minutes, 5 days per week? That seems like a lot all at once . . .
Rodgers: You don’t have to get all your physical activity at one time. For example you can do some physical activity during the day in 10 minute sessions, 3 times a day. Choose something you enjoy. Ask family members to be active with you.
Writing down all the foods you eat and drink and the number of minutes you are active is very important. Review it every day. And this will help you reach your goals.
Balintfy: Are there special considerations for women?
Rodgers: It’s also important for women who were diagnosed with diabetes during pregnancy—also known as gestational diabetes—to know that they are at increased risk for developing diabetes in the future. And the child from that pregnancy is also at increased future risk for obesity and type 2 diabetes.
It is important for you to talk to your doctor about your history of gestational diabetes. Get tested for diabetes 6 to 12 weeks after your baby is born, and then at least every 3 years thereafter. Breastfeed your baby, if possible. Breastfeeding is beneficial for both mom and the baby. And talk to your doctor if you plan to become pregnant again in the future. Try to reach your pre-pregnancy weight 6 to 12 months after your baby is born. And evven if you do not reach your “goal” weight, research shows that keeping a healthy lifestyle can help reduce risk for diabetes.
Balintfy: Where can people get more information on diabetes?
Rodgers: NDEP has free resources – and they’re available in English, Spanish, and Asian-American/Pacific Islander languages – to help people learn more about diabetes, such as risk factors for diabetes, ways to help delay or prevent type 2 diabetes, as well as ways to prevent health problems associated with diabetes and for people who have been diagnosed with this disease. They can get this information by calling a toll-free number 1-888-693-6337; or 1-888-693-NDEP. O they can visit www.YourDiabetesInfo.org.
Balintfy: Thank you Dr. Griffin Rodgers. And that does it for this episode of NIH Research Radio. Please join us again on Friday, December 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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