Do I Really Need a Diabetes Screen?

By Peter J. Gagianas, M.D. 
We are in the midst of a health care crisis. We are all aware of the rising cost of health care, as seen in our escalating health insurance premiums and higher out-of-pocket medical expenses. A significant contributor to these high costs is the staggering rise of diabetes and its complications. According to the American Diabetes Association, 23.6 million children and adults in the United States (7.8% of the population) have diabetes. Of those 60 and older, 23.1% are diabetic! This is a direct result of our aging population, which is becoming less active and more overweight. 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year. According to the World Health Organization, people with diabetes require at least 2-3 times the health care resources of people who do not have diabetes, and diabetes care accounts for up to 15% of national healthcare budgets. 
The complications of diabetes are common and serious. The risk of a heart attack or a stroke is 2-4 times higher in a diabetic than in a non-diabetic. Two out of three people with diabetes die from heart disease or stroke. Diabetes is a leading cause of blindness and kidney failure, as well as limb amputations and nerve damage. By the time diabetes is diagnosed, half will already have developed complications. These complications can be avoided or minimized if diabetes is detected early, and proper care is delivered. A study at Emory University even showed that screening adults for diabetes could yield greater cost-savings for healthcare systems than not screening them at all. 
The American Diabetes Association recommends screening all adults for diabetes, with a blood test, every 3 years starting at age 45. If there are additional risk factors for developing diabetes, then testing is recommended earlier and more frequently. Some of these risk factors include: physical inactivity, a close relative with diabetes, certain high-risk ethnic populations, hypertension, abnormal cholesterol, and a history of heart disease. 
Make sure you see your doctor for regular physical exams and health screens, so that diseases like diabetes may be detected and treated early. You’ll be glad you did! 
Dr. Peter J. Gagianas is a Family Practice Physician with Family Practice Medical Associates, South. He has been with Primary Physicians Research as a Sub-investigator since 2006 and in 2008 became a Primary Investigator. Dr. Gagianas can be reached at (412) 831-8089.

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UPMC research study on postpartum depression seeking local participantss

Hermitage, PA  – 3/4 Mercer County area women interested in participating in a postpartum depression research study now have the option to do so without going far from home.
        Womens Behavioral HealthCare of Western Psychiatric Institute and Clinic, locally based at the Womancare Center of UPMC Horizon in Hermitage, is currently recruiting participants for a research study on treatment of depression after childbirth.
        The study, which has screened more than 8,000 women since 2005, is conducted by Katherine L. Wisner, MD, MS, professor of psychiatry, obstetrics, and gynecology and epidemiology at the University of Pittsburgh School of Medicine and director of Womens Behavioral HealthCare.
        Postpartum depression affects one out of eight new mothers within a year of giving birth. Symptoms include loss of interest and energy, sleeping too much or too little, irritability, anxiety, feeling guilty or worthless, withdrawal from friends and family, eating too much or too little, crying, and thinking about hurting yourself or your baby.
        Women between the ages of 18 and 40 who have given birth during the past three months and have had an episode of depression qualify for the study. Participation includes contact with a staff member, either over the telephone or in person at the Womancare Center, for up to eight weeks. After the first visit, participants will be randomly assigned to receive estrogen, and antidepressant, or a placebo. Compensation is available.
        For more information about the research study, call 1-800-436-2461 or visit www.womensbehavioralhealth.org. Questions may also be directed to Laurie Joanow, research coordinator, at 724-699-2870.  Information on research studies available through UPMC Horizon can be found on the hospital web site at www.horizon.upmc.com.

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Moms Who Breastfeed Less Likely to Develop Heart Attacks or Strokes

The longer women breastfeed, the lower their risk of heart attacks, strokes and cardiovascular disease, report University of Pittsburgh researchers in a study published in the May issue of Obstetrics & Gynecology.
“Heart disease is the leading cause of death for women, so it’s vitally important for us to know what we can do to protect ourselves,” said Eleanor Bimla Schwarz, M.D., M.S., assistant professor of medicine, epidemiology, and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. “We have known for years that breastfeeding is important for babies’ health; we now know that it is important for mothers’ health as well.”
According to the study, postmenopausal women who breastfed for at least one month had lower rates of diabetes, high blood pressure and high cholesterol, all known to cause heart disease. Women who had breastfed their babies for more than a year were 10 percent less likely to have had a heart attack, stroke, or developed heart disease than women who had never breastfed.
Dr. Schwarz and colleagues found that the benefits f rom breastfeeding were long-term? an average of 35 years had passed since women enrolled in the study had last breastfed an infant.
“The longer a mother nurses her baby, the better for both of them,” Dr. Schwarz pointed out. “Our study provides another good reason for workplace policies to encourage women to breastfeed their infants.”
The findings are based on 139,681 postmenopausal women enrolled in the Women’s Health Initiative study of chronic disease, initiated in 1994.
Co-authors of the study include Roberta Ray, M.S., Fred Hutchinson Research Center; Alison Stuebe, M.D., University of North Carolina School of Medicine; Matthew Allison, M.D., University of California, San Diego; Roberta Ness, M.D., M.P.H., University of Texas; Matthew Freiberg, M.D., University of Pittsburgh School of Medicine; and Jane Cauley, Dr.P.H., University of Pittsburgh Graduate School of Public Health.
The research was funded by grants from the National Institutes of Health’s National Heart, Lung, and Blood Institute and the National Institute of Child Health and Development.

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Glass Half Full? Optimists Live Longer, According to University of Pittsburgh Study

In a large study of post-menopausal women, optimists had decreased rates of death and were less likely to be hypertensive, diabetic and smokers than pessimists, according to researchers at the University of Pittsburgh School of Medicine. In addition, women identified as highly mistrustful of other people had increased rates of death when compared to their less “cynically hostile” counterparts.
The study, led by Hilary Tindle, M.D., M.P.H., assistant professor of medicine in the Division of Internal Medicine, analyzed data from nearly 100,000 women in the Women’s Health Initiative, a National Institutes of Health-funded study that has followed women ages 50 and over since1994, with follow-up ongoing.
Optimism was defined as the expectation that good, rather than bad, things will happen. Female optimists in the group surveyed had a decreased rate of death and were 30 percent less likely to die from coronary heart disease than pessimists. Those identified as being more cynically hostile had a higher rate of death and were 23 percent more likely to die from a cancer-related condition.
For the study, optimism and cynical hostility were not directly compared. Rather, optimists were compared to pessimists, while women with a high degree of cynical hostility were compared to those with a low degree of cynical hostility.

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Pitt Study of Pregnant Women Shows Antidepressants, Depression May Raise Risk of Premature Birth

Pregnant women who had untreated major depression in all three trimesters of pregnancy, as well as those who took certain antidepressants, had preterm birth rates exceeding 20 percent, according to a study by University of Pittsburgh School of Medicine researchers published in the March issue of American Journal of Psychiatry.
Approximately 10-to-20 percent of women struggle with symptoms of major depression during their pregnancies, but treating it can be complicated. Selective serotonin reuptake inhibitor (SSRI) antidepressants are usually the first line of depression treatment, but can lead to unwanted outcomes such as preterm births if used continuously throughout pregnancy, the findings suggest.
“It is well-known that the prevalence of depression in women is highest during the childbearing years, and treating the symptoms with SSRIs is a common medical therapy,” said Katherine L. Wisner, M.D., M.S., director of the Women’s Behavioral HealthCARE program at Western Psychiatric Institute and Clinic of UPMC, associate investigator at Magee-Womens Research Institute, and professor of psychiatry, obstetrics, gynecology and reproductive sciences and epidemiology at the University of Pittsburgh School of Medicine. “However, given the similarity in outcomes we found for continuous SSRI treatment and continuous depression, it is possible that underlying depressive disorder is a factor in preterm birth among women taking SSRIs.”

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Prostate Cancer Screenings Don’t Cut Death Rates, Nationwide Study Finds

Annual screenings for prostate cancer led to more diagnoses of the disease, but no fewer prostate cancer deaths, according to a major new report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The University of Pittsburgh Cancer Institute (UPCI) is one of 10 sites that enrolled participants into the PLCO, which was designed to assess the effectiveness of prostate cancer screening.
“Prostate cancer screening in the trial increased detection of early prostate cancer,” said Joel L. Weissfeld, M.D., M.P.H., principal investigator for the UPCI PLCO Cancer Screening Center. “However, over the first seven to 10 years of follow-up, we have not yet seen a corresponding decrease in deaths from prostate cancer.”
The U.S. Preventive Services Task Force, whose recommendations are considered the gold standard for clinical preventive services, recently concluded that there is insufficient evidence to assess the balance of benefits and harms of prostate cancer screening in men younger than 75 and recommended against prostate cancer screening in men ages 75 and older.

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Researchers Study for Signs
of Early Detection of Autism

By Kathleen Ganster-Sauers

Like many babies, the 11- month- old is closely watching Mr. Rogers on TV. But unlike many babies, this one is being studied while she watches.
The infant is part of a research study by two University of Pittsburgh professors. Drs. Jana Iverson and Mark Strauss are researching infants to detect early signs of autism. “We are trying to identify autism in infants under the age of 2,” said Dr. Iverson, “There is a gap between the times that parents notice things might be wrong to the time that autism can be reliably diagnosed. We are trying to tighten that gap.”
According to Dr. Iverson, early diagnosis is important for early intervention. Experts believe the earlier the intervention is offered to the children, the more progress can be made with the children.
While the two researchers share common goals and their studies overlap, they both also have their own studies. Dr. Strauss’ research focuses on the early development of perceptual and cognitive abilities including how children learn about faces and categories, while Dr. Iverson’s research focuses on early motor and vocal development in infants.
The baby mentioned above is taking part in Dr. Mark Strauss’ research. “We follow the eye movement as we watch how the babies react to different pictures and videos. They will watch video clips of Mr. Rogers and we watch as they move their eyes to look at him and how he interacts with the other people on the program,” he said.
According to Dr. Strauss, there is evidence that shows babies with autism react differently. “For example, they will look at one object, and focus just on that one object, while other babies will follow the interaction of the people.”
Dr. Strauss’ research takes place in the Infant and Toddler Development Center laboratory at Pitt, but Dr. Iverson takes her research studies on the road. “We go into the babies’ homes so that we can see them in their natural settings. We want to try to catch them in their everyday behavior,” she said.
In her research, Dr. Iverson watches differences in developmental issues including playing, movement such as crawling and walking, and interaction with family members beginning when infants are 5 months old. “There is very general delay in children with autism, delays in their motor skills, their social skills, big delays in their communication skills. These are all factors we look at,” she said.
Dr. Strauss begins his research as early as six months. “It is our hope to identify signs that the babies have symptoms of autism as early as possible.” he said.
Both researchers are currently researching younger siblings of children already diagnosed with autism. “These are infants who are known to have high-risk factors. It is the easiest method to identify children that may have autism,” explained Dr. Iverson.
The projects are both funded separately by NIH, but there is some collaboration between the two researchers and their studies. Dr. Iverson said, “We were originally funded by Autism Speaks but we had enough positive results that we are now funded by the National Institute of Health.
Due to the limited nature of identifying infants for the studies, both researchers are constantly looking for more infants to participate. “We would love to have more infants in our studies. We need to do more research,” said Dr. Iverson.
According to Dr. Strauss, the Pitt researchers are one of only five research sites funded by NIH as an “Autism Center of Excellence.”

Pittsburgh Early Autism Study
Dr. Iverson and Dr. Strauss are currently recruiting infants for the Pittsburgh Early Autism Study. According to Stacey Becker, project coordinator for the infant research program, the researchers are studying infants who have an older sibling diagnosed with an autism spectrum disorder (ASD) to look for infant behaviors that may predict a later ASD diagnosis.
Infants may be part of the “How Babies Communicate” study directed by Dr. Jana Iverson, the “How Babies Develop Intellectually” study directed by Dr. Mark Strauss, or both.
For more information about Dr. Iverson and Dr. Strauss’ research or to participate in the studies, please contact the NIH Autism Center of Excellence at (412) 246-5485 or 1-866-647-3436 or by e-mail at autismrecruiter@upmc.edu or www.pitt.edu/~peas.

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Happily Married Women Have Less Trouble Sleeping, Pitt Study Finds

It is no secret that a good night’s sleep can lead to a well-balanced and healthy lifestyle, but the age-old question of how to get a decent eight hours still remains. However, a University of Pittsburgh study finds that a happy marriage can lead to a better night’s sleep for women. The findings are reported in the current issue of Behavioral Sleep Medicine.
The Pitt study finds that women who believe they have happy marriages reported less difficulty falling asleep, less likelihood of waking up during the night or too early in the morning and less restless sleep compared to women who report less happiness in their marriages.
The study examined the association between marital happiness and sleep disturbances in multiple ethnic groups of married or partnered women. Researchers found that Caucasian and African-American women had more sleep complaints than the Japanese, Hispanic and Chinese women. Caucasian and Japanese women reported the highest marital happiness.
In assessing the effects of marital happiness on sleep, the researchers took into account many other factors that might contribute to sleeplessness, such as a woman’s social support network, depressive symptoms, economic hardship and employment status, alcohol and caffeine consumption, presence of children in the home, sexual activity, age and hormonal status. The results showed that even after taking into account all of these factors that are known to influence sleep, the level of marital happiness emerged as an independent risk factor for the existence of sleep disturbances.

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Fruits and Vegetables in Cancer Prevention and Treatment

Relatively recently, researchers have become keenly interested in exploring which food compounds are beneficial in treating and preventing serious diseases such as cancer and osteoporosis.
Omer Kucuk, M.D., is one of those researchers. Kucuk, a professor of hematology and medical oncology at Emory Winship Cancer Institute, studies specific food compounds and their effect on cancer prevention and treatment. Evidence indicates that some food compounds, such as soy isoflavones and curcumin, can increase the effectiveness of chemotherapy and radiation therapy.
Kucuk conducted the first clinical trials to show the benefits of soy and lycopene supplements in pros tate cancer treatment.
“In our preclinical studies we have observed that taking soy isoflavones during chemotherapy and radiation for advanced prostate cancer can improve the efficacy of the treatments," says Kucuk. “The compounds sensitize the cancer cells to chemotherapy and radiation while at the same time they protect the normal tissues from side effects.”
Most nutritional compounds used for therapy or disease prevention can be taken as part of a routine diet and have little if any side effects, Kucuk says. “People can get enough lycopene by eating tomato paste and tomato sauce, which is very rich in lycopene. So, if people ate a couple of ounces of tomato paste a day as part of a regular diet, they would eat enough to get all the benefits,” he says.
Kucuk and his colleagues are currently exploring how soy isoflavones make chemotherapy and radiation more effective. “These are pleiotropic agents. That means they affect multiple pathways in cancer cells as well as other cells,” Kucuk says. “This is actually good, because a lot of the drugs that are developed target one pathway, and they’re usually very toxic. But because nontoxic nutritional compounds work with multiple pathways they have mild side effects making them very attractive for treatment.”.

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Teens Girls Smoke Now, Pay Later With Larger Waistlines As Adults

Girls who smoke 10 cigarettes per day or more are at greatest risk, particularly for abdominal obesity. Their waist sizes are 1.34 inches larger than nonsmokers' waists are as young adults, according to the study in the February 2009 issue of the American Journal of Public Health.
But smoking in adolescence did not necessarily predict weight problems for men, according to the study.
Scientists know a correlation exists between women's weight and smoking, said lead study author Suoma Saarni, a researcher with the Department of Public Health in Helsinki.
However, she added, "We do not know why smoking did not affect men's weight, as we do not know why smoking affected women's weight."
The study followed twins born between 1975 and 1979 with questionnaires mailed shortly after their 16th birthdays. Researchers collected more data on the 2,278 women and 2,018 men when the twins were in their 20s.
Scientists looked at twins to take into account familial or genetic factors affecting smoking and weight gain, Saarni said. Half of the participants had never smoked, and 12 percent were former smokers in adolescence. About 15.5 percent of men and 9.4 percent of women smoked at least 10 cigarettes daily.
By the time participants reached their 20s, weight problems became evident. By age 24, roughly 24 percent of men and 11 percent of women were overweight. However, male smokers were not necessarily more prone to become overweight than nonsmokers.
The young women who smoked more than 10 cigarettes per day were 2.32 times more likely to become overweight than nonsmokers, according to the study.
The difference could be either biological or cultural, Saarni said. Biologically, it might be that tobacco and gender specific hormones interact differently in girls and boys in ways that affect appetite and fat20distribution.

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For more articles, download the Spring '10 issue (PDF)