all Department of Ambulatory Care and Prevention stories

Infant weight gain linked to childhood obesity

50443248 — Mon, 30 Mar 2009 00:03:04 -0400

As childhood obesity continues its 30-year advance from occasional curiosity to cultural epidemic, health care providers are struggling to find out why — and the reasons are many. Increasingly sedentary environments for both adults and children, as well as cheap and ubiquitous processed foods no doubt play a role, but researchers are finding more evidence that the first clues for childhood obesity may begin as far back as early infancy.

Diabetes Doubles Chances of Postpartum Depression

50443248 — Wed, 25 Feb 2009 11:30:49 -0500

Diabetic mothers at higher depression risk

50443248 — Wed, 25 Feb 2009 11:42:05 -0500

Low-income women with diabetes at increased risk for postpartum depression

50443248 — Tue, 24 Feb 2009 15:59:25 -0500

Researchers at Harvard Medical School (HMS) and the University of Minnesota have found that living just above the poverty line and having diabetes increases by 50 percent a woman’s chance of developing postpartum depression — a serious illness that affects about one in 10 new mothers.read more

Value of direct-to-consumer drug advertising oversold, study finds

404132862 — Tue, 02 Sep 2008 13:00:58 -0400

Direct-to-consumer advertising may not be giving big pharma such a big bang for their five billion bucks after all. Despite the billions spent on bringing drug marketing campaigns straight into patients’ living rooms, such strategies have a modest effect at best—and in some cases, no effect at all.

“People tend to think that if direct-to-consumer advertising wasn’t effective, pharma wouldn’t be doing it,” says Harvard Medical School professor Stephen Soumerai, principal investigator on the study. “But as it turns out, decisions to market directly to consumers is based on scant data.”

NIH awards Harvard Medical School $117.5 million, five-year grant for patient-centered research

404132862 — Thu, 29 May 2008 12:42:32 -0400

The National Institutes of Health today announced that Harvard Medical School (HMS) will receive $117.5 million over the next five years for the establishment of a Clinical and Translational Science Center (CTSC) that will transform patient-oriented, laboratory-to-bedside research at HMS and its affiliated hospitals.

Suboptimal sleep, TV watching correlate with overweight in infants and toddlers

404132862 — Mon, 07 Apr 2008 15:25:02 -0400

Infants and toddlers who sleep less than 12 hours a day are twice as likely to become overweight by age 3 than children who sleep longer. In addition, high levels of television viewing combined with less sleep elevate the risk, so that children who sleep less than 12 hours and who view two or more hours of television per day have a 16 percent chance of becoming overweight by age 3.

Weight gain in pregnancy linked to overweight in kids

Tue, 10 Jul 2007 15:35:18 -0400

Pregnant women who gain excessive or even appropriate weight, according to current guidelines, are four times more likely than women who gain inadequate weight to have a baby who becomes overweight in early childhood. These findings are from a new study at the Department of Ambulatory Care and Prevention of Harvard Medical School (HMS) and Harvard Pilgrim Health Care, and are published in the April issue of the American Journal of Obstetrics and Gynecology.

High-deductible health plans are linked to fewer ER visits

Wed, 11 Jul 2007 09:31:12 -0400

Patients who switched to high-deductible health plans went to the emergency department 10 percent less than patients who remained in traditional plans, according to a new study by the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care). The study, published in the March 14 Journal of the American Medical Association, shows that most of this reduction was for less severe conditions like colds, nausea, and headaches. The authors followed members for approximately one year after the switch to the high-deductible plan.

"Our study showed that for most members, the high-deductible plan seemed to work as intended," said Frank Wharam, research fellow in the Department of Ambulatory Care and Prevention and the study's lead author. "Patients went to the emergency room less frequently for nonemergency conditions."

However, the authors stress that more research is needed to determine long-term health consequences and the impact on different segments of the population. "It will be important to determine how the health of low-income and chronically ill patients is affected," said Wharam. "Our study could not provide conclusive answers. Ideally, high-deductible plans will be structured so that all patients readily seek care when they think they have an emergency."

High-deductible health plans are playing a central role in Massachusetts health insurance reform efforts. Nationwide, they have become increasingly popular as a way to stem rising health care costs and make insurance more affordable to individuals and employers. Monthly premiums are lower than traditional health insurance plans but enrollees must pay for most medical services up to a deductible amount that averages $1,000 to $4,000 per year. Emergency department visits and hospitalizations are often subject to the deductible.

This work was supported by the Harvard Pilgrim Health Care Foundation.

Nicotine vaccine to be tested at Massachusetts General Hospital

70652986 — Mon, 26 Mar 2007 06:27:57 -0400

A novel approach to helping smokers kick the habit - a vaccine - will be tested at Massachusetts General Hospital (MGH). The nicotine vaccine NicVax is designed to keep nicotine from reaching the brain where it produces its rewarding effects. Earlier studies of the vaccine, which has not yet received FDA approval, have indicated that it is safe and may be effective.

"We currently have several proven ways to help smokers quit - including nicotine patches and gum and the antidepressant bupropion - but if someone using these medications slips and smokes a cigarette, he or she experiences rewarding sensations from smoking," says Nancy Rigotti, MD, director of the MGH Tobacco Research and Treatment Center, who will lead the study at the hospital. "Since this vaccine keeps nicotine out of the brain, smoking no longer has any pleasurable effects, and the smoker should find it easier to quit."

Although the immune system does not normally respond to nicotine, NicVax - manufactured by Nabi Biopharmaceuticals, which is sponsoring the current trial - is designed to elicit the production of nicotine antibodies. If someone smokes after being immunized, the antibodies bind with nicotine molecules in the bloodstream and prevent them from entering the brain where nicotine receptors are located.

The MGH is one of 10 centers across the country participating in the current study and is the only location in the Northeast.

Warning labels on high-risk drugs inconsistently heeded by doctors

70652986 — Mon, 26 Mar 2007 05:42:20 -0400

In a survey of approximately 930,000 ambulatory care patients, researchers from the Department of Ambulatory Care and Prevention (of Harvard Medical School and Harvard Pilgrim Health Care) and colleagues found that 42 percent received prescriptions for drugs with Black Box Warnings (BBW), the Food and Drug Administration's strongest label for high-risk medication. Additionally, physicians' compliance with the recommendations of the BBWs was highly variable, which suggests that better methods are needed for ensuring the safe use of medications that carry serious risks.

In the categories studied, doctors' noncompliance to BBWs ranged from 0.3 percent to 49.6 percent. These results are reported online in the Nov. 18, 2005 issue of Pharmacoepidemiology and Drug Safety.

"In ambulatory care settings, approximately 1.4 billion prescriptions are written per year," said Anita Wagner, Harvard Medical School assistant professor at DACP. "Until now, there has been no information about how frequently doctors prescribe BBW drugs, nor whether prescribing is consistent with the warnings. This study tells us that these drugs are prescribed often and that in some categories, prescribing is inconsistent with the warnings."

Research in brief

50443248 — Fri, 20 Jul 2007 13:27:17 -0400

Home is where healthy food is

Adolescents who eat large amounts of food away from home are heavier and more likely to have a poor-quality diet. Among 14,355 children surveyed over three years, researchers from Harvard's Department of Ambulatory Care and Prevention (DACP) found that 9- to 14-year-olds who increased their consumption of fried food away from home over the course of a year gained weight above the normal rate. This research was conducted at the DACP Center for Child Health Care Studies and is reported in this month's Pediatrics journal.

"Doctors should encourage teens to limit their intake of food prepared away from home and to eat family dinners together, the benefits of which appear to include improved diet quality," said lead author Elsie Taveras, instructor in ambulatory care and prevention at Harvard Medical School and Harvard Pilgrim Health Care.

For full story, http://web.med.harvard.edu/sites/RELEASES/html/10_3tavares.html.

Catheter procedure does not increase mortality in advanced heart failure patients

Pulmonary artery catheterization (PAC), an invasive diagnostic procedure used to guide treatment for patients with critical illness, has remained one of the most controversial topics in critical care medicine, following publication of a major observational study that suggested it may unintentionally increase risk of death in severely ill patients. Some physicians urged the procedure be banned all together.

Researchers from Brigham and Women's Hospital (BWH) and Duke University put an end to many aspects of an ongoing debate over PAC's use specifically for heart failure patients. Hospitalized patients whose therapy was guided by PAC experienced the same survival and rehospitalization outcomes as patients whose therapy was evaluated with expert physical assessment. The findings are published in the Oct. 5 issue of the Journal of the American Medical Association.

For the full story, http://jama.ama-assn.org/cgi/content/full/294/13/1625.

- Compiled by Alec Solomita

Spread of common day care illnesses caused by misconceptions about illness transmission

70652986 — Mon, 26 Mar 2007 06:17:53 -0400

A Harvard Medical School study found that only two-thirds of parents believed that contact transmission was important for the spread of colds, and fewer than half believed it was important in the spread of stomach flus. Perhaps more surprising, fewer than half stated that changing a diaper and eating food prepared by a person with gastroenteritis were important in spreading stomach flus.

Low-dose aspirin shown to reduce risk of first stroke in women

70652986 — Mon, 26 Mar 2007 06:19:38 -0400

The Women's Health Study is a large, randomized, double-blind, placebo-controlled trial funded by both the National Heart, Lung and Blood Institute and the National Cancer Institute to evaluate the benefits and risks of low dose aspirin as well as vitamin E supplementation in the primary prevention of cardiovascular disease. The trial included healthy women 45 years of age and older who were monitored for 10 years for first major cardiovascular events.

With regard to aspirin, data addressing these issues in women have been limited. During follow-up, 477 major cardiovascular events were confirmed in the aspirin group as compared to 522 in the placebo group, a 9 percent overall reduction that was not statistically significant. However, the benefit of aspirin within the WHS was due almost entirely to a statistically significant reduction in stroke events without a reduction in heart attack rates. The most consistent benefits were observed among women 65 years of age and older. Among such women, low- dose aspirin use resulted in a 26 percent reduction in risk of major cardiovascular events.

"From a clinical standpoint, the new data suggest that many women are likely to attain a net benefit from preventive aspirin therapy," said Paul Ridker, M.D., and a BWH cardiologist also involved in the WHS clinical trial.

Preventive removal of both breasts reduces chance of breast cancer in women at elevated risk

70652986 — Mon, 26 Mar 2007 06:18:44 -0400

"Prophylactic mastectomy appears very effective in preventing breast cancer but choosing this procedure is a complex decision," said Ann M. Geiger, PhD, lead author of the study. "Prophylactic mastectomy prevents breast cancer but also carries a risk of complications and may impact a woman's psychosocial health. We suggest a woman considering the procedure talk to her doctor, family and friends, and get genetic counseling to help her understand her risk of breast cancer and learn about all her options.