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The research, described in the Journal of Psychiatric Research, was completed by Dr. Maureen Murdoch and colleagues of the Minneapolis VA Health Care System and University of Minnesota Schools of Medicine and Public Health in collaboration with researchers from Illinois State University, Normal, IL; North Florida/South Georgia Veterans Health System, Gainesville, FL; and Analytic Services, Inc., Arlington, VA. 

The researchers conducted a mailed survey of 681 confirmed active duty troops registered in the VA’s Enrollment Database between 2001 and 2003. Eighty-four percent of contacted troops responded.

Most prior research examining associations between military sexual stressors and psychiatric symptoms has not accounted for participants’ other stressor experiences and consequently may have over- or under-estimated the association between military sexual stressors and psychiatric symptoms.

By evaluating troops’ stressor experiences more comprehensively, the researchers discovered that many stressors are interrelated. For example, troops who experienced childhood maltreatment were also more likely than other participants to report military sexual stressor experiences, and they were more likely to report other high magnitude stressors.

Working in a military unit seen as tolerating sexual harassment was also associated with reporting more types of military sexual stressors and with reporting more psychiatric symptoms. Findings remained the same when men and women were analyzed separately. The researchers speculated that learning how and why childhood maltreatment increases troops’ odds of experiencing military sexual stressors might lead to interventions to reduce the latter.

"Eradicating tolerance for military sexual harassment might also reduce troops’ risk of experiencing military sexual stressors and reduce psychiatric symptoms," Dr. Murdoch said.

The researchers studied a unique sample of military personnel, and members of the Marine Corps were especially underrepresented. Therefore, the researchers cautioned that the results may not pertain to the Marine Corps or to the military as a whole. The researchers urged that additional studies be done in other military populations to see if their findings could be replicated.

The research was funded by the Department of Veterans Affairs Health Services Research and Development Service.

As Christensen stops to describe different species in the room, collected from native ranges in Egypt, India, Iowa and Colorado, a single free-range mosquito darts overhead. The mind anticipates that next step in the dance: a sudden stinging pain and an awkward slap at some hard-to-reach patch of exposed skin.

The nuisance factor of Wisconsin’s unofficial state bird is trivial compared to the life-and-death issues that concern Christensen’s lab. He is exploring the mosquito’s role as a carrier of serious diseases such as malaria, yellow fever and encephalitis.

Christensen, a professor of animal health and biomedical sciences, has been tracking mosquito-borne diseases for the past two decades. The work begins with field collections of mosquitoes and the parasites that cause human disease, primarily in sub-Saharan Africa and other tropical regions.

In the lab, Christensen’s team investigates the genetic rules that determine whether mosquitoes can kill disease-causing parasites, or pass them on to humans.

This is a high-stakes field, and getting more so every year, Christensen says. In a recent address, President Clinton identified malaria along with tuberculosis and HIV as the three greatest public health threats facing the world.

“Most people don’t realize how catastrophic these things are,” he says. “When you’re dealing with malaria, you’re dealing with about a half-billion people infected at any one time.

“We’re talking about one to three million people dying each year. The vast majority are in sub-Saharan Africa and the vast majority are children under the age of five.

“As an analogy, think of anywhere from 10 to 18 jumbo jets full of children crashing every day. Can you imagine the amount of emphasis malaria would have if this was a disease that was ravaging the North American continent or Europe?”

What’s worse, Christensen says, is that traditional methods of controlling mosquitoes are losing their effectiveness. And potentially useful controls such as DDT are so toxic they potentially create more problems than they solve. DDT is targeted for a worldwide ban on its usage.

That means new controls are needed and some ideas are coming from genetic research.

“Our major question is, what genetic functions allow a mosquito to kill parasites?” Christensen says. All mosquitoes have an innate ability to kill a foreign invader, but serious parasites like malaria somehow elude these natural defenses.

By fully understanding the genetics involved, Christensen hopes to identify the anti-parasitic genes in mosquitoes. The question is not only finding a potential genetic silver bullet, but transferring it into a wild population without monstrous consequences.

Although it sounds far-fetched, Christensen says this line of work could lead to a “mosquito vaccination strategy,” by introducing molecules into the environment that produce an immune response in mosquitoes. It could be passed on in wild mosquitoes from regions with high infectious disease rates.

“We’re not trying to produce a “super-mosquito’ with a foreign gene that would make it radically different from its counterpart,” he says. “We’re not changing genes as much as helping mosquitoes express genes they already have.”

Christensen’s group has been focusing special attention on a mosquito from the Nile River Delta which carries a disease called lymphatic filariasis, caused by a parasite whose only host is humans. They are finding some strains of the mosquito that are remarkably adept at killing this parasite, which gives the researchers a comparison group to other mosquitoes.

Infectious diseases are beginning to take center stage in this country as fears are fueled by disease outbreaks in new territory, such as the West Nile Fever outbreak recently in New York City. And as Americans travel more and pursue ever-more exotic locales, the likelihood of new outbreaks increases.

On a recent international plane trip, Christensen was headed to Bombay, India, via airport stops in Chicago and England. On the way, he became aware of a fly buzzing around in the cabin. He had no idea whether it came from Chicago or London. “But it’s definitely headed to Bombay,” he says.

Christensen sees an encouraging trend on the UW-Madison campus today. Many students are interested in studying infectious diseases, and nearly 200 undergraduates take his general parasitology course each semester. Some of them go on to do stints in the Peace Corps.

“For infectious diseases, it’s a very scary time right now,” he says. “People are starting to feel more vulnerable.”

Georgia Health Sciences University scientists have devised a way to reduce lung cancer cells’ ability to repair the lethal double-strand DNA breaks caused by radiation therapy.

"Radiation is a great therapy — the problem is the side effects," said Dr. William S. Dynan, biochemist and Associate Director of Research and Chief, Nanomedicine and Gene Regulation at the GHSU Institute of Molecular Medicine and Genetics. "We think this is a way to get the same amount of cancer cell death with less radiation or use the same amount and maybe cure a patient that could not be cured before."

Radiation therapy capitalizes on radiation’s ability to kill cells by causing double-strand breaks in DNA. But the fact that varying levels of radiation are essentially everywhere — food, air, the ground, etc. — means all cells, including cancer cells, have internal mechanisms to prevent the lethal breakage.

GHSU scientists are targeting the natural defense mechanisms by packaging a piece of an antibody against one of them with folate, which has easy access to most cells, particularly cancer cells. Many cancers, including the lung cancer cells they studied, have large numbers of folate receptors so that cancer cells get a disproportionate share of the package.

Previous efforts to destroy cancer cells’ ability to avoid radiation damage have focused on receptors on their surface, said Dr. Shuyi Li, molecular biologist, pediatrician and corresponding author on the study in the International Journal of Radiation Oncology.

To get a more direct hit, the scientists took advantage of folate receptors as a point of entry by chemically binding folate with the small piece of their antibody, ScFv 18-2. The package heads straight for the cell nucleus where a different chemical environment breaks the bond, freeing ScFv 18-2 to attack the regulatory region of DNA-dependent protein kinase, an enzyme essential to DNA repair.

"We are joining a targeting molecule with a cargo," said Dynan. "This strategy targets one of the key enzymes so it’s harder to repair," Li said. This makes cancer cells more vulnerable to radiation.

Dynan and Li say the approach could be used to deliver any number of drugs directly inside cancer cells. Future studies include looking at other cell entry points as well as other targets to ensure they have the most effective package. Studies to date have been in human lung cancer cells in culture, so next steps also need to include animal studies.

Their approach mimics a natural process called endocytosis in which cells engulf proteins and other substances they want to let inside but can’t fit through normal doorways.

Folate receptors already are being used as direct entry points for chemotherapeutic drugs, including clinical studies of a new strategy for ovarian cancer. GHSU is participating in clinical trials of a therapy that pairs an agent too toxic to be delivered through the bloodstream with folate to better target one of the most deadly cancers.

Dynan is the Georgia Research Alliance Eminent Scholar in Molecular Biology. Dynan and Li are both faculty members in GHSU’s Medical College of Georgia. Dynan also is a faculty member in the College of Graduate Studies.

“The good news is that the vast majority of these cancers were low and intermediate grade, which often are not clinically significant,” said Leslie Ford, M.D., associate director for clinical research in NCI’s Division of Cancer Prevention, who participated in the research.

“This was the first systematic study of men with PSA levels from 0 to 4 nanograms per milliliter (ng/ml). It shows that cancer of the prostate can be present in men with ‘normal’ PSAs,” said Ian Thompson, M.D., University of Texas Health Science Center at San Antonio, who led the study. Doctors often use the value of 4.0 ng/ml or greater as the trigger for further investigation, such as a prostate biopsy. A PSA level below 4.0 is generally considered normal.

Prostate cancer clinicians often say that men are much more likely to die with prostate cancer than from it. According to recent autopsy studies, many men over age 50 have early, undiagnosed prostate cancer. Clinicians concur that most early cancers remain harmless, though some may progress to clinically significant disease.

The 2,950 men in this study were from the “control arm” of the Prostate Cancer Prevention Trial (PCPT), an NCI-funded study that found in 2003 that the drug finasteride reduced by 25 percent a man’s chances of getting prostate cancer.

Men in the control arm were given a placebo, or sugar pill, instead of finasteride and, like the men on the finasteride arm, received annual prostate screening for seven years with a PSA test and a digital rectal exam (DRE). All men in PCPT entered the trial at age 55 or above, had an initial PSA level of 3 ng/ml or less, and a normal DRE. All were asked to undergo an end-of-study prostate biopsy. The report released today focused on men at low risk of having prostate cancer––the 2,950 men on the placebo arm who had normal DREs and PSAs less than or equal to 4 ng/ml for the seven-year study duration.

Since the late 1980s, PSA tests have been widely used in the United States in an attempt to detect prostate cancer at an early stage. However, PSA testing has never been proven to reduce the risk of dying from prostate cancer. Not all prostate cancer detected by PSA screening is clinically relevant and, therefore, screening carries a risk of “over-diagnosing” the disease, which could lead to unnecessary surgery or radiation therapy. Thus, PSA testing is not a universally recommended screening procedure. An ongoing NCI study is addressing the issue of whether PSA screening reduces the risk of death from prostate cancer.

“The main study finding was that 15 percent of the men in the PCPT control arm had a positive end-of study biopsy despite having PSA levels below 4 ng/ml and normal DREs throughout the study,” said Thompson.

Importantly, the study also found that only 2.3 percent of men in the PCPT control arm with PSA levels of 4 ng/ml or less had high-grade cancers. For men with a PSA of 2 or lower, the chance of having a high-grade cancer was even lower––1.4 percent. Grade was measured by Gleason score, a system that ranks tumors from 2 to 10 based on their appearance under the microscope. High-grade tumors––Gleason scores of 7 to 10––often grow more quickly and may be more likely to spread than lower-grade tumors.

Gleason scores of the highest grades––8 or 9––were found in only seven participants, or 0.2 percent of men in the PCPT control arm. Most of the men with prostate cancer, 349 of them (78 percent), had Gleason scores of 5 or 6.

“Most of these men would not have been diagnosed if they had not taken part in this study, since biopsies are not routinely performed in men with such low PSA levels,” said Ford.

“We need better methods to distinguish the harmless, slow-growing cancers from the more aggressive ones,” continued Ford. “If more biopsies are performed at lower PSA levels, more cancers will be found and treated. But some men would undergo treatment, and the risks associated with it, for tumors that would never have been clinically significant.”

Treatment for prostate cancer can sometimes lead to impotence, urinary incontinence, and other problems, causing a substantial health burden for men.

“Lowering the PSA threshold for proceeding to prostate biopsy would increase the risks of overdiagnosing and overtreating clinically unimportant disease,” said Thompson.

NCI-funded researchers are looking for ways to determine which men harbor aggressive tumors. The NCI Early Detection Research Network (EDRN) has a Prostate Collaborative Group, which is applying a variety of strategies to find ways to detect prostate cancer early. Some scientists are using the new tools of genomics and proteomics to look at how gene expression patterns and proteins in the blood may differ in men with aggressive tumors vs. those with slow-growing ones.

“There is a great need for methods, beyond tumor grade, to better predict which men have prostate cancers requiring treatment,” said Thompson.

Prostate cancer is the most common cancer in men, after skin cancer. It estimated that approximately 230,110 men in the United States will be diagnosed with the disease this year, and about 30,000 men will die from it.

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For more information about cancer, visit the NCI Web site at cancer or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

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* Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level less than or equal to 4.0 ng per Milliliter. New England Journal of Medicine, May 27, 2004; 350(22):2239-2246.

“We set out to look at the safety and impact of zinc supplements in children with HIV. Not only did we learn that zinc is safe for these children, but we also realized that this may be a low-cost intervention to reduce morbidity in HIV-infected children who don’t have access to antiretroviral therapy or are not eligible for treatment,” said William J. Moss, MD, MPH, senior author of the study and an assistant professor in the Bloomberg School of Public Health’s Department of Epidemiology.

The researchers completed a randomized, double-bind, placebo-controlled trial of zinc supplementation at an urban hospital in Pietermaritzburg, South Africa. The 96 children in the study were cared for on a monthly outpatient basis by a team of medical doctors and nurses. Parents were taught how and when to give the 10-mg zinc or placebo tablets to their child every day for six months. The children were seen at the hospital every two weeks for the first month, monthly for five months and, as a final visit, nine months after zinc or placebo supplementation began. At each follow-up visit, parents were asked about illnesses since the last visit. In addition, HIV-1 RNA in plasma and CD4+ T lymphocyte cell counts were measured one month before the study, at the first study visit and three, six and nine months after the start of supplementation.

The study authors found no increase in plasma HIV-1 viral load measurements in the children receiving zinc, meaning that zinc supplementation is safe for HIV-infected children. The CD4+ T lymphocytes and hemoglobin concentrations also were similar between the two study groups. Importantly, HIV-infected children who received zinc supplementation were less likely to get watery diarrhea.

“Programs to increase zinc supplementation in populations with a high prevalence of HIV infection can and should be implemented, and can be done so now that we know zinc does not have an adverse effect on HIV replication. Also, in light of the fact that zinc is known to reduce episodes of diarrhea and pneumonia, zinc supplementation should be used as an adjunct therapy for children with HIV infection,” said Moss.

The study was funded by the Johns Hopkins Family Health and Child Survival Cooperative Agreement with the Office of Health, Infectious Diseases and Nutrition Global Health Bureau at the U.S. Agency for International Development.

Robert E. Black, MD, MPH, chair of the Bloomberg School of Public Health’s Department of International Health, co-authored the study. Additional co-authors are Raziya Bobat, Hoosen Coovadia, Cindy Stephen, Kimesh L. Naidoo and Neil McKerrow.

Statistics show that gains in survival rates for teenagers and young adults (age 15 – 29) with cancer are dismal when compared to those for youngsters and older adults with the disease.

"While there have been improvements in survival in children and older adults in recent decades there has been no such improvement in this age group in the past 25 years or so," said Barr, a professor of pediatrics of the Michael G. DeGroote School of Medicine at McMaster University and chief of hematology-oncology at McMaster Children’s Hospital.

Barr is involved in local, national and international efforts to reverse this trend.

Barr is one of the editors of the recently released and first definitive document on the incidence, survival and mortality of 15 – 29 year-olds. Funded by the National Cancer Institute (NCI) in the United States, this monograph was a co-operative venture between the Children’s Oncology Group (all 17 pediatric oncology centers in Canada and more than 200 American institutions) and the SEER (Survival Epidemiology and End Results) program.

Barr is a member of the NCI and Lance Armstrong Foundation’s new Progress Review Group whose sole purpose is identifying and prioritizing the scientific, medical and psychosocial barriers facing adolescent and young adult (AYA) cancer patients. They plan to develop strategies to better the odds for this age group.

"The Lance Armstrong Foundation is very keen to advocate for young people with cancer and educate them in high schools, colleges and work places to the fact cancer can afflict people in their age group – and that when they get a lump they shouldn’t say ‘it’s just a lump’ but that it might be a form of cancer," Barr said.

Barr co-chairs the Working Group on AYA within the International Society for Pediatric Oncology which will soon publish proceedings from its first workshop on AYA adolescent and young adults with cancer. He is also one of the authors and editors of an upcoming book on this issue.

He said there are a variety of reasons why the outlook is so poor for this particular age group. Chief among them is the fact so few are participating in clinical trials – organized studies which test the value of various treatments, such as drugs or surgery in human beings. This lack of involvement correlates directly with their poor survival rates, he said.

Young people’s feelings of invincibility, coupled with a lack of awareness about their cancer risk, are other factors. And often family physicians aren’t suspicious enough of teenagers’ symptoms, interpreting a lump in the neck as an infection or leg pain as an athletic injury or growing pains, which delays an accurate diagnosis.

Even more confusing, Barr said, is the fact that the types of cancer within the 15 – 29 age group occur at different frequencies across this age range, the most common types in teenagers being different from the most common types in young adults.

In a study of preschoolers ages 3 to 5, involving two separate experiments, researchers found that salt, sugar and fat are what kids most prefer — and that these children already could equate their taste preferences to brand-name fast-food and soda products.

In a world where salt, sugar and fat have been repeatedly linked to obesity, waiting for children to begin school to learn how to make wise food choices is a poor decision, says T. Bettina Cornwell, a professor of marketing in the University of Oregon Lundquist College of Business. Children even are turning to condiments to add these flavors — and with them calories — to be sure that the foods they eat match their taste preferences.

"Our findings present a public policy message," Cornwell said. "If we want to pursue intervention, we probably need to start earlier." Parents, she said, need to seriously consider the types of foods they expose their young children to at home and in restaurants. "Repeated exposure builds taste preferences."

Cornwell and co-author Anna R. McAlister, a consumer science researcher at the University of Wisconsin-Madison, involved both developmental psychology and marketing for the two-part study. It appeared online in January ahead of regular publication in the journal Appetite.

In the first experiment, 67 children (31 boys, 36 girls) and their mothers were recruited from pre-school classes in a large city. The mothers completed a 21-item survey to report on their taste preferences of their children. The children responded to their perceived tastiness of 11 natural and 11 flavor-added foods. The photos of the foods were presented without labeling or packaging. Researchers found strong agreement in that both parental and children’s perceptions matched: Parents noted the desire for foods high in sugar, fat and salt, while their children showed preference for flavor-added foods, which contained these ingredients.

Foods well within the preschoolers’ experience were presented in the experiment. Natural foods included apples, bananas, plain milk, fruit salad, water, green beans and tomatoes (strawberries and watermelon were the top picks; flavor-added foods included such things as cheese puffs, corn chips, watermelon hard candy, jellybeans, banana soft candy, ketchup, colas and chocolate milk (strawberry ice cream and jellybeans scored the highest).

In the second experiment, researchers explored the association of preschoolers’ palate preferences to their emerging awareness of brands of fast foods and sugar-sweetened beverages. Participating were 108 children (54 boys, 54 girls) from five urban pre-schools. Each child was shown 36 randomly sorted cards — 12 related to each of two popular fast-food chains, six to each of the two leading cola companies and six depicting irrelevant products. All children were able to correctly place some of the product cards with the correct companies, indicating their differing levels of brand recognition.

The results, the researcher wrote, "suggest that fast food and soda brand knowledge is linked to the development of a preference for sugar, fat and salt in food." The relationships, they added, appeared to reflect the children’s emotional experiences in a way that says the brand-named products deliver their developed taste preferences.

It may well be, Cornwall said, that when parents repeatedly serve certain foods, their children acquire a taste for them and soon recognized what brands deliver that taste. Earlier research has shown that children given red peppers on 10 different occasions will acquire a taste for red peppers and that logic extends to other foods. Children served French fries will, in turn, develop a preference for French fries.

Fighting childhood obesity, Cornwell says, should begin at home. First, families should focus on reducing the consumption of low-nutrient "junk" foods and replacing them with increased servings of healthy foods. Such an approach, the researchers noted in their conclusion, moves away from issues of weight and dieting — instead targeting the development of tastes preferences.

In a previous paper in the Journal of Public Policy & Marketing, Cornwell and McAlister found that children begin to understand persuasion as early as age three and most develop this sense by age six. They argued that advertising targeting children should be monitored and regulated.

"Lifestyle modification should be the first line of treatment for obesity," says Susan Yanovski, M.D., director of the Obesity and Eating Disorders Program for NIDDK, and author of an accompanying editorial in the journal. "But for obese adults who can’t lose enough weight to improve their health, medication used as an adjunct can help."

"The take home message is that weight loss medications will be most effective when they are combined with a reduced calorie diet and increased physical activity," says Thomas A. Wadden, Ph.D., Professor of Psychology in the Department of Psychiatry at the University of Pennsylvania School of Medicine, and lead author of the study. "Weight loss medication used alone can produce some weight loss, but lifestyle modification treatment can help patients acquire skills to successfully make changes in their diet and physical activity."

A total of 224 obese adults aged 18 to 65 years participated in the one-year study. Participants were randomly assigned to one of four groups: 1. weight loss medication alone; 2. lifestyle modification alone; 3. weight loss medication plus lifestyle modification; and 4. weight-loss medication plus brief physician-mediated therapy. The researchers included the fourth treatment group to measure the effectiveness of weight-loss medication combined with brief lifestyle modification counseling delivered by primary care providers. The researchers looked at this type of therapy as a possible model for delivering lifestyle modification therapy in the setting of primary care practice.

Participants in the lifestyle modification therapy group attended a total of 30, 90-minute group meetings. During the meetings participants were instructed to complete and share weekly assignments, which included keeping detailed daily food and physical activity records. Participants in the brief lifestyle modification counseling group met with primary care physicians eight times for 10 to 15 minute visits, where they were given homework assignments, which also included keeping daily food and activity records. Participants in the weight-loss medication therapy alone group also met with primary care physicians eight times for 10 to 15 minute visits, but were not instructed to keep food or activity records and were provided only general information on diet and exercise. Those participants in the combined therapy group received both the lifestyle modification therapy and the weight-loss medication. All groups were prescribed a 1200 to 1500 calorie diet and the same exercise plan.

After one year, patients in the weight-loss medication plus lifestyle group lost an average of more than 26 pounds – more than double the weight loss seen with medication alone (11 pounds). In addition, 73 percent of participants in the combined therapy group lost 5 percent or more of their initial body weight, compared to 56 percent of participants in the brief therapy plus weight-loss medication group, 53 percent of participants in the lifestyle modification alone group, and 42 percent of participants in the weight-loss medication alone therapy group. More than half or 52 percent of people in the combined therapy group lost 10 percent or more of their initial body weight compared to 29 percent of participants in the lifestyle modification alone group, 26 percent of participants in the brief therapy plus weight-loss medication group, and 26 percent of participants in the weight-loss medication alone group.

Interestingly, those participants in the combined therapy group who were most successful were those who frequently recorded their food intake. Those participants with high adherence to food intake record keeping lost more than twice as much weight as those with low adherence (41.5 versus 17 pounds).

"Some people have questions about how they can do lifestyle modification," says Dr. Wadden. "I think that a first step is to complete daily food logs. Food records help people become aware of their eating patterns and identifying areas for improvement." Dr. Wadden adds that the second step to weight loss is to increase physical activity and one of the best ways to do that is to obtain a pedometer to count steps and gradually increase daily walking.

One limitation of the study is that it only included obese patients who were otherwise healthy and excluded obese patients with health problems possibly related to their obesity, such as hypertension, cardiovascular disease, cerebrovascular disease, kidney disease, liver disease, and diabetes. Because many obese patients also have other conditions that can adversely affect their health, physicians should carefully monitor patients enrolled in weight-loss programs that include weight-loss medications.

The findings of the study are consistent with the NIH Obesity Clinical Guidelines, which recommend that weight loss medications be used in a supportive role to a comprehensive program of behavioral treatment, diet therapy, and increased physical activity. The NIH Obesity Clinical Guidelines state that the most successful strategies for weight loss include calorie reduction, increased physical activity, and behavioral therapy designed to improve eating and physical activity habits. The Guidelines also recommend that physicians prescribe a regimen of lifestyle therapy for at least six months before adding weight-loss medication to the regimen. More information on the NIH Obesity Clinical Guidelines is available on the NIH web site at nhlbi.nih/guidelines/obesity/ob_home.htm.

According to data from the 1999 to 2000 National Health and Examination Survey (NHANES), approximately 65 percent of Americans aged 20 years or older are overweight with 31 percent of adults obese as defined by body mass index (BMI). BMI is a calculation that takes into account both height and weight. Overweight is defined as having a BMI of 25 to 29.9 kg/m2. Obesity is defined as having a BMI of 30 kg/m2 or higher. The NIDDK Weight-control Information Network fact sheet, Statistics Related to Overweight and Obesity (win.niddk.nih/statistics/index.htm) provides more information.

They examined the implementation of current treatment guidelines and found that few countries are equipped to quickly adapt policies, and many struggle to develop and maintain the recommended supplies. The analysis is featured in the October issue of Bulletin of the World Health Organization.

"Low osmolarity ORS and zinc are inexpensive, safe and easy to use and have the potential to dramatically lower diarrhea morbidity and mortality," said Robert Black, MD, MPH, co-author of the article, chair and Edgar Berman Professor of International Health at the Bloomberg School. "Many countries have changed diarrhea management policies to include low osmolarity ORS and zinc, but there is a significant gap between policy change and effective program implementation, leaving few children treated appropriately. In many countries, adopting child health policies is complex and the registration and importation of zinc supplements requires input from drug regulatory agencies and procurement officials, making it difficult to secure these necessary supplies."

Diarrhea remains the second leading cause of death among children globally, accounting for 18 percent of childhood deaths and 13 percent of all disability-adjusted life years. In 2004 the World Health Organization (WHO) and UNICEF released a joint statement recommending countries switch to a lower osmolarity formulation ORS and introduce zinc supplements for 10 to 14 days to decrease diarrhea deaths among children. The recommendation came after scientific consensus that this treatment has the potential to reduce more than three quarters of all diarrhea associated deaths. Large scale programs in Bangladesh and India have demonstrated that together they can decrease unnecessary use of antibiotics and reinvigorate community management of diarrhea while keeping costs low and saving lives.

"Of 68 priority countries, very few have zinc widely available and coverage within all countries is extremely limited. Ranked by leading global economists as one of the most cost-effective intervention for advancing human development, zinc supplementation in diarrhea management should be a top global health priority," said Christa Fischer Walker, PhD, MHS, lead author of the analysis and an assistant scientist with the Bloomberg School’s Department of International Health.

Although there is an urgent need for better studies in this area, research to date provides some evidence that high alcohol consumption in late adolescence often continues into adulthood and is associated with long-term alcohol problems, including dependence.

The authors of the current study conducted a comprehensive literature review to identify 54 relevant studies which included at least one quantitative measure of the effects of alcohol, on outcomes in adulthood such as death, alcohol dependence, criminal offences, mental health, educational attainment, and smoking. The majority of these studies were multiple reports from ten cohorts, half of which were from the US.

The authors found that although there is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is associated with alcohol and other problems, most of these studies could not strongly support direct causality because of their weak designs. Furthermore, although a number of studies suggested links with late adolescent drinking to adult physical and mental health and social consequences, this evidence is generally of poorer quality and insufficient to infer causality.

According to the authors: "It is clear that the evidence base on long-term consequences is not as extensive nor as compelling as it could be." Despite this limitation, they are able to say: "late adolescent alcohol consumption appears a probable cause of increased drinking well into adulthood, through to ages at which adult social roles have been achieved." However, they caution: "Heavier drinking seems most likely, however, to be only one component in a complex causal process, whose contribution has probably been overestimated in previous studies because of uncontrolled confounding, setting aside the uncertainties induced by self-reported data."