i on NIH Vodcast
June 17, 2009
“i on NIH” Vodcast Episode #0021
Welcome to “i on NIH”!
Featured in this month's episode are segments about, the MedlinePlus African Tutorial, awareness of Sudden Cardiac Arrest, and the importance of sleep.
From the national institutes of health in Bethesda, Maryland - America’s premiere medical research agency - this is "i on NIH"!
Covering health-research topics important to you and the nation, this public service vodcast is your information source from inside all 27 institutes and centers at NIH.
Half an hour, once a month, we’ll show you the excitement of advances and the important information that comes from medical research. And now, here’s your host, Joe Balintfy.
Host: Welcome to the 21st edition of I on NIH. Coming up in this episode, we'll have part one of a two part series on the MedlinePlus African Tutorial. Also, we'll have a report on an athlete who visited NIH to raise awareness of sudden cardiac arrest; and to wrap up this episode, we'll hear an interview about the relationship between sleep and exercise when it comes to cancer. But first, the NIH Research Update with Harrison Wein. What do you have for us this month, Harrison?
Harrison: What's on your skin? And acupuncture can improve low back pain, even when it's not real.
Joe: So the first study is about what's living on our skin. Why is it important to know that?
Harrison: The skin is one of the body's first lines of defense against illness and injury. Basically, it keeps microbes from getting inside. The skin's health depends on a delicate balance between your our own cells and the millions of bacteria and other microbes that live on its surface. We need to really understand this balance so we can develop better ways to treat and prevent difficult skin diseases like eczema, psoriasis and acne.
Joe: So I see there was a surprise in this study.
Harrison: Yes, there was. Researchers at NIH found that our skin is home to a much wider array of bacteria than previously thought. Past studies had looked at this by growing samples from human skin in the laboratory. In the new study, researchers extracted DNA from human skin samples and sequenced a type of gene specific to bacteria. They wound up identifying, classifying and comparing more than 112,000 bacterial gene sequences.
Joe: That's a staggering number.
Harrison: Absolutely, Joe. It really shows the power of modern DNA sequencing technology and computational analysis. What's most important about the results is that they now lay the groundwork for future studies.
The researchers found lots of interesting things about the different bacteria that live on different parts of the body. For example, the bacteria that live under your arms likely are more similar to those living under my arm than they are to the bacteria on your own forearm.
Joe: Now, the next story is about using acupuncture to treat chronic low back pain.
Harrison: As you probably already know, acupuncture involves stimulating specific points on the body, usually by inserting thin metal needles though the skin. In the U.S., acupuncture is considered part of complementary and alternative medicine.
Back pain is the leading reason for visits to licensed acupuncturists. Several recent studies suggested that both real acupuncture and "sham" acupuncture-that's the shallow needling of points on the body-are equally effective for treating chronic low back pain, and that both are superior to best-practice medical care.
So NIH-funded researchers did a study of over 600 people with chronic low back pain who had never had acupuncture. The people were randomly divided into 4 groups. The first received acupuncture that was customized for them. The second received standardized acupuncture, targeting points that acupuncture experts consider generally effective. People in the third group didn't realize it, but they actually received an imitation of acupuncture, which used toothpicks to stimulate acupuncture points but didn't break the skin. The fourth group received standard medical care.
Joe: So what did they find?
Harrison: Well, up to a year later, there was no significant difference between the 3 groups receiving acupuncture, whether real or imitation. But all 3 acupuncture groups showed significantly more improvement than the standard-care group.
Joe: That's surprising, Harrison. What does it mean?
Harrison: It means there is something taking place during acupuncture treatments that seems to help with chronic low back pain. But it's likely something other than the actual needling itself. It's going to take further studies to figure out what's going on.
Joe: And where can people find out more about these studies?
Harrison: You can read about these and other NIH research studies in "NIH Research Matters." Go to the NIH home page and click the link on the right-hand side, under "In the News" that says, "eColumn: NIH Research Matters"
Joe: And what's in this month's health newsletter?
Harrison: With the weather improving and people getting outside more, our cover story is about sports injuries. And among others, we also have a story about making sure ticks don't take a bite out of your summer.
Joe: And where can people find that?
Harrison: That's at news-in-health-dot-nih-dot-gov.
Joe: Thank you Harrison
Harrison: Thank you Joe.
Host: For our first feature in this episode, we have an interview with Dr. Julia Royall at the National Library of Medicine. In this part one of two interviewS, she explains the MedlinePlus African Tutorials as a teaching tool. Our first question:
Q: Can you tell us about the Malaria Tutorial? How did you decide to focus on malaria initially?
Royall: Actually I was.I had been brought to NLM in 1997 to work with a project that NIH had taken on under then director Harold Varmus to help African malaria researchers. And one of the things they wanted was better access to the Internet and to medical literature and that's the work that I had done previously. So I was brought here to do that and stayed on and became very interested in NLM's attempt to reach the end user with information. And was . . . this happened right when I came as well in 1997.
PubMed made Medline available to the public and not too long after that Medline Plus made health information generally - now there are over 700 topics - available to the public. And of course it's not just patients that use that information - doctors use it - it's impossible to keep up with everything. And so, doctors like to go to that site and they get the latest news and a lot of things. And so those topics are chosen. Users can write in and say how they think a certain topics important and it's not there yet - and that's kind of how MedlinePlus has been built. For the African tutorials - I have an all African advisory board that spans countries all over the continent. And although we knew the burdens - generally what the top burdens would be - it needed to come from them, not from us. And so - you know - I asked them what they thought the ten top health burdens were in their areas and of course malaria and HIV and TB are at the top of the list - no surprise there. But it was important that it come from them. In Uganda, where I was based and where we worked with students and faculty and artists on these tutorials, malaria is the number one health burden and kills from 70(000) to 110,000 people a year.
Q: You conducted a baseline survey about malaria. What did the survey reveal about the knowledge of the causes and measures one can take to prevent malaria?
Royall: The survey was very interesting and it was carried out by students, medical students from Makerere University in the Mifumi village in eastern Uganda. It revealed so many interested things. One was - let's see where do we start? One was that a lot of health messages have been sent to folks, you know a lot of organizations come in and give health messages. And people pick up health messages. They don't always connect the health message to the health challenge. So you had some cases where - and this happens with all of us I think - you have some cases where people are saying, responding to "Can malaria be prevented?" - they would say yes. And then the question was how, and they would say, "Use latrines. Drink clean water" - things like that. All of which are good things to do. None of which has anything to do with preventing malaria. So it's a challenge to connect health messages with the actual issue at hand. Now the problem with malaria is that you get that bite from the mosquito and its two weeks before you get sick. So it's a natural thing that you don't necessarily connect malaria, your sickness, your fever, with that vector. So one piece of what we were trying to do in the village was make sure that people understood that is was a vector issue. And until they understand that, nothing is going to happen - really.
Q: What role did the Ugandans play in the success of this tutorial?
Royall: The Ugandans were responsible completely for the success of the tutorial as far as the use of it on the ground. The making of it - they shared success with the team at NLM. But once it was made - you know you can have a beautiful tutorial, but it's not necessarily going to be used, and even if it's used it has to be used so that it can what make better health in a country - that's the idea. So their role was major. And I think they understand that very clearly and they own it - very clearly. That it's their tutorial that they made and their sharing it with other people, other students in the region. They're very articulate in talking about it. And because they went into the village and made these discoveries that mangos don't cause malaria, witchcraft doesn't cause malaria - it's like any discovery, you want to share it. And you want to make it - integrate it into the presentation so that people see their views reflected in what's been done. It's not just something coming from the outside. It's something that even the village folks have had a hand in. And it's held up and they see their views in there, but hopefully also understand that they need to perform certain things, or do certain things in order to prevent malaria.
Q: Is there any way to measure if there was a shift in behavior as a result of the tutorial?
Royall: Right- that is the challenge. In Mifumi village we were working with the health center that's a wonderful health center - and the person who's in charge of it is Nurse Sister Gorretti, and she, each month, sends to the district health office - which sends to the ministry - all the records on how many malaria, how much malaria morbidity, how much malaria mortality, there was that month. So what we can do over time - and of course there are many things that affect morbidity and mortality in malaria, not just this health information intervention. But in a highly malarias area, like Mifumi village, we think that over time we'll be able to see some kind of change, hopefully for the better. And that some of that, because the Nurse Sister sees everyone who comes in - she'll be able to see how the tutorials have played a role in that. How the people look at these visuals and hear what's being said and when it's presented in that way. And that way meaning - on the screen of my little laptop in the village, or on the screen that they've set up for people to look at - the difference that that kind of intervention makes vis-à-vis posters and booklets and things that people normally do. So we're doing a couple of things - we're creating a tutorial that incorporates beliefs of people in the village - and that's an important and different kind of thing to do - we're making it in their languages, we're also presenting it in some new formats, like on the computer. And she says when people see it like that, on a screen that somehow it does make a difference, because they - I think in a way they can put themselves into it. It's like watching a movie.
Q: We're seeing a shift in the way that people are obtaining information with more Americans getting information from electronic media. How did the Ugandans respond to the materials that were presented in an electronic format as opposed to a hard copy?
Royall: Well according to Nurse Gorretti when people were looking at the tutorial on a screen, where you could punch a button, to advance it to the next screen that is was very interesting how people were drawn into it. They were drawn to the visuals. They were drawn to the information. And gradual became kind of immersed in it in a way that was different from posters and booklets. So we believe that there is something about this screen and the digital presentation that could make a difference. We'll be exploring that over time. And longitudinally we'll be seeing over time how those morbidity and mortality records change - because that's the bottom line isn't it.
Host: For more information on the tutorials, visit: www.nlm.nih.gov/medlineplus/africa/ We'll have more from Dr. Royall in an upcoming episode of I on NIH. Now we turn to sudden cardiac arrest, or SCA. SCA usually causes death if it's not treated within minutes. It's especially tragic when young athletes are the victims. While the National Heart Lung and Blood Institute takes the lead on this, an event at the National Library of Medicine featured this condition. Wally Akinso brings us the story.
Wally: Apart from wowing many with the "Super Bowl Shuffle" . . .
(Super bowl shuffle audio)
Wally: Former National Football League star and Olympic track and field gold medalist, Willie Gault, is helping many people across the United States who suffer from sudden cardiac arrest. Gault attended a program held by the National Library of Medicine which focused on sudden cardiac arrest.
Gault: Every 10 hours a young athlete dies of a heart attack. Every 30 minutes someone in American dies from a heart attack or heart disease. So when you look at those numbers it's staggering. We need to figure out, what we're doing, how we're doing it, and early detection is the key. If we can find out, get at the early stage and we can take care of them. We can save lives and that's what I'm all about, and that's what Athletes for Life is saving lives.
Wally: Gault is the founder of Athletes for Life, a non-profit organization to detect and prevent sudden cardiac arrest. Sudden cardiac arrest, also known as sudden cardiac death, is when the heart suddenly and unexpectedly stops beating. Gault is in a race against time to help the 250,000 to 450,000 Americans who suffer from this condition each year.
Gault: We go around the country with a 40 foot trailer and we test people for heart disease, through a treadmill or a twelve lead and we've had amazing results. We've actual literally saved people's lives and people are really gratified. And everything we do is totally free to the public.
Wally: Gault hopes he can gain support from various organizations.
Gault: I hope to raise the awareness of what's happening and also what we are accomplishing. And I hope to get support from the NIH and some of the other organizations here to look at and take a big look because we're going to do it. I mean we're doing what we're going to do and we're going to continue doing it but we want other people to come on because to achieve our goals we need help.
Wally: Dr. Donald Lindberg is the Director of the NLM and he discusses the partnership between science and the athletic world.
Lindberg: To Bring together basic science and the athletic world and a little communication with the public.
Wally: Gault was spurred to this effort after Sudden Cardiac Arrest claimed lives of four close friends.
Gault: I've had three of my teammates or friends die of heart attacks in a matter of a month. The oldest was 46. I've had young athletes die-I know people that I known dead. No one in my family, immediate family has but you know those guys who I played with are very, very dear and close to me and so that effected me in this way to help me start this organization.
Wally: Gault has plenty of help from many top flight world class athletes, and medical professionals. Gault says his foundation is working towards health care, life opportunity, and equality for all people in need.
Gault: I just want to get the word out. And we are screening people around the country and I want support because I want to screen everyone we can in the next 3-5 years you want to screen almost every man, woman, child in American which is a huge undertaking but it's something that can be done.
Wally: Heart disease is the number one leading cause of death in the United States. Through the efforts of Athletes for Life, Gault and others are employing cutting edge science and technology to prevent Sudden Cardiac Arrest and other health problems. For more information, visit, www.athletesforlife.com. For I on NIH, This is Wally Akinso.
Host: Don't let that last story discourage you from exercise. Exercise can be good for more than just your heart-health and waistline. A recent study suggests that regular physical activity can actually lower a women's overall risk of cancer-but only if she gets a good night's sleep, too.
For this next interview, we talked Dr. James McClain, a researcher with the National Cancer Institute about a study of women that examined the link between exercise and cancer risk, paying special attention to whether or not getting adequate sleep further affected a her risk of developing cancer.
Q: What did this study show about the relationship of physical activity, sleep and cancer risk?
McClain: The major findings of this study, although preliminary, are that among younger and more active women, a short duration of sleep appears to be associated with increased cancer risk.
Q: What is known about the association of physical activity, sleep duration and cancer risk?
McClain: Well, we know quite a bit about the association between, the relationship between physical activity and cancer. We know that the more active you are, the more you reduce your risk of developing cancer. There have been a few studies that have looked at the relationship between sleep duration and cancer. Some of those have found that shorter duration sleep can increase your risk for cancer, but there's been some mixed results on that. We were interested in the relationship between physical activity, sleep, and cancer just because we know there's a lot of effects, beneficial effects of physical activity that seemed to be counterbalanced by the effects of short duration of sleep, so we wondered if maybe the relationship would change.
Q: How did women who got exercise and didn't sleep, compare to women who got exercise and did sleep?
McClain: Sleep in our study did not prevent you from getting cancer, so you can't just go and sleep more and reduce your risk of getting cancer. What we did find is that among the most active women in our study—these younger, more active women -- that if they slept more than seven hours, they were protected relative to those who slept less than seven hours. So the women who were younger and more active, sleeping less than seven hours increased the risk of cancer, basically—experienced more cancer, about one and a half times as much.
Q: This was an association study. Can you explain the difference between an association study and a clinical trial?
McClain: So basically, in our study we took measures of physical activity and sleep at the beginning, and we followed these women over a period of 10 years to see what kind of outcomes they experienced. So these women either developed cancer or did not develop cancer. That doesn't—that association does not mean that the physical activity necessarily caused—or prevented cancer, sleep prevented cancer, but was just associated, whereas if we were in a more tightly controlled, randomized clinical trial and we delivered the physical activity dose specifically, or took aims to quantify sleep more and control sleep more precisely, we might know a bit more.
Q: Who were the study participants and what are the next steps?
McClain: So our study—the study was a cohort of about 6,000 women who lived in Washington County, Md. They participated in a study named CLUE II that's funded by Johns Hopkins University, that's where our data source was. And the next focus of this study basically would be to replicate this in a larger sample, a larger population of people.
Q: What's the take-home message from this study?
McClain: So the main message here was this study, along with many in the past, showed that physical activity was predictive, so among the most active women in the study compared to the least active, there's a 25 percent reduction in cancer risk. And among a special group, among a group of younger -- so women younger than 65, and more active women -- sleep duration appeared to be particularly important for cancer risk.
Joe: For more on this study and other research on cancer, visit www.cancer.gov.
Host: And that's it for another episode on I on NIH. If you'd like to see or forward individual segments from this program, they're available on YouTube. Check out the NIHOD channel. Thanks for tuning in and please watch again next time. We're working on stories about Alzheimer's Disease and diabetes, plus much more. For I on NIH, I'm Joe Balintfy.
Narrator: "I on NIH" is a public service vodcast from the Department of Health and Human Servives. Produced by NIH News Media Branch, of the Office of the Director, Office of Communications and Public Liaison. Thanks for tuning in. We'll be back again next month with another episode of "I on NIH."
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