Rates of Sexually Transmitted Diseases On the Rise in the United States
Reports of sexually transmitted diseases (STDs) increased increased in 2007, with a particularly heavy burden in women and minorities, according to an annual report by the Centers for Disease Control and Prevention (CDC).

More than 1.4 million new cases of chlamydia and gonorrhea—the most commonly reported STDs—were reported in the United States in 2007. The chlamydia rate among women was three times that in men (543.6 cases per 100,000 women, compared to 190 cases per 100,000 men). The gonorrhea rate was also higher among women (123.5 per 100,000 women, compared to 113.7 per 100,000 among men). The report found that there were more than 1.1 million chlamydia cases reported in 2007, up from about 1 million in 2006. More than 350,000 cases of gonorrhea were reported in 2007. However, it is estimated that more than half of all new infections with chlamydia and gonorrhea continue to go undiagnosed.

Although they represent 12% of the US population, blacks accounted for about 70% of reported gonorrhea cases, 48% of chlamydia, and 46% syphilis cases. Black women 15 to 19 years of age accounted for the highest rates of both chlamydia (9,646.7 per 100,000 population) and gonorrhea (2,955.7 per 100,000 population) of any group, the CDC report said.

Syphilis remains a serious threat to the health of gay and bisexual men, the CDC reported. In 2007, gay men continued to account for the majority of primary and secondary syphilis cases, representing 65% of the 11,466 primary and secondary syphilis cases reported. Additionally, while primary and secondary syphilis continued to occur at substantially lower levels among women than men (1.1 cases per 100,000 among females compared to 6.6 among males), syphilis rates have been increasing among women and infants.

Overall, the CDC estimated that almost 19 million new sexually transmitted infections occur each year, and almost half of those are among 15- to 24-year-olds. To reduce the toll of STDs and protect the health of millions of Americans, the CDC said it supports a comprehensive approach to STD prevention that includes screening, treatment, and behavioral interventions, with a focus on reducing health disparities among racial and ethnic groups.

Internet Weight-Loss Pills Tainted with Dangerous Ingredients
The Food and Drug Administration (FDA) has listed on its Web site 28 weight-loss products that consumers should avoid because they contain unlisted, dangerous ingredients. Most of the diet pills appear to be made innChina and are sold mainly on the Internet.

According to the FDA, nearly all of the pills contain sibutramine, an appetite suppressant that can cause heart attacks, strokes, and heart palpitations, especially in people with high blood pressure or heart problems. Some of the diet pills contain nearly three times the recommended maximum dose of active pharmaceutical ingredient, the FDA found.

Additionally, several of the pills contain phenolphthalein, a chemical found in laxatives. Phenolphthalein is being withdrawn from the market because of its reported cancer risks.

None of the supplements lists these or other dangerous ingredients on their labels. The FDA is considering pressing criminal charges against some of the companies because they have not responded to requests to their recall their products, a news release from the FDA reported.

To view the list of these weight-loss products, please visit the FDA Web site: www.fda.gov/bbs/topics/NEWS/2008/NEW01933.html.

Cancer Incidence and Death Rates Decreased in the United States
The incidence and death rates for all cancers appear to have decreased significantly for both men and women in the United States, according to an annual report from the American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR).

Both incidence and death rates from all cancers combined decreased statistically significantly (P<.05) in men and women overall and in most racial and ethnic populations. These decreases were driven by significant declines in both incidence and death rates for lung, colorectum, and prostate cancer in men and breast and colorectum cancer in women, as well as a leveling off of lung cancer death rates in women.

Although the national trend in female lung cancer death rates has stabilized since 2003, lung cancer incidence and/or death rates among women increased in 18 states, 16 of which were in the South or Midwest. The annual percentage decrease in current smoking among adult women was lower in the Western and Northeastern regions of the country. California was the only state with decreasing lung cancer incidence and death rates in women, the report said.

Alzheimer's Disease Not Slowed by Ginkgo Biloba
Ginkgo biloba may not delay progression of Alzheimer's disease (AD), according to a clinical trial conducted in five academic medical centers in the United States between 2000 and 2008. The findings were reported in the Journal of the American Medical Association.

First author Steven T. DeKosky, MD, of the University of Virginia, and colleagues assessed 3,069 community volunteers aged 75 years or older with normal cognition (n=2,587) or mild cognitive impairment (MCI; n=482) at study entry and every 6 months for incident dementia. Participants were randomized to received 120 mg extract of ginkgo biloba (n=1,545) or placebo (n=1,524) twice daily.

Dr. DeKosky and colleagues found that 523 individuals developed dementia (246 receiving placebo and 277 receiving ginkgo biloba), with 92% of the dementia cases classified as possible or probable AD, or AD with evidence of vascular disease of the brain. The overall dementia rate was 3.3 per 100 person-years in participants assigned to ginkgo biloba and 2.9 per 100 person-years in the placebo group. The hazard ratio for ginkgo biloba compared with placebo for all-cause dementia was 1.12 (P=.11). Ginkgo biloba also had no effect on the rate of progression to dementia in participants with MCI (P=.39), according to the study authors.

Insufficient Sleep May Increase Heart Disease Risk
Longer measured sleep is associated with lower coronary artery calcification incidence independent of examined potential mediators and confounders, according to a report in the Journal of the American Medical Association.

First author Diane Lauderdale, PhD, of the University of Chicago, and colleagues conducted a 5-year observational cohort study of home monitoring in a healthy middle-aged population of 495 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort Chicago site. Participants had no detectable calcification at baseline.

According to the researchers, 5-year calcification incidence was 12.3% (n=61). Longer measured sleep duration was significantly associated with reduced calcification incidence (P=.01), and no potential mediators considerably altered the magnitude or significance of sleep (P=.02).

College-Aged Individuals Prone to Mental Health Disorders
Nearly 20% of young adults may have a psychiatric disorder, according to a study in the Archives of General Psychiatry.

Mark Olfson, MD, MPH, of Columbia University, and colleagues, analyzed data from interviews with 5,092 college-aged individuals (aged 19 to 25) both attending (n=2,188) and not attending (n=2,904) college in the United States in the previous year. The interviews were conducted in 2001 and 2002.

Researchers found that almost half of college-aged individuals had a psychiatric disorder in the past year. The overall rate of psychiatric disorders was not different between college-attending individuals and their non-college-attending peers.

Individuals attending college were more likely to develop alcohol disorders. However, after adjusting for sociodemographic characteristics, the risk of developing an alcohol disorder was as great for non-college attending individuals. College students were significantly less likely to have a diagnosis of drug use disorder or nicotine dependence or to have used tobacco than their non-college-attending peers, the study said. Also, bipolar disorder was less common in individuals attending college. College students were significantly less likely to receive past-year treatment for alcohol or drug use disorders than their non-college-attending peers.

Although treatment rates varied across disorders, overall fewer than 25% of individuals with a mental disorder sought treatment in the year prior to the survey.

Weight Loss Surgery May Reverse Diabetes in Teens
Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass, according to a report in Pediatrics. The weight loss surgery also improved insulin resistance, beta-cell function, and cardiovascular risk factors in adolescent patients that underwent gastric bypass.

First author Thomas Inge MD, PhD, and colleagues at the Cincinnati Children's Hospital Medical Center and five other medical centers followed 78 teenagers with type 2 diabetes, 11 of whom had gastric bypass surgery. Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean body mass index [BMI] of 50 ±5.9 kg/m2) with numerous cardiovascular risk factors.

Approximately one year after surgery, all but one patient in the surgery cohort had dropped approximately one-third of body weight and had stopped taking medication for type 2 diabetes. Investigators also found significant improvements in BMI (-34%), fasting blood glucose (-41%), fasting insulin concentrations (-81%), hemoglobin A1c levels (7.3%-5.6%), and insulin sensitivity. There were also significant improvements in serum lipid levels and blood pressure.

In comparison, adolescents with type 2 diabetes who did not receive gastric bypass but were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 ±7.3 kg/m2; 1-year BMI: 34.9 ±7.2 kg/m2) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% ±2.3%; 1 year: 7.1% ±2%).

Electronic Prescribing Reduced Drug Spending in Study
Clinicians using an electronic prescribing (e-prescribing) system appear more likely to prescribe lower-cost medications, according to a report published in the Archives of Internal Medicine.

First author Michael A. Fischer, MD, MS, of Brigham and Women's Hospital and Harvard Medical School, and colleagues studied an e-prescribing system designed to track copayment tiers across insurance plans. In April 2004, two large Massachusetts insurers implemented the system, which provided community-based practices with free wireless devices and access to a secure web portal that color-coded drugs by copayment tier. The researchers compared the change in proportion of prescriptions for the three tiers before and after e-prescribing began, and also compared the prescription habits of clinicians using the e-prescribing system to those of controls, over 18 months.

Between October 2003 and March 2005, more than 1.5 million patients filled 17.4 million prescriptions. After implementation of e-prescribing, tier 1 prescriptions (generic drugs) increased by 3.3% and second- and third-tier prescriptions (moderately priced brand-name medications and expensive brand-name medications, respectively) decreased accordingly among clinicians using the system.

E-prescriptions of tier 1 medications increased 6.6%, compared with a 2.6% increase among prescriptions in the control group, the investigators said.

Among clinicians using the new system, e-prescriptions accounted for 20% of prescriptions, the study authors found. These clinicians prescribed more tier-1 medications than the control group even when not e-prescribing; however, prescriptions of lower-cost medications were most common among e-prescriptions.

Based on average medication costs for private insurers, the researchers estimated that using such an e-prescribing system at this rate could result in savings of $0.70 per patient per month, or $845,000 annually per 100,000 insured patients filling prescriptions.

David S. Boyer, MD, is a Clinical Professor of Ophthalmology at the University of Southern California Keck School of Medicine, Department of Ophthalmology in Los Angeles. He is a member of the Retina Today Editorial Board. Dr. Boyer may be reached at +1 310 854 6201; fax +1 310 652 7250; or via e-mail: VITDOC@aol.com.