Login Form

Trauma: Live or die? White vs "minority" trauma center may determine your outcome

Study conclusion: Patients treated at hospitals with higher proportions of minority trauma patients have increased odds of dying, even after adjusting for potential confounders.



“Trauma patients have a better chance of survival if they receive care at a trauma center in a hospital that treats primarily non-minority patients versus being treated in a hospital that provides care to primarily minority patients.”

-source



This is surprising because it would seem that hospitals that deal with more trauma would be in large city centers with more crime, and more traffic.  Large, city-center hospitals tend to have many training residency programs which means that access to specialists is readily available (even IF they are trainees, they are more prepared treat the specific injury patterns unique to their specialty than a physician who doesn’t typically deal with such problems).  And they have mechanisms in place, protocols, processes, and equipment to deal with high volume trauma that may be lacking in smaller, more suburban hospitals.



However, it was discovered that patients (of all races) were 45% more likely to die in minority hospitals with blunt trauma injuries, and 37% more likely to die of traumatic injuries overall when compared with white hospitals.



So this means that even if a white person went to a minority hospital, their likelihood of death would be higher.  Likewise, if a minority patient went to a white hospital, their mortality is lower.  This information condemns minority hospitals, which seem to save less people, no matter who they are, in trauma.



The researchers speculate that this might be due to funding issues, and the fact that minority hospitals have a larger payer mix of uninsured patients.  Specifically, white hospitals had about 75% of it’s patients with insurance, whereas minority hospitals had just over half at 55%.



"Minorities and the uninsured were more likely to die of trauma injury," stated Haider.



Seems to me that, if this is the problem, it could be alleviated if everyone had insurance.  That way, all hospitals will have a more consistent payer mix, and those hospitals that see more patients, will have more money available in which to treat those patients appropriately.  Sometimes people “forget” that healthcare indeed is NOT free.  And without adequate funds, things don’t work well.





Intervening to prevent breast cancer: a study



Intervening to prevent breast cancer in African-American women.


We love this article because it focuses on aggressive breast cancer in African-American women and attempts to identify possible points of early intervention in an effort to PREVENT the cancer from developing!!



"What’s new about our study is that we can find activation of some of the things that are bad in triple-negative breast cancer in precancerous cells,"



The researchers’ goal was to evaluate abnormally behaving pre-cancerous cells from the breast tissue of high-risk African American woman and discover what *causes* them to become abnormal.  Which pathways are activated that changes the cell from a normally functioning cell, into a cancerous cell.



They discovered that:


1.  abnormal (pre-cancerous) breast cells used more than the normal amount of glucose (sugar), which is known as the Warburg effect.


Warburg effect: In oncology, the Warburg effect is the observation that most cancer cells predominantly produce energy by a high rate of glycolysis followed by lactic acid fermentation in the cytosol, rather than by a comparatively low rate of glycolysis followed by oxidation of pyruvate in mitochondria like most normal cells.[1] The latter process is aerobic (uses oxygen). Malignant rapidly-growing tumor cells typically have glycolytic rates that are up to 200 times higher than those of their normal tissues of origin; this occurs even if oxygen is plentiful.



2.  a particular cancer-signaling pathway is activated in these abnormal (atypical/pre-cancerous and cancerous) cells called AKT/mTOR.  It is known that insulin stimulates AKT/mTOR.  So it is reasonable to deduce that insulin stimulates aggressive triple negative breast cancer formation in pre-menoupausal African American women!


“If untreated, someone with prediabetes or diabetes, in which the body produces more sugar, might stimulate precancerous cells and promote a conversion to cancer cells every time they ate.”




The researches believe that they can use this (Warburg effect) measurement of how much glucose is being used by the cells as a marker for early detection of abnormal cells (before they are aggressive cancers).  And if a woman’s breast tissue demonstrated this increased glucose utilization, they could start preventative intervention and treatment that involve lowering blood insulin levels.



How to lower blood insulin levels (even in women who may not be diabetic)?  They propose that weight loss, exercise, and metformin would do the trick.



Metformin is a medicine that increases insulin sensitivity in the body, decreased glucose absorption from the gut, and decreases the amount of glucose made by the liver.  Collectively these actions of metformin cause the body glucose burden to decrease so less insulin is needed.  AND it helps the body use the insulin that IS there, so lower doses actually control the blood sugar levels.


Lower insulin means lower activation of the AKT/mTOR signaling pathway.  Lower cancer signaling pathway stimulation means less cancer.



Awesome!



Changing your diet and lifestyle in an effort to prevent diabetes will serve you well.   In addition to avoiding diabetes, you avoid the entire metabolic syndrome (obesity, vascular disease, cholesterol issues) AND breast cancer as well!  Especially if you are a woman of color!




Probiotics = Less Colds And Less Antibiotic Use


Probiotics modestly help stave off colds and the need for antibiotics to treat them, according to a Cochrane review.  The points to take away from the study are:


"Taking prophylactic doses of healthy bacteria in yogurt and supplements was associated with 12% fewer acute upper respiratory tract infections."


and


"Antibiotic use to treat these infections was also lower compared with individuals not taking probiotics..."


Good bacteria...yum, yum, yum. 




Moderate Drinking Enhances Successful Aging In Middle-aged Women


A new study connecting moderate drinking and the health of women is out and the New York Times has the story.  "Middle-aged women who have an alcoholic drink every day may increase their chances of enjoying health in their old age, according to a new report."


The study is published in the September Issue of PLoS Medicine and provides the following conclusion:

"These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages."


Overall health status was determined by successful ageing as meeting all four of the following criteria:


(1) no history of cancer (except nonmelanoma skin cancer), diabetes, myocardial infarction, coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, congestive heart failure, stroke, kidney failure, chronic obstructive pulmonary disease, Parkinson's disease, multiple sclerosis, or amyotrophic lateral sclerosis;


(2) no impairment of cognitive function 


(3) no [abnormal or unexpected] physical limitations 


(4) good mental health status



This is further support for moderate drinking (less than 15 grams of ethanol per day -  a can of beer or a small glass of wine).


C'mon ladies, bottoms up! 


- PLoS Medicine



Motrin causing kidney cancer?


NSAIDs (non-steroidal anti-inflammatory drugs) are drugs that we take to alleviate pain and decrease acute inflammation.  They are extremely useful for many painful conditions and are preferred over narcotics by many as they are not addicting, safer in overdose, and inexpensive.  They are preferred over steroid anti-inflammatory medication because steroid use adversely affects many bodily systems and has major negative side-effects if used over time. 


It has generally been accepted that NSAIDs are safe despite a small bleeding risk, and a slight (temporary) decrease in kidney function with their use.


So you can imagine our surprise when we heard that this tried and true medication may be causing kidney cancer.


Prospective Evaluation of Analgesic Use and Risk of Renal Cell Cancer:  Our prospective data suggest that longer duration of use of nonaspirin NSAIDs may increase the risk of RCC.



Dr. Matthew Galsky reminds us that "the absolute risk is really on the small side. It's nine to 10 per 100,000 person years," he said. "So many patients take these medications and so many benefit from them; the risk is really on the small side....for the person taking these medicines daily for over 10 years, it is food for thought".



Like everything in life, you must weigh the risks and benefits.  After all, as stated, each class of anti-inflammatory medication has negative drawbacks, and overall, NSAIDs are safe.