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No rationale for giving penicillin for a sore throat
    Penicillin for acute sore throat in children: randomised, double blind trial BMJ Volume 327, pp 1324-7
    Most children should not be given penicillin for a sore throat, finds a study in this week's BMJ.
    Dutch researchers identified 156 children aged 4-15 who visited their family doctor with a severe sore throat. The children were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days.
    Penicillin did not reduce the duration of symptoms, nor did it affect school attendance or recurrences of sore throat.
    Penicillin may, however, reduce the development of complications, such as quinsy or scarlet fever. Although, once a complication is diagnosed, sufficient time is left to start antibiotic treatment, say the authors.
    The authors advocate prudent prescription behaviour with respect to penicillin. General practitioners should treat children with an acute sore throat only when they are severely ill or are at high risk of developing serious complications, they conclude.
Smoke-free laws do not harm charitable bingo profits, study finds
    A new economic analysis finds that smoke-free laws do not reduce profits from charitable bingo parlors, contrary to claims made by groups opposing smoking restrictions. The analysis follows other studies that have found no loss of business - and sometimes increased business - at restaurants and bars when smoke-free ordinances are put in place.
    The new analysis is the first objective assessment of the effect of smoke-free policies on gaming profits. Researchers collected information on profits from state-licensed bingo and other charitable gaming from 220 towns and cities in Massachusetts that permitted such games from 1985 to 2001. The Massachusetts State Lottery Commission, which supervises these games, provided the raw data.
    The analysis by researchers at UCSF showed that while bingo profits were falling over the entire period studied, this trend was well established before passage of smoke-free laws in the early 1990s, and was unaffected by these laws. The result held regardless of the size of the community.
    The study is reported in the December 2003 issue of the journal Tobacco Control.
    Authors are Stanton Glantz, PhD, professor of medicine at UCSF and director of the UCSF Center for Tobacco Control Research and Education; and Rebecca Wilson-Loots, project assistant at the Center.
    "The tobacco industry has long claimed that smoke-free laws hurt restaurants and bars, but as these claims have been discredited, the industry has increasingly emphasized claims that smoke-free policies would hurt gaming," according to Glantz. "The data shows that policy makers can enact smoke-free policies without concern that they will affect charitable gaming."
It's never too late to start exercising and losing weight , Joslin study shows
BOSTON - There's good news on the research front for those who want to shed some pounds and get in shape this holiday season. A new study by Joslin Diabetes Center researchers shows that obese adults who lost just 7 percent of their weight - or 16 pounds in a 220-pound, 5'5" tall woman - and did moderate-intensity physical exercise for six months improved their major blood vessel function by approximately 80 percent, regardless of whether or not they had type 2 diabetes.
    "This means that it is never been too late to intervene in order to prevent progression of atherosclerosis," said Osama Hamdy, M.D., lead author of the study, recently published in Diabetes Care. "Altered function of the endothelium, the inner lining layer of the blood vessels, is an early stage in atherosclerosis that eventually leads to coronary artery disease and heart attack or stroke, which are the leading causes of death in at least 75 percent of patients with type 2 diabetes," said Dr. Hamdy, a Joslin physician who specializes in obesity. This thin layer inside the artery secretes a substance called nitric oxide that causes the arteries to dilate and improves blood flow. "In the majority of people with type 2 diabetic and even in many obese individuals who do not have diabetes the function of this layer is altered, initiating the atherosclerotic process," he said.
    Diabetes affects an estimated 18.2 million Americans, about one-third of whom do not even know they have the disease. Type 2 diabetes, the most common form of diabetes, traditionally was considered a disease of middle-aged and older adults. Type 2 diabetes is increasingly occurring in young people and children due in large part to increasing obesity and sedentary lifestyle. Diabetes is a leading cause of heart disease, stroke, blindness, kidney disease and nerve damage. Coronary artery blockage remains a major killer among people with diabetes, he said.
    How the study was conducted
    The study of 35 obese subjects included three groups of volunteers; all were obese and had a body mass index above 30 kg/m2 had insulin resistance. It has been known that obese individuals, especially those with a family history of diabetes, have a condition called insulin resistance syndrome, syndrome-X or the metabolic syndrome years before they develop type 2 diabetes, Dr. Hamdy explained. Metabolic syndrome is seen in 23.7 percent of all adult Americans above age 20 and in approximately 40 percent of those above age 60, according to a recent survey. This condition puts them at higher risk for developing type 2 diabetes, high blood pressure and high cholesterol and triglycerides and can lead to an increased tendency for blood clotting and coronary artery disease. This condition also is associated with low-grade inflammation caused by several substances secreted by the body fat and, in particular, the internal fat in the waistline (intra-abdominal or visceral fat).
    The first group in the Joslin study did not have diabetes; the second group had a condition known as impaired glucose tolerance and was at high risk for developing diabetes; and the third group had type 2 diabetes. The three groups were put on a calorie-restricted diet, simply by cutting 500 calories from their daily caloric consumption.
    The participants also exercised in the gym at Joslin in Boston two to three times per week. Exercise was moderate in intensity and for 30 minutes each session using both upper and lower body like brisk walking or mild running on a treadmill with movement of the upper body, or using the stationary bike and rowing machine.
    "After 6 months, the study participants had lost an average of about 7 percent of their initial weight or approximately 16 pounds in a 220-pound person," Dr. Hamdy said.
    The researchers found significant improvement in the function of the major blood vessels; as their capacity to dilate in response to the nitric oxide secreted by the endothelium improved significantly, their risk of developing arteriosclerosis and heart disease was reduced, Dr. Hamdy said. The researchers also found improvement in several markers of blood coagulation, inflammation and vascular activity, which are usually altered in this population, putting them at higher risk for developing coronary artery disease.
    Significance of the findings
    "The important finding of this study is that a weight loss as low as 7 percent can improve or reverse the early abnormalities of blood vessels that lead to atherosclerosis and coronary heart disease and that obese people get equal clinical benefit from weight loss, whether they have diabetes, pre-diabetes or have normal blood glucose levels," Dr. Hamdy said. These latest findings are consistent with those of the recently completed national Diabetes Prevention Program (type 2 diabetes study), which was conducted at Joslin and other institutions. The DPP showed modest weight loss and regular exercise, like brisk walking, reduced the risk of developing type 2 diabetes in people at risk by 58 percent.
    "Now that we have the results of this study as well as the DPP findings, it's more important than ever to get people moving and eating a healthier diet because we know that even modest weight loss and increased physical activity is good for our cardiovascular system," Dr. Hamdy said.
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