Faculty Bibliography

The gonorrhea rates began soaring in the late 1960s and peaked in the '70s because of changes in sexual mores and behavior, wide use of oral contraceptives, and decreased use of condoms, said [Ronald O. Valdiserri] and Dr. John M. Douglas, who directs STD prevention at the disease centers in Atlanta. The rates dropped in the 1980s as health officials stepped up control measures. Still, Douglas said, the 330,132 gonorrhea cases reported in 2004 are believed to be less than half the 700,000 cases estimated to have occurred that year

''There's definitely a resource challenge,'' said Dr. Ronald O. Valdiserri, acting director of the AIDS and S.T.D. prevention unit at the disease centers. ''We certainly hear from state and local health departments that they do not always have the resources they require to address all the S.T.D. issues that they need to address.'' The gonorrhea rates began soaring in the late 1960's and peaked in the 1970's because of changes in sexual mores and behavior, wide use of oral contraceptives, and decreased use of condoms, said Dr. Valdiserri and Dr. John M. Douglas, who directs S.T.D. prevention at the disease centers in Atlanta. The rates dropped in the 1980's as health officials stepped up control measures. Still, Dr. Douglas said, the 330,132 gonorrhea cases reported in 2004 are believed to be less than half the 700,000 cases estimated to have occurred that year. Rates for early-stage syphilis, which reached an all-time low in 2000, have increased for four straight years to 2.7 cases per 100,000 people in 2004. The rise is largely due to increases in early syphilis infections among gay men, to 4.7 cases per 100,000 from 2.6 cases in 2000, the disease centers said

Activation of melanocortin-4-receptors (MC4Rs) reduces body fat stores by decreasing food intake and increasing energy expenditure. MC4Rs are expressed in multiple CNS sites, any number of which could mediate these effects. To identify the functionally relevant sites of MC4R expression, we generated a loxP-modified, null Mc4r allele (loxTB Mc4r) that can be reactivated by Cre-recombinase. Mice homozygous for the loxTB Mc4r allele do not express MC4Rs and are markedly obese. Restoration of MC4R expression in the paraventricular hypothalamus (PVH) and a subpopulation of amygdala neurons, using Sim1-Cre transgenic mice, prevented 60% of the obesity. Of note, increased food intake, typical of Mc4r null mice, was completely rescued while reduced energy expenditure was unaffected. These findings demonstrate that MC4Rs in the PVH and/or the amygdala control food intake but that MC4Rs elsewhere control energy expenditure. Disassociation of food intake and energy expenditure reveals unexpected divergence in melanocortin pathways controlling energy balance.

Scarce supplies of the antiviral drug Tamiflu might be extended as much as 100 percent by using it in combination with a second drug in the event of a pandemic of influenza, the journal Nature reported

Can we improve access in primary care without compromising the quality of care? The purpose of this article is to demonstrate how timely access to primary care can be achieved without compromising the quality of the care being delivered. The Veterans Health Administration (VHA) is an integrated healthcare system that has implemented change to improve primary care access to the veterans it serves, while not only maintaining but also actually improving the quality of care. Many healthcare executives are struggling with achieving desirable access to care and continuity of care. To confront this problem, many large and small practices have initiated an approach known as advanced clinic access, open access, or same-day scheduling, introduced by the Institute for Healthcare Improvement (IHI). This approach has increasingly been used to reduce waits and delays in primary care without adding resources. To measure quality of care, specific performance measures were developed to quantify the effectiveness of primary care in VHA. Although it was initially viewed with concern and suspicion and was seen as a symptom of unnecessary micromanagement, healthcare team members were encouraged to use performance feedback as an opportunity for systems improvement as well as self-assessment and performance improvement for the team. All quality data are posted quarterly on VHA's internal web site, providing visible accountability at all levels of the organization. Clinical workflow redesign leads to reduced wait times without compromising quality of care. These large system improvements are applicable to large and small organizations looking to tackle change through the use of a collaborative model.

Surgical repair of recurrent postmyocardial infarction septal defect is associated with a high mortality rate. We present 2 patients whose recurrent defects were closed percutaneously using an Amplatzer device

OBJECTIVE: There is a rapidly evolving debate on the indications and appropriate duration of therapy for postmenopausal hormone therapy. The objective of this meta-analysis was to examine the specific relationships of postmenopausal estrogen therapy (ET), postmenopausal combined (estrogen-progestogen) hormone therapy (CHT), and the incidence of breast cancer. DESIGN: We performed computerized searches of MEDLINE and CancerLit through September 2003 and reviewed reference lists of retrieved studies and meta-analyses. We included English-language studies that identified noncontraceptive postmenopausal hormone use; reported on the risks of 'current use' of ET and/or CHT and breast cancer incidence; were case-control, cohort, or experimental; and reported either an odds ratio (OR), relative risk (RR), or HR with CIs. Two investigators were involved during all stages of study selection and independently extracted all data selected for inclusion in meta-analyses. RESULTS: Meta-analysis of 13 studies of ET and breast cancer (700,000 women) resulted in an OR of 1.16 (95% confidence limits [CL] 1.06, 1.28), with estimates for less than 5 years use 1.16 (1.02, 1.32) and more than 5 years use 1.20 (1.06, 1.37). Meta-analysis of eight studies of CHT and breast cancer (650,000 women) resulted in an OR of 1.39 (95% CL 1.12, 1.72), with estimates for less than 5 years use 1.35 (1.16, 1.57) and more than 5 years use 1.63 (1.22, 2.18). CONCLUSIONS: Data from observational studies support the association of increased but considerably different risks for breast cancer incidence among current users of ET and CHT. These represent the first pooled estimates for ET. CHT estimates correspond to those from randomized trials