Category: Health & Medicine

Midlife High Blood Pressure May Negatively Impact the Brain Years Later

July 16th, 2015 in 2015, Health & Medicine, News Releases, School of Medicine 0 comments

FOR IMMEDIATE RELEASE, July 16, 2015
CONTACT: Gina DiGravio, 617-638-8480, ginad@bu.edu

Midlife High Blood Pressure May Negatively Impact the Brain Years Later

(Boston)–Having high blood pressure in your 50’s may impact your ability to keep track or plan ahead in your 80’s.

This study reports a connection between high blood pressure at a younger age can affect cognition many years later. It currently appears in the Journal of Alzheimer’s Disease.

Life expectancy is on the rise and people the age of 80 are the fastest growing demographic in the world. Several studies have demonstrated that high cardiovascular risk at midlife, particularly hypertension, is linked to subsequent increased risk of dementia. However, there is a lack of studies that examine the impact of midlife cardiovascular risk on early cognitive impairment in individuals in their later decades.

Using data from the Framingham Heart Study (FHS), Boston University School of Medicine  researchers measured blood pressure from 378 FHS participants when they were between 50-60 years old, and then tested their cognitive performance approximately 30 years later when they were 80 years or older. Participants with high blood pressure at midlife scored more poorly on tests of attention and executive function later in life.

“Decline in cognition is often considered an inevitable consequence of aging, and age is the single biggest risk factor for dementia, but perhaps managing factors that impact brain aging, such as blood pressure, will help increase brain health and reduce the risk for dementia,” explained corresponding author Rhoda Au, PhD, professor of neurology at BUSM.

According to the researchers, if your blood pressure is not within normal range when you are younger, you should speak to your doctor and develop a plan to reduce it to normal levels and sustain it, which might include exercise, weight loss and medication.

“Midlife health matters. The pathway to one’s older years is through the younger years and taking care of your health while you are younger may help you better preserve your cognitive health when you are older,” added Au.

The design, conduct, collection and management of the data was supported by the Framingham Heart Study’s National Heart, Lung, and Blood Institute contract (N01-HC-25195) and by grants from the National Institute of Neurological Disorders and Stroke (R01 NS17950) and from the National Institute on Aging (R01AG16495;AG08122; AG029451).

Rapid Skin Improvement Seen after Treating Systemic Sclerosis Patients with Fresolimumab

June 22nd, 2015 in 2015, Health & Medicine, News Releases, School of Medicine 0 comments

EMBARGOED by the Journal of Clinical Investigation until June 22, 2015, 4 pm ET
CONTACT: Gina DiGravio, 617-638-8480, ginad@bu.edu

Rapid Skin Improvement Seen after Treating Systemic Sclerosis Patients with Fresolimumab

(Boston)— A major treatment breakthrough for total body scarring of the skin that occurs in patients with systemic sclerosis (SSc), also known as scleroderma, may soon be available for the estimated 300,000 Americans who suffer with this condition. Currently, no treatment is available.

Boston University School of Medicine (BUSM) researchers worked with 15 SSc patients who were treated with either one or two doses of fresolimumab, a new, unapproved drug therapy that targets a chemical mediator in the body known as TGF-beta. After seven weeks of treatment, the researchers examined the effect on skin scarring and on expression of molecular markers in the skin. In both clinical and molecular evaluations these patients showed profound decreases in skin scarring.

The researchers found that TGF-beta plays a critical role in skin scarring in patients with SSc. Although TGF-beta has long been implicated in causing scarring, this is the first clinical study to clearly show its impact on humans. The study appears online in the Journal of Clinical Investigation.

SSc is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. The disease may affect the connective tissue in many parts of the body including the skin, esophagus, gastrointestinal tract (stomach and bowels), lungs, kidneys, heart and other internal organs. It also can affect blood vessels, muscles and joints. The tissues of involved organs become hard and fibrous, causing them to function less efficiently.

“Our study shows that TGF-beta plays a critical role in skin scarring in patients with systemic sclerosis,” explained corresponding author Robert Lafyatis, MD, professor of medicine at BUSM and Director, BU Scleroderma Center of Research Translation. “Our results strongly indicate that targeting the TGF-beta in these patients will block skin scarring.”

According to the researchers proving that TGF-beta can block scarring may provide a major treatment advance for scarring-mediated organ dysfunction common to many diseases including lung fibrosis in idiopathic or radiation induced pulmonary fibrosis, liver fibrosis from viruses or toxins, kidney fibrosis from diabetes and other less common kidney diseases, and heart fibrosis that occurs after heart attacks and during heart failure.

A larger study with a placebo-treated group of patients is needed to confirm these results.

Research reported in this press release was supported by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award numbers P30AR061271, P50AR060780 and R01AR051089. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Genzyme (now a fully owned subsidiary of Sanofi) supplied the study drug and assisted with regulatory aspects, supplying the IND cross–‐reference letter and reviewing adverse events, but provided no other financial support for the study.

BUSM Researcher Receives $1.6 million NIH grant for Pneumonia Research

June 19th, 2015 in 2015, Health & Medicine, News Releases, School of Medicine 0 comments

FOR IMMEDIATE RELEASE, June 19, 2015
CONTACT: Gina DiGravio, 617-638-8480, ginad@bu.edu

BUSM Researcher Receives $1.6 million NIH grant for Pneumonia Research

(Boston)—Joseph Mizgerd, ScD, professor of medicine, microbiology and biochemistry at Boston University School of Medicine (BUSM), and director of the University’s Pulmonary Center, recently was awarded $1.6 million from the National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID). The four-year grant will be used to fund his project to better understand how immunity to pneumonia develops and how it protects certain individuals.

Pneumonia is a significant public health concern for infants, young children and the elderly. For children, pneumonia is the most common cause of death worldwide and of hospitalization in the US. Pneumonia rates plummet in early childhood and remain low for decades, until they begin rising around the fifth decade and escalate ever after. Beginning at age 50 for older Americans, pneumonia confers a significantly higher risk of death compared to all other common causes of hospitalization and half of all infectious disease hospitalizations and deaths are due to pneumonia.

According to Mizgerd there is little known about the naturally acquired protection against pneumonia in most older children and young adults. “The goal of this study is to better define the immune mechanisms preventing pneumonia during late childhood and much of adulthood,” he said.

Mizgerd believes that this pneumonia protection involves a special type of immunity that localizes in the lung tissue itself and cannot be measured with usual samples like blood, lymph nodes, or washings from the lung surface. “The study will determine whether a specialized immune cell that is only beginning to be known (resident memory T cells) is naturally generated by the usual childhood infections, whether it confers protection against pneumonia and whether it decreases with advancing age,” explained Mizgerd. “A better understanding of how the immunity that resides in the lung develops and protects against pneumonia will help us to figure out exactly who is most likely to get pneumonia and why, and how we can prevent or cure it.”

NIAID conducts and supports basic and applied research to better understand, treat and ultimately prevent infectious, immunologic and allergic diseases. For more than 60 years, NIAID research has led to new therapies, vaccines, diagnostic tests and other technologies that have improved the health of millions of people in the United States and around the world. NIAID is one of the 27 Institutes and Centers of the NIH.

Researchers Find NAS Treatment Needs Standardization

September 26th, 2014 in 2014, Health & Medicine, News Releases, School of Medicine 0 comments

FOR IMMEDIATE RELEASE: September 25, 2014
CONTACT: 
Jenny Eriksen Leary, 617-638-6841, jenny.eriksen@bmc.org

Researchers Find NAS Treatment Needs Standardization 

(Boston) – When it comes to treating infants with neonatal abstinence syndrome (NAS), researchers from Boston University School of Medicine (BUSM) believe the care for these infants should be consistent and objective, with standardized assessment tools and evidence to back up pharmacologic and nonpharmacologic treatment choices.

The review paper, which is published online in Addiction Science & Clinical Practice, highlights the need for more research in this field to optimize care for both infants and their mothers.

NAS is a collection of signs and symptoms infants can develop after birth following exposure to drugs in utero. These can include gastrointestinal, respiratory, autonomic and central nervous system disturbances from opioid withdrawal that affect critical regulatory areas after birth. According to a recent study in JAMA, the incidence of infants with NAS has increased over the past 10 years.

The initial development of the NAS assessment using a type of scoring system began in the 1970s and was considered a turning point in the care of infants with opioid exposure since pediatricians recognized the need for a consistent way of assessing exposure. The “Finnegan Score” (FS) was developed and is still widely used by observers seeking common signs of opioid withdrawal. Above a certain threshold, infants are started on pharmacologic therapies. However, since initial inception, the FS has been modified and used differently across institutions.

“We found that the data are limited to guide physician assessment and management of these infants and said lead author Sarah Bagley, MD, an addiction medicine fellow at BUSM and a physician in General Internal Medicine at Boston Medical Center.

The authors also highlight that nonpharmacologic interventions, including breastfeeding, may decrease the severity of NAS symptoms.

“We need more research in order to develop consistent criteria for physicians that will guide them in their treatment decisions, which can include medication and nonpharmacologic interventions,” added Bagley.

Funding for this research was provided in part by the National Institute on Drug Abuse under grant award numbers R25DA03211 and R25DA013582.

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Lactation Linked to Reduced Risk of Estrogen Receptor-Negative and Triple-Negative Breast Cancer

September 17th, 2014 in 2014, Health & Medicine, News Releases 0 comments

FOR IMMEDIATE RELEASE: September 17, 2014

CONTACT: Jenny Eriksen Leary, 617-638-6841, jenny.eriksen@bmc.org

Lactation Linked to Reduced Risk of
Estrogen Receptor-Negative and Triple-Negative Breast Cancer

(Boston) — Women who have had children (parous women) appear to have an increased risk of developing estrogen receptor-negative breast cancer, the subtype that carries a higher mortality rate and is more common in women of African ancestry.  A similar relationship was found for triple-negative breast cancer. However, the association between childbearing and increased risk of estrogen receptor-negative and triple-negative breast cancer was largely confined to the women who had never breastfed. These findings, published in the Journal of the National Cancer Institute, suggest that low rates of breastfeeding in African American women may contribute to their higher incidence of the more aggressive and difficult-to-treat subtypes of breast cancer.

Researchers from Boston University’s Slone Epidemiology Center (SEC) collaborated with the Roswell Park Cancer Institute of Buffalo, NY and the University of North Carolina Lineberger Cancer Center to form a consortium to study the determinants of breast cancer subtypes in African American women.  They combined data on breast cancer cases and controls from four large studies, including the Boston University Black Women’s Health Study. The combined analyses included 3,698 African American women with breast cancer, including 1,252 with the estrogen receptor-negative subtype.

They found that parous women had a 33 percent higher chance of developing estrogen receptor negative breast cancer than women who had never given birth. Women who had four or more births and had never breastfed any of their babies had a 68 percent higher chance of developing this type of cancer compared with women who had only one birth and had breastfed that baby. By contrast, parous women who had four or more births had a slightly decreased risk of estrogen receptor-positive breast cancer, regardless of whether or not they had breastfed.

Although previous studies have shown that overall risk of breast cancer may be elevated during the first 5 or 10 years after giving birth with a subsequent reduction in risk, this study suggests that the adverse impact on estrogen receptor negative breast cancer persists over time. The biologic mechanisms behind the association, however, are unclear. One hypothesis is that the immune system/inflammatory processes that occur during postpartum involution may play a role.

“Breast cancer mortality is disproportionately high in African American women of all ages, in part due to the higher incidence of estrogen receptor-negative breast cancer, with fewer targets for treatment,” says Julie Palmer, ScD, professor of epidemiology at SEC and lead author of the study.  “Breastfeeding represents a modifiable factor that could prevent some cases of this breast cancer subtype and reduce the number of African American women dying from this disease.”

Funding for the study was provided by the National Institutes of Health’s (NIH) National Cancer Institute under award number P01CA151135. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Dr. Belinda Borrelli Appointed Professor and Director of Behavioral Science Research in the Department of Health Policy & Health Services Research

September 17th, 2014 in 2014, Health & Medicine, News Releases 0 comments

FOR IMMEDIATE RELEASE: September 17, 2014

Contact:  Mary Becotte
Director, Communications & External Relations
Boston University Henry M. Goldman
School of Dental Medicine
617-638-5147, becottem@bu.edu

Dr. Belinda Borrelli Appointed Professor and Director of Behavioral Science Research in the Department of Health Policy & Health Services Research

(Boston) – The Boston University Henry M. Goldman School of Dental Medicine is pleased to announce the appointment of Belinda Borrelli, PhD as Professor and Director of Behavioral Science Research in the Department of Health Policy & Health Services Research.

Dr. Borrelli also holds an appointment as Visiting Professor at the University of Manchester in the United Kingdom, and Adjunct Professor at Brown University. She received her MA and PhD in Clinical Psychology from the University of Illinois, and completed her residency and fellowship training in Behavioral and Preventive Medicine at Brown University.  She proceeded through the academic ranks at Brown and became Full Professor in 2009.

Dr. Borrelli is internationally known for her work in motivating health behavior change, with over 85 peer-reviewed publications, over 20 NIH grant awards, and numerous grant awards from other agencies and foundations. Dr. Borrelli has made significant contributions to the field of Health Psychology. Her research includes developing and testing treatments to motivate smoking cessation and secondhand smoke reduction, improve oral health and dietary behaviors, and promote adherence to medications and treatment regimens for chronic diseases including sleep apnea, cystic fibrosis, and asthma.  Moreover, Professor Borrelli has been recognized for conducting high quality, theory-based, longitudinal research in urban, ethnically diverse, and low income and understudied populations, including Latinos, persons living with disabilities, Native Americans, and older adults.

Dr. Borrelli has served on grant review panels in the US, Europe, and the UK and is a Fellow of the American College of Reviewers.  She served as an advisor to the NIH on treatment fidelity, for both NIDCR and NHLBI, and has published several invited articles on best practice guidelines that have been widely disseminated.  She provided expert testimony to the Health Resources and Services Administration (HRSA) on motivating health behavior change. She is also a Fellow of the American Psychological Association. Dr. Borrelli is a member of several journal editorial boards and has been Associate Editor at leading journals in psychology such as Journal of Consulting and Clinical Psychology and Health Psychology, and the most cited journal in addiction science, Addiction. She has taught Motivational Interviewing to health care practitioners in the US and abroad.  During her tenure at Brown, she served as primary mentor to over 25 interns, post-docs, and NIH K award recipients.

Dean Jeffrey W. Hutter congratulated Dr. Borrelli on her appointment and said “I am excited to welcome Dr. Borelli to The Boston University Henry M. Goldman School of Dental Medicine. Her contributions in the field of preventative medicine and health research will be an asset to our community as we strive to fulfill our mission of becoming the premier academic dental institution promoting excellence in dental education, research, oral health care, and community service to improve the overall health of the global population.”

Dr. Borrelli will be working under Dr. Raul Garcia, Professor and Chair for the Department of Department of Health Policy & Health Services Research. He said, “I am very pleased that after six years of collaboration with our Center for Research to Evaluate and Eliminate Dental Disparities, Dr. Borrelli has now joined the GSDM faculty.  Dr. Borrelli is a talented researcher, whose internationally renowned work in promoting health behavior change will foster multidisciplinary collaborations, diversifying and strengthening the research program at GSDM and Boston University. “

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About Boston University Henry M. Goldman School of Dental Medicine: Founded in 1963, the Boston University Henry M. Goldman School of Dental Medicine is the premier academic dental institution promoting excellence in dental education, research, oral health care, and community service to improve the overall health of the global population. With a faculty of more than 325 educators, clinicians, and researchers and more than 250 staff members, the School offers a full spectrum of pre-doctoral and post-doctoral specialty education programs and a complete range of graduate programs and degrees to more than 700 students.

About Boston University: Founded in 1839, Boston University is an internationally recognized institution of higher education and research. With more than 33,000 students, it is the fourth-largest independent university in the United States. BU consists of 16 schools and colleges, along with a number of multi-disciplinary centers and institutes integral to the University’s research and teaching mission. In 2012, BU joined the Association of American Universities (AAU), a consortium of 62 leading research universities in the United States and Canada.

Epigenetic Drugs: A Hope to Treat Cancer Resistance and Reduce Cancer Relapse?

September 15th, 2014 in 2014, Health & Medicine, News Releases, School of Medicine 0 comments

Contact: Jenny Eriksen, 617-638-6841jenny.eriksen@bmc.org

(Boston)—High school biology taught us that we inherit certain traits from our parents that are pre-determined. But what if you could change how these genes play out by taking certain drugs or better yet, just changing your diet?

That’s exactly what a team of researchers at the Boston University School of Medicine (BUSM) have proposed through their research of epigenetics. Epigenetics regulates gene expression in a reversible manner by chemically modifying DNA and histone proteins, which prevent permanent mutations or alterations within the gene themselves.  Throughout the DNA processing, a single strand will go through countless modifications that determine whether certain genes will eventually be expressed. Often, the question is, to methylate or not to methylate? A single addition or subtraction of a few carbon and hydrogen ions can determine the silencing of a tumor suppressor gene, or the overexpression of an oncogene.

In a previous article published in the May issue of the journal Genetics & Epigenetics, the authors discuss how epigenetic modifications play a role in the development of diseases including cancer, cardiovascular, metabolic, neurologic and pulmonary disorders. They emphasized that pretreatment of cancer cells with epigenetic drugs in addition to standard chemotherapy may sensitize these cells to other cytotoxic (anti-cancer) drugs, especially important in the setting of drug resistance.

“Recent studies suggest that epigenetic modifications may contribute to the development of cancer progenitor cells that can induce drug resistance and the relapse of different types of cancer,” said Sibaji Sarkar, PhD, instructor of medicine at BUSM and the article’s corresponding author.

Adult drug resistant cancer cells may contribute to this problem, and the authors discuss these and other cancer drug resistance mechanisms in their recent publication in the September issue of the journal Cancers. Drug resistance is a major problem in cancer treatment, as drug resistant cancers are thought to be the primary cause of cancer relapse. The mechanisms that promote or enable drug resistance include drug inactivation, drug target alteration, drug removal from cells, DNA damage repair, cell death inhibition and the epithelial-mesenchymal transition (EMT) that enable solid tumors to transform into more metastatic grades. Cancer progression is extremely complex, and the variation in pathogenesis along with the heterogeneity of cancer cells in tumors and metastasized cancers, makes effectively treating cancer akin to hitting a moving target.

Cancer cells are opportunistic in the sense that they hijack cellular events necessary for development and survival. For example, genes involved in suppressing tumor formation are turned off via epigenetic mechanisms, and genes involved in rapid growth and replication are turned on too high. The authors hypothesize that in addition to these functions, epigenetic alterations may also serve as a common trigger through which susceptible and genetically predisposed stem cells become cancer progenitor cells. These progenitor cells are often drug resistant and can initiate cancer development and are possibly involved in cancer relapse. Moreover, epigenetic changes regulate cancer cell metastasis and the formation of heterogeneous cell populations that are very difficult to treat.

An example of epigenetic modifications leading to cancer progenitor cell formation possibly occurs in leukemia development. Mature leukemia cells express the MDR1 gene and are sensitive to normal drug regimens. However, cancer progenitor cells that highly express MDR1 are drug resistant. The MDR1 gene codes for a protein that helps to extract drugs from cells. When it is overexpressed, the cells become drug resistant. MDR1 expression is epigenetically regulated in leukemia progenitor cells, which makes it a prime target for possible drug therapies.

Epigenetic changes beyond a normal expression pattern can cause a variety of diseases. Previous studies have shown that a diet deficient in certain amino acids such as folate could alter some methylation actions in the liver, which if prolonged, could lead to hepatic carcinoma. Another study suggests that transient hyperglycemia could alter histone methylation, leading to diabetic complications.

“The reversible nature of these changes gives us hope that epigenetic drugs will be able to manage and cure these types of diseases and disorders,” said Sarkar.

Studies in cancer patients indicate reduced rates of relapse when patients are pretreated with epigenetic drugs due to its far-reaching capabilities; killing progenitor cells at the site of the tumor, in circulation, or at a distant site. These drugs sensitize cancer cells to alternative treatments and stave off progenitor cells that could prevent cancer relapse. There already has been great effort to elucidate the mechanisms of gene expression regulation, but it will be important to continue research to fully realize the potential of these epigenetic therapies and their applications in clinical settings.

Genevieve Housman, who serves as the first author of the Cancers article, was a student at Boston University (BU) and is now a graduate student at Arizona State University. Other BU student co-authors of this article fare Shannon Byler, Sarah Heerboth, Karolina Lapinska, Mckenna Longacre (currently at Harvard Medical School) and Nicole Snyder. Heerboth is the first author of the article in Genetics & Epigenetics. The other co-author BU students are Karolina Lapinska, Nicole Snyder, Meghan Leary and Sarah Rollinson.

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Clinical Assessment May Benefit Postpartum Women with Methadone Treatment Changes

August 26th, 2014 in 2014, Health & Medicine, News Releases, School of Medicine 0 comments

For Immediate Release, Aug. 25, 2014
Contact:
Jenny Eriksen Leary, 617-638-6841, jenny.eriksen@bmc.org

A recent study led by researchers at Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) found that women may not need significant methadone dose reductions in the first three months after pregnancy. Researchers reviewed the charts of 101 women who received care at a methadone maintenance treatment program between 2006 and 2010 after giving birth. They discovered that under the clinical assessment model—in which clinicians estimate patients’ methadone dose based on their individual physiologic parameters, rather than using a standard formula to reduce doses—women experienced on average only a small reduction in methadone dose. This suggests that, contrary to prior belief, changes in the physiology of women’s bodies from delivery to 12 weeks postpartum did not significantly affect their response to methadone.

Treatment for addiction in pregnant women is a complex topic. The gold standard for treatment is methadone maintenance, which has been shown to reduce illicit drug use and improve neonatal outcomes such as birth weight. Given the physical changes that happen to a woman’s body while pregnant, women often need higher doses to help them effectively manage their addiction during and after pregnancy. Yet, the optimal approach to adjusting methadone maintenance dosages during the postpartum period has long been unclear. Nonetheless, ensuring that women receive an appropriate dose is crucial to ensure ongoing sobriety while avoiding dangerous oversedation.

“This is an important issue because the postpartum period can be vulnerable for women struggling with opioid dependence, and it is crucial to ensure that the methadone dose is adequately high to continue to support recovery, while not causing oversedation,” said lead author Christine Pace, MD, an internist at BMC who specializes in addiction. “Oversedation is dangerous because women who are lethargic or sleepy are not able to care appropriately for themselves or their infants. In addition, patients who become over sedated from an excessive dose of methadone, with or without the addition of other medications or illicit drugs, may be at risk for overdose.”

The number of events where women appeared oversedated was slightly increased during the postpartum period, but still rare, occurring less than 6 times per 10,000 visit days. Many of the women who experienced these were also concurrently prescribed benzodiazepines. The authors caution that women receiving multiple sedating medications are particularly vulnerable and require more frequent surveillance.

“Our findings suggest that, given the physiologic changes and psychosocial stressors unique to the postpartum period, it is appropriate for methadone clinics to implement regular postpartum assessments at intervals extending at least up to 12 weeks after delivery. Clinicians also should take into account benzodiazepine use,” said Pace, also an assistant professor of medicine at BUSM. “Further studies are needed to guide safe and effective methadone dosing during the postpartum period in order to improve outcomes for both mother and child.”

Funding for this study was provided by National Institute on Drug Abuse (award number R25DA13582) and National Institute of Allergy and Infectious Disease (award AI052074-06A2).

 

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Low Birth Weight Linked to Higher Incidence of Type 2 Diabetes in African American Women

August 26th, 2014 in 2014, Health & Medicine, News Releases 0 comments

EMBARGOED by Diabetes Care until 3 p.m. ET, Thursday, August 21, 2014
Contact: Jenny Eriksen, 617-638-6841, jenny.eriksen@bmc.org

(Boston)— African American women born at a low or very low birth weight may be at a higher risk for developing type 2 diabetes. The findings, which appear in Diabetes Care, may explain in part the higher occurrence of type 2 diabetes in African American populations, which has a high prevalence of low birth weight.

Researchers from Boston University’s Slone Epidemiology Center followed more than 21,000 women enrolled in the Black Women’s Health Study over the course of 16 years, analyzing characteristics such as birth weight, current age, family history of diabetes, body mass index, physical activity and socioeconomic status.

The study results indicate that women with low birth weight had a 13 percent higher chance of developing type 2 diabetes than those with normal birth weight, and those with very low birth weight had a 40 percent higher chance of developing the disease. Low birth weight was defined as less than 2.5 kg, and very low birth weight as less than 1.5 kg. It appeared that body size did not play a role in this relationship as there was a clear association between birth weight and diabetes even for women who were not obese.

Although previous studies have shown that birth characteristics such as birth weight can have a major impact on adult health, this is the first large-scale study to demonstrate this effect in an African American population.

“African American women are at increased risk of developing type 2 diabetes, and also have higher rates of low birth weight than white women,” said Edward Ruiz-Narváez, ScD, assistant professor of epidemiology at Boston University School of Public Health. “Our study shows a clear relationship between birth weight and diabetes that highlights the importance of further research for this at-risk group.”

According to the researchers, there are two leading hypotheses for the phenomenon. The first, known as the “thrifty phenotype hypothesis,” states that once the newborn body perceives that it lacks nutrition, it reprograms itself to absorb more nutrition, causing an imbalance in metabolism that eventually leads to type 2 diabetes. The second, known as the “fetal insulin hypothesis,” states that genes that are responsible for impaired insulin secretion also have a negative effect on birth weight. Some of these genes have been discovered in recent studies, supporting the latter hypothesis.

Funding for this study was provided by grants from the National Institute on Minority Health and Health Disparities, the National Cancer Institute and the American Heart Association.

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Review of Clinical Treatment of Bronchiolitis in Infants Reveals Overreliance on One Test

August 19th, 2014 in 2014, Health & Medicine, News Releases, School of Medicine 0 comments

EMBARGOED BY JAMA until 4 p.m. Tuesday, Aug. 19, 2014
Contact: Jenny Eriksen Leary, 617-638-6841, jenny.eriksen@bmc.org

(Boston) – An editorial published in this week’s JAMA highlights the importance of physicians using all available clinical assessment tools when considering how to treat patients. Written by Robert Vinci, MD, chief of pediatrics at Boston Medical Center and chair of pediatrics at Boston University School of Medicine and Howard Bauchner, MD, editor-in-chief of JAMA, the editorial examines results of a study published in the same issue of the journal as an example of how doctors can often over-emphasize certain types of data.

The study examined how pediatric emergency medicine physicians treat a respiratory tract infection called bronchiolitis in infants, and how they incorporate factors such as respiratory exam, imaging tools and blood tests when deciding on treatment. Doctors also commonly use the level of oxygen saturation, measured by a simple machine called an oximeter, which measures how well the blood carries oxygen; generally, the higher the number, the better. In the study, emergency department physicians were presented with two groups of infants with bronchiolitis, one in which they were shown the true oxygen saturation level and the other in which they were shown an altered number that was three percent higher than the actual saturation level.

The results indicated that the clinicians were 40 percent less likely to admit the patients with the falsely higher oxygen saturation level into the hospital even though the two groups had otherwise similar symptoms and illness severity. This supports the notion that clinicians may often overlook other important components of the clinical assessment in favor of a single parameter.

The editorial stresses the challenges that clinicians often face in treating disorders where there are no standard treatment protocols and emphasizes that analyzing all available data to make the best clinical judgments and decisions is the true art of medicine.

“Although it may seem wrong, the study authors followed established guidelines such as obtaining consent from parents and also ensured the safety of patients by only enrolling patients with mild disease,” said Vinci about the ethics of deceiving physicians for the purpose of research in the editorial. “In an area of research where there is much uncertainty about how we should best treat patients, studies such as this may be necessary to gather important information, as long as researchers ensure patient safety.”

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