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The recent NHMRC research grant announcements provided some very good news for Active Living Research in Perth. Active Living were successful in gaining a NHMRC Capacity Building Grant which will help establish a research centre to examine the impact of community design on physical and mental health across the life course. The grant is worth $2, 067, 750 over five years. The large multi-disciplinary team working on the project will be based in Perth and is made up of researchers in several disciplines including biostatistics, aging, GIS, behavioural science, urban design, transportation planning, child health and social determinants of health. The team includes Professor Billie Giles-Corti who is a Career Development Fellow, co-funded by the Heart Foundation and the NHMRC. The Heart Foundation is very proud to count her amongst our successful Fellowship recipients. In addition to the Capacity Building Grant, funding was allocated for Eco-RESIDE which will study the health economics of creating more walkable neighbourhoods. The increasing prevalence of overweight and obesity in Australia is of major concern to the Heart Foundation and we are committed to making a difference in this key public health issue. Obesity, low levels of physical activity and poor diets are all key risk factors for cardiovascular disease and many other chronic diseases. Unfortunately, researchers around the world currently have a very poor understanding of the best ways to prevent this escalating obesity epidemic. There is also little known about the most effective ways of promoting physical activity or healthy diets. Research in these areas is therefore critically important. The Weight Related Research Register provides the research community with a central point of information about past and present Heart Foundation funded research into weight related issues. The Heart Foundation has also developed an Action Plan to guide its work in addressing Australia's weight problem. The research grants are a huge boost for Active Living Research in Perth and will focus on determinants of physical activity and mental health. The studies will have an enormous impact on their capacity for research in Western Australia and the results will have far-reaching relevance. As part of the grant some post-doctorate positions were named, however, there are still some positions remaining. Active Living will soon be advertising for these post-doctorates. For more information on the positions or the projects, contact the Research Program. The Heart Foundation is proud to be associated with Active Living in Perth and congratulates them on these two important grants.|
Taken together, MHO and MONW patients demonstrate the point that it is not simply the abnormal increase in normal adipose tissue that reliably predicts subsequent adverse metabolic consequences of adiposopathy. Instead, it is the sufficient presence of or sufficient increase in inadequately functional or blatantly dysfunctional adipose tissue that is the essential, underlying pathology. Emerging from this paradigm are two other concepts: the `obesity metabolic cycle' and `adipose autodysharmonia'. As noted above, the predisposition to dysfunctional adipose tissue is largely genetic, and in many cases exacerbated by adiposity and sedentary lifestyle Figure 1 ; . One of the more important consequences of adiposopathy is the promotion of insulin resistance and hyperinsulinemia. In an environment where adipose tissue remains relatively sensitive to insulin a growth factor ; while other organs such as skeletal muscle and liver become more and more insensitive to insulin, hyperinsulinemia may ensue, which in turn may lead to increased adipose tissue and subsequent worsening of adipose function. This worsening adiposopathy may cause yet further insulin resistance among other body organs. Adiposopathy, followed by insulin resistance and hyperinsulinemia, followed by worsening adiposity and adiposopathy, followed by even greater insulin resistance has been termed the `obesity metabolic cycle' . The fact that increased insulin levels may increase adipose tissue mass may help to explain why antidiabetes drugs that lower blood sugar through increased insulin levels may further increase body weight, while antidiabetes drugs that lower blood sugar through increasing insulin sensitivity without increase or perhaps decrease in insulin levels ; are often associated with no weight gain, or perhaps modest weight loss . Also as noted above, the location of adiposity may provide clues as to when adipose dysfunction is most likely to occur. Indeed, studies of human fat depots abdominal subcutaneous, mesenteric and omental ; have shown that even after multiple doublings, preadipocytes retain the characteristics of the fat depots from which they had originated . This suggests that subcutaneous and visceral fat may be genetically predisposed to have significantly different functions. Thus, within the same individual, various fat depots may exhibit functional conflicts in which well-functioning subcutaneous peripheral fat may be providing favorable metabolic benefits, while at the same time, malfunctioning subcutaneous truncal and visceral fat may be, for instance, birth control pills brands.
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MIBEFRADIL Posicor, Roche Laboratories Inc, Nutley, NJ ; is a long-acting nondihydropyridine calcium channel blocker CCB ; that uniquely blocks both the T transient ; calcium channels and the L long ; calcium channels.1 All other CCBs currently approved for use in the United States block the L channel. Less than a year after its release in mid-1997, almost 200 000 Americans were taking mibefradil.2 Roche Laboratories voluntarily withdrew Posicor from the market on June 8, 1998, 3 as numerous cytochrome P-450mediated drug interactions became apparent. We report 4 cases that suggest that switching to dihydropyridine CCBs the day after taking mibefradil may be hazardous. Report of Cases Case 1.--A 79-year-old woman with hypertension was taking daily doses of and allegra.
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Various groups have developed strategies to overcome barriers to immunization and improve immunization rates. Standards for adult immunization practices Table 2 ; developed by the National Vaccine Advisory Committee address the availability of vaccines, the assessment of patient immunization status, effectiveness of communication with patients, proper administration and documentation of vaccines, and the implementation of community-based strategies to improve vaccination rates.17 The CDC recommends a variety of age-based, organizational, community-based, and provider-based strategies to improve vaccination rates.2 Assessment of immunization status during checkups at the age of 50 years and 11 or 12 years are age-based strategies. Using standing orders instead of requiring a physician's order for immunization is an organizational strategy recommended by the CDC, although the feasibility of standing orders hinges on state laws.2 The Centers for Medicare and Medicaid Services no longer requires a prescription for pneumococcal or influenza vaccines to obtain reimbursement.18 Other organizational strategies include programs to identify high-risk patients e.g., residents of nursing homes or skilled-nursing facilities ; . Community-based strategies include utilizing outreach clinics e.g., influenza and pneumococcal vaccine clinics ; . Providerbased programs recommended by the CDC include practicebased tracking systems e.g., lists of patients at risk for infection and unvaccinated patients ; and physician reminder systems e.g., chart notations, preventive health checklists, computerized "pop up" notations on patient medical records ; .2 In recent years, efforts to improve vaccination rates have focused on emergency departments. A retrospective study of 300 unvaccinated patients who were hospitalized with pneumococcal bacteremia in an inner city public teaching hospital found that 87% of patients had visited the emergency department within the 4 weeks to 5 years prior to hospital admission.19 About half of patients had been admitted to an inpatient medical ward i.e., hospitalized ; and 31% had visited a general medicine clinic in the same time frame. Therefore, the emergency department at the inner city hospital appeared to afford a better opportunity to vaccinate patients at risk for infection than the inpatient setting or the general medicine clinic and alprazolam.
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71 180 85.7% ; had no evidence of acne. The rate of treatment initiation with Diane-35 increased from the year 1998; plateaued in 2002 mean 669 mo declined to 476 71% of the plateau mean ; during February 2003, the month after the CBC broadcast; and continued to decline to the end of the study period Fig. 1 ; . In contrast, new prescriptions for Alessw increased to the end of 2003. The proportions of women with no acne among those initiating Diane-35 use before and after the CBC broadcast differed little 45.5% v. 46.8% ; . Fig. 2 illustrates the numbers of women who switched from Diane-35 to an oral contraceptive, which rose sharply in February 2003 for both subgroups of women possible and no acne ; . The difference between predicted and actual trends became significant from February 2003, within one month of the CBC show: for starting Diana-35, p 0.009; for switching from Diana-35, p 0.0001. Nearly half of the initial prescriptions for Diane-35 from 1998 through 2003 were for women with no record of acne diagnosis, referral or drug therapy. This suggests that the drug was used for more than its approved indication. Our estimate of off-label use "no acne" ; is conservative as we excluded all "possible acne" cases, not just severe acne that had failed to respond to other treatments. Although women who used only over-the-counter acne treatments and had no medical diagnoses were counted as having no acne, few cases of severe, unresponsive acne.
N E W Brief inhalation of dilute diesel exhaust at levels comparable to those encountered curbside along city streets promotes myocardial ischemia in patients with coronary heart disease, Dr. David E. Newby reported at the annual meeting of the American College of Cardiology. He presented the first-ever study in which patients with known CHD were deliberately exposed to air pollution. The purpose was to pinpoint the mechanisms underlying the well-established epidemiologic association between air pollution and increased cardiovascular morbidity and mortality. "Not everybody believes that air pollution is linked to cardiovascular disease, particularly pressure groups backed by the automobile industry. So we felt it was very important to show what the mechanisms are, " explained Dr. Newby, professor of cardiology at the University of Edinburgh. He and his coinvestigators in Edinburgh and at Ume Sweden ; University briefly exposed 20 Swedish patients with prior MI to either dilute diesel exhaust at a concentration of 300 mcg m3 or to filtered air during intervals of moderate exercise or rest in a double-blind crossover study conducted in a special chamber. All patients had stable CHD, having previously undergone coronary revascularization. All were on standard evidence-based medications for secondary prevention and ambien.
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