Stress may play a key role in the development of type 2 diabetes in obese black women, U.S. researchers say.

“Much attention has been given to the role of obesity in the development of type 2 diabetes, but stress may be as important in this at-risk population,” study co-author Anastasia Georgiades, of Duke University in Durham, N.C., said in a news release.

The study included 62 healthy, non-diabetic black women who were asked to recall stressful life events. As they did, the researchers measured the women’s levels of blood sugar and epinephrine, the “fight or flight” hormone that’s released in reaction to stress.

Women with high epinephrine levels (25 picograms or more per milliliter of blood) while recalling stressful events and with more belly fat (33 percent or more of total body fat) had significantly higher fasting glucose scores (about 100 milligrams per deciliter) than women with lower epinephrine levels and less belly fat (85 mg/dl). A fasting blood glucose level of 100 mg/dl is considered within the low range of pre-diabetes, and a level of 125 mg/dl is the benchmark for type 2 diabetes.

Women with high epinephrine levels and more belly fat also had bigger increases in blood sugar levels during the stress test.

The findings were to be presented this week at the annual scientific meeting of the American Psychosomatic Society.

“While we don’t fully understand the nature of the association, women with abdominal obesity may be more vulnerable to the impact of stress — causing their body to increase blood sugar production and elevating their risk for diabetes,” Georgiades said.

Further research is needed to determine exactly how epinephrine production affects blood sugar levels in black women. Nearly one in four black women in the United States has type 2 diabetes, according to the American Diabetes Association.

Both share a need for quick answers or more detailed information about a broad range of topics involving diagnosis, treatments, or unexpected symptoms.

A new section of the Indiana University Melvin and Bren Simon Cancer Center’s web site, http://www.cancerinfo.cancer.iu.edu, helps patients and their families find information about a variety of topics in an easily accessible format.

In the symptom management section, for example, people can learn about anemia, dry mouth, nausea, and shortness of breath.

Overall, according to Anna McDaniel, DNS, a professor at the IU School of Nursing and a researcher with the IU Simon Cancer Center, the section “makes information more accessible to the public as well as patients. It has been designed so there is a clearly defined way to access quality, or evidence based, information.”

Such information is beneficial for patients. “Research has shown that having access to good information can increase coping in cancer patients and lead to better treatment outcomes,” Dr. McDaniel said.

Dr. McDaniel received a $250,000 grant from Indianapolis-based Walther Cancer Foundation in 2007 for the project. She and others from the IU schools of nursing and informatics and the cancer center worked together to create the section, which made its debut Feb. 23.

The new section is dedicated to Dr. Harold Burdette, a visionary leader committed to eliminating the burden of cancer in Indiana.

Dr. McDaniel and others are now testing the section’s next phase, which takes symptom management to an interactive level.

Patients will log into a secure system to answer questions about any side effects they might be experiencing from chemotherapy. They will rate their symptoms on a scale of zero to 10. Depending on the severity of the symptoms, the patient will be directed to information on the Internet, or his or her oncologist will be notified.

Twenty patients are currently being recruited into this test phase.

“The unique aspect of this is that it will connect the patient and the health-care provider,” Dr. McDaniel said. “Not only does the system give patients useful information about how to help themselves during chemotherapy, it increases communication with oncology doctors and nurses.”

Also Included In: IT / Internet / E-mail; Primary Care / General Practice

Research in a new field called oncofertility has advanced the ability of doctors to preserve the reproductive health of women, men and children who are diagnosed with cancer. Yet, many oncologists aren’t familiar with these new strategies to help their patients.

A leading oncofertility researcher and a breast surgical oncologist from the Northwestern University Feinberg School of Medicine have written a guide to help doctors navigate their patients through the new technologies to preserve their fertility and understand the fertility threats posed by cancer treatments. The guide, based on the latest research, offers strategies based on each kind of cancer, age and gender of the patient.

The article is published in the February 26 issue of the New England Journal of Medicine and is included in the NEJM Audio Summary.

“We hope that physicians who are not used to dealing with fertility threats associated with treatment can now talk confidently with their patients about their options,” said article co-author Teresa Woodruff, chief of fertility preservation and the Thomas J. Watkins Professor of Obstetrics and Gynecology at the Feinberg School. “This is a new tool for them.”

Woodruff and Northwestern colleagues also recently launched www.myoncofertility.org, an interactive web site to educate patients about the potential effect of cancer and treatments on their fertility and options to preserve it.

“Doctors are focused on saving a patient’s life and are not used to thinking about preserving a patient’s fertility and incorporating fertility preservation into her or his care,” said lead author Jacqueline Jeruss, M.D., assistant professor of surgery at Feinberg. Jeruss also is a surgical oncologist at Northwestern Memorial’s Prentice Women’s Hospital and a basic science researcher at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Younger patients in particular are not benefiting from fertility preservation options. A new national survey of pediatric oncologists showed that more than half of them are not using fertility preservation techniques that are available at most medical centers for their adolescent patients. The survey was conducted by Robert Brannigan, M.D., associate professor of urology at the Feinberg School and a physician at Northwestern Memorial Hospital.

“Adolescent oncology patients are at the same risk as adults to become permanently infertile as a result of their cancer or cancer treatment, but they are not getting what they need to save their fertility,” Brannigan said.

When a young patient is diagnosed with cancer, doctors feel like it is a medical emergency, even when there may be time to consider fertility before treatment begins, Jeruss explained. “We aren’t used to taking a step back to look at the big picture of patients’ lives after they survive cancer,” she said.

“Clinicians need to break through old practice patterns,” Jeruss said. “In the past, if I saw a young woman with breast cancer, I would be focused on getting her into surgery and through chemotherapy and radiation. Now we have a better sense that with the improvements we’ve made in cancer management, many of our young patients with cancer are going on to survive and live healthy long lives. We need to do everything possible so patients can look forward to a life that looks as much like the life they had planned on before the day they were diagnosed.”

The survival rate of children with cancer is nearly 80 percent in the United States. Approximately 10,700 children were diagnosed with cancer in 2008. In addition, there are 140,000 young adults (men and women younger than 45 years old) who face a cancer diagnosis each year.

Northwestern has led the emerging field of oncofertility and has provided a template of fertility preservation patient care to other medical centers. Woodruff developed and is principal investigator of the national Oncofertility Consortium, a National Institute of Health- funded network of doctors and scientists working to provide improved fertility preservation options for people diagnosed with cancer and other diseases.

At the Lurie Cancer Center, newly diagnosed men, women and adolescents work with a special Fertility Preservation Patient Navigator to figure out the best options to preserve their reproductive health before starting cancer therapy. The patient navigator then coordinates that plan with the patient’s doctors.

Several fertility preservation techniques are under investigation at Northwestern. One is an entirely new way of growing and preserving a woman’s immature eggs, or young follicles, so they can be fertilized and implanted into the uterus when she is ready to have children. Thus far, this technology has been used successfully in mice to produce live, healthy offspring.

Radiation Therapy for Breast Cancer is a four-color brochure that helps women understand the types of radiation therapy they may be offered, including newer treatments like three-dimensional radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT) and breast brachytherapy. The brochure also explains possible side effects, how to get more information on clinical trials and support groups, and offers tips for caring for yourself during treatment.

“The diagnosis of breast cancer can be overwhelming. Recognizing this, ASTRO created its brochures to educate patients on the lifesaving benefits of radiation therapy,” said Gregory Patton, M.D., chair of ASTRO’s Communications Committee and a radiation oncologist at Northwest Cancer Specialists, P.C., in Portland, Ore. “We continue to update our brochures on a regular basis, so that patients can have the most up-to-date information when making treatment decisions.”

Radiation Therapy for Breast Cancer is one of 16 brochures in English and Spanish ASTRO offers. As part of its public awareness campaign, ASTRO has distributed more than 650,000 hard copies of its brochures. Materials can also be downloaded free through its patient Web site, http://www.rtanswers.org. Printed copies are sold athttp://www.astro.org for $7.50 for 50 copies, including shipping and handling.

Originated in 2003, ASTRO’s Public Awareness Campaign brings valuable and supportive information to patients and their families. Each brochure is written in collaboration with physicians familiar with the site-specific material and patient support organizations.

To learn more about breast cancer, visit http://www.rtanswers.org. To learn more about ASTRO, visit http://www.astro.org.

ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit http://www.rtanswers.org. To learn more about ASTRO, visit http://www.astro.org.

Less than 0.5% of the human genome differs between individuals, but this small fraction holds clues that can reveal how each person will respond to a particular disease, therapy or environmental factor. In the past years, genome-wide association (GWA) studies – comprehensive surveys that look for differences in people’s DNA code – have uncovered millions of small genetic variations known as single-nucleotide polymorphisms (SNPs). By sharing GWA data, scientists have gained insight into the genetic basis of many complex diseases including cancer and heart disease, and embarked on developing personalized therapeutics.

According to Dr. Nicolas Guex, a senior bioinformatician at the SIB, those who carry out GWA studies need simple ways to integrate datasets from different sources. They also rely on tools that help them visualize SNPs across the entire map of the genome. “AssociationViewer provides an elegant solution to efficiently mine the wealth of data to generate hypotheses,” he says. Another user, Dr. Sam Deutsch at the U.S. Department of Energy Joint Genome Institute, USA, also considers the software to be a powerful tool for computational genetics. “Compared to other tools out there, AssociationViewer brings more flexible integration of external data sources and incorporates novel functionalities for comparing results across different studies.” He adds that special features allow users to quickly zoom into relevant regions the genome. “Visualizing significant SNPs in their genomic context is very intuitive,” he says.

Dr. Ioannis Xenarios, co-author of the article and Director of the Vital-IT group at the SIB, comments that data sharing remains a challenge for GWA studies, since many scientists still are reluctant to upload their unpublished data on public genome browsers. “AssociationViewer is a way to alleviate data transfer problems and allows people to perform their analyses by tapping into essential external resources. We hope that this tool will deliver new ways to mine complex genomic features.”

“The software was developed on the principle that a picture is worth a thousand words,” says the study’s senior author, Dr. Brian Stevenson at the LICR Lausanne Branch. “It stems from a very successful collaboration between the LICR Computational Genomics Group, the SIB Vital-IT group and researchers who generate association data at the University Hospital of Lausanne, and should prove popular among clinicians, biologists and computer scientists.”

This study was conducted by investigators from: Ludwig Institute for Cancer Research (LICR) Lausanne Branch, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland; and the Institute of Microbiology, University Hospital, University of Lausanne, Lausanne, Switzerland. Funding was provided by LICR, the Swiss National Science Foundation, Infectigen, the University of Lausanne and SIB.

Google Health, a new product that launched in mid-May of this year, allows people to store and organize their medical records online, safely and securely. The product is available at no charge, and only requires a username and password to get started.

“Google Health is an important tool for our members to improve the safety and effectiveness of their health care,” said Cleve Killingsworth, Chairman and CEO of BCBSMA. Killingsworth added that the partnership demonstrates BCBSMA’s continuing leadership in using technology to make health care better, building on the company’s funding of the Massachusetts eHealth Collaborative and its role as a founding member of the Massachusetts eRx Collaborative.

“Our members tell us they want easier and more portable access to their health care information,” said Steven Fox, BCBSMA’s Vice President of Provider Network Management. “Having this information in one place can help our members and their doctors make health care decisions that can improve the quality of care they receive.” To hear more from Steve, go here and click on Listen.

Many people have primary care doctors, specialists, labs, pharmacies, and non-traditional providers at multiple institutions. A PHR with the Google Health allows BCBSMA members to manage their health information in one place, and share it with health care providers who currently don’t have access to data from other sources. Members can sign up for a Google Health Account at http://www.google.com/health and then authorize the import and sharing of their BCBSMA personal health information into Google Health by selecting “Import Medical Records”.

The benefits of integrating BCBSMA personal health information into Google Health are:

- Organizing, storing and managing medical records and personal health information online in one secure location, including personal health information from BCBSMA;

- Downloading medical records and prescription history from other connected providers, such as retail pharmacies, Pharmacy Benefit Managers (PBMs), labs and doctors offices;

- Sharing medical information with providers and/or third party services offering customized services;

- Learning about important health issues and potentially dangerous drug-to-drug interactions;

- Searching for a doctor or hospital online.

Getting Started:

In three easy steps, Blue Cross Blue Shield of Massachusetts members can elect to start a Google Health Account and authorize the import and sharing of their personal health history from BCBSMA into Google Health:

1) BCBSMA members need to register with Member Self Service and activate a PIN at http://www.bluecrossma.com by clicking on Member Self Service. A PIN number will be mailed for members to confirm and activate the account.

2) Establish a Google Health Account at http://www.google.com/health.

3) Link the Google Health Account to Blue Cross Blue Shield of Massachusetts by selecting “Import Medical Records” and selecting the BCBSMA link to profile button.

Member Privacy:

Google Health has committed to storing information securely and keeping that information private. Google never sells user data under any circumstances and the user data are never shared with any third party unless the user directs Google to do so. Also there are no advertisements in Google Health. . The Google Health Terms of Service outlines how the user information is protected and used. A copy of the Google Health Privacy Policy is available at http://www.google.com/intl/en-US/health/privacy.html.

About Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts was founded 72 years ago by a group of community-minded business leaders. Today, headquartered in Boston, BCBSMA provides coverage to approximately 3 million members. BCBSMA believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association

The provision directs the NIH to change its existing Public Access Policy, implemented as a voluntary measure in 2005, so that participation is required for agency-funded investigators. Researchers will now be required to deposit electronic copies of their peer-reviewed manuscripts into the National Library of Medicine’s online archive, PubMed Central. Full texts of the articles will be publicly available and searchable online in PubMed Central no later than 12 months after publication in a journal.

“Facilitated access to new knowledge is key to the rapid advancement of science,” said Harold Varmus, president of the Memorial Sloan-Kettering Cancer Center and Nobel Prize Winner. “The tremendous benefits of broad, unfettered access to information are already clear from the Human Genome Project, which has made its DNA sequences immediately and freely available to all via the Internet. Providing widespread access, even with a one-year delay, to the full text of research articles supported by funds from all institutes at the NIH will increase those benefits dramatically.”

“Public access to publicly funded research contributes directly to the mission of higher education,” said David Shulenburger, Vice President for Academic Affairs at NASULGC (the National Association of State Universities and Land-Grant Colleges). “Improved access will enable universities to maximize their own investment in research, and widen the potential for discovery as the results are more readily available for others to build upon.”

“Years of unrelenting commitment and dedication by patient groups and our allies in the research community have at last borne fruit,” said Sharon Terry, President and CEO of Genetic Alliance. “We’re proud of Congress for their unrelenting commitment to ensuring the success of public access to NIH-funded research. As patients, patient advocates, and families, we look forward to having expanded access to the research we need.”

“Congress has just unlocked the taxpayers’ $29 billion investment in NIH,” said Heather Joseph, Executive Director of SPARC (the Scholarly Publishing and Academic Resources Coalition, a founding member of the ATA). “This policy will directly improve the sharing of scientific findings, the pace of medical advances, and the rate of return on benefits to the taxpayer.”

Joseph added, “On behalf of the Alliance for Taxpayer Access, I’d like to thank everyone who worked so hard over the past several years to bring about implementation of this much-needed policy.”

For more information, and a timeline detailing the evolution of the NIH Public Access Policy beginning May 2004, visit the ATA Web site at http://www.taxpayeraccess.org.

The Alliance for Taxpayer Access is a coalition of patient, academic, research, and publishing organizations that supports open public access to the results of federally funded research. The Alliance was formed in 2004 to urge that peer-reviewed articles stemming from taxpayer-funded research become fully accessible and available online at no extra cost to the American public. Details on the ATA may be found at http://www.taxpayeraccess.org.

http://www.arl.org/sparc

“One-third to one-half of all compensatory injuries are repetitive-motion injuries associated with office-type work,” says Hedge, professor of design and environmental analysis in Cornell’s College of Human Ecology.

Back injuries also account for one-third of all workplace injuries. A decade ago most of these were associated with heavy lifting. Today they are mostly caused by people sitting for longer periods of time — often in front of a computer.

The younger onset of computer use makes the current rate of compensatory damage claims the canary in the coal mine. There is typically a 10- to 15-year latency before injuries start to develop, Hedge has found. In the early 1990s he showed that the average age of workers reporting carpal tunnel syndrome was late 30s to early 40s; last year, he found the average age of onset had dropped to the mid-20s and even younger for some people.

“Now kids are using computers at age 2, so by the time they enter the workforce they’ll already be primed for injuries,” Hedge says. “This is very serious because an injury can become life-changing; carpal tunnel, for example, is not curable. They’ll have to manage this chronic condition for the rest of their lives.”

To better determine how design concepts can prevent such injuries, Hedge’s Cornell Human Factors and Ergonomics Research Group studies innovative products. Among his recent projects:

* Vibrating mouse: To see if a vibrating mouse could prevent upper extremity musculoskeletal disorders in computer users by signaling people to take their hand off the mouse to avoid overuse, Hedge and graduate student Chris Moe reported at the Human Factors and Ergonomics Society Annual Meeting in October 2007 that although subjects do remove their hands more often with a vibrating mouse than with a conventional mouse, they tended to hold their hand just above the mouse.

“This position is potentially more detrimental because of a potential increase in static muscle activity required to hover the hand,” Hedge says, concluding that people should rest their hands on a flat surface when they feel the vibration.

* Undulating chairs: Another study examined whether a seat that made a continuous massaging, wavelike movement at an adjustable rate would alleviate back pain in people whose pain increases when they are seated. Although his findings were mixed, Hedge and graduate student Erin Lawler concluded that the movable seat was a concept with promise, particularly for individuals with back problems.

* Movable arms for monitors: A third study looked at how suspending a flat panel computer monitor on a movable arm affects people’s comfort, posture and preference. Hedge and graduate student Kathryn Boothroyd found that people unanimously liked the monitor arm because they could adjust their LCD screen, and it gave them more room on their desktop for documents.

“We saw fewer complaints about neck problems and about the workstation because people had more space,” says Hedge. He was surprised, however, that users liked the versatility of the movable arm to show others what was on their screen. “This simple design change in screen adjustability has many potential benefits associated with it,” Hedge concludes.

“Everything we do can be summed up in the phrase: Good ergonomics is great economics,” Hedge says. “More than 90 percent of a company’s costs are people costs, so making small investments in improving the workplace by using good ergonomic products pays huge dividends.”

The research team — led by Joseph Konstan, a professor of computer science and engineering at the university, and B.R. Simon Rosser, a professor in the university’s School of Public Health — has worked for more than five years to create a program that assesses risky behaviors among men who are seeking sex with other men through online networks. The team currently is testing an online intervention program that aims to reduce risky sexual behaviors that contribute to the spread of HIV and other sexually transmitted infections.

The software program asks users questions about body image, self-esteem, sexual health and risky behaviors and then provides information about HIV/AIDS. The team’s research, which is part of an interdisciplinary project called the Men’s Internet Study, has found that seeking sex partners is the most popular Internet activity for high-risk groups, such as men who have sex with men. According to the researchers, the online model can be used for other health purposes, such as cancer prevention, substance abuse intervention and obesity prevention. The researchers said they hope the trial finds that the tool is effective in preventing risky behaviors.

According to Konstan, the “goal of this research is to create a genuine online experience that promotes healthier sexual behavior and encourages people to take fewer risks in sexual encounters.” Konstan added that it is important to use the Internet for HIV prevention programs. If HIV prevention outreach is not conducted properly “or in a way that’s most responsive, we’re going to have a new HIV epidemic,” he said, adding, “There’s enormous urgency in addressing gaps in HIV prevention” (ANI/Malaysia Sun, 12/19).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

According to Sanne Magnan, commissioner of the Minnesota Department of Health, what consumers “really want to know is, can I get a doctor and clinic who cares about me, and who can I have a good experience with?” She added that doctors likely will use consumer evaluations to gauge patients’ reactions to their performance. Some sites offer price information and quality of care statistics information, as well (Olson, St. Paul Pioneer Press, 12/17).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.