Among patients who are insured by Medicare, the risk of early death after bariatric surgery, sometimes known as gastric bypass surgery, is considerably higher than has been suggested by previous research.

According to an article in the Oct. 19 issue of the Journal of the American Medical Association, death soon after surgery was strongly associated with advancing age. Men and patients of surgeons with less experience in bariatric surgery were at highest risk.

Dr. David Flum, 91探花associate professor of surgery and director of the Surgical Outcomes Research Center, and colleagues conducted the retrospective cohort study by surveying all Medicare beneficiaries nationwide who underwent bariatric surgery between 1997 and 2002. The objectives of the study were to evaluate the risk of early death among these patients and to determine the relative risk of death among older patients.

“Several case series have demonstrated that bariatric surgery can be performed with a very low rate of post-operative mortality, somewhere under 1 percent,” Flum said. “These reports, though, are often from the best doctors doing surgery in the best circumstances. We wanted to show what the risks are in high-risk patients, such as medically disabled Medicare patients and older Medicare patients, as well as in the community at large. Studying Medicare patients undergoing these operations at nearly every hospital in America gives us more realistic numbers that patients can use in their decision to have this surgery.”

The rates of 30-day, 90-day and one-year mortality from all causes were 2 percent, 2.8 percent and 4.6 percent respectively. Men suffered death rates more than twice those of women. After statistical adjustments for gender and existing medical problems, such as diabetes, osteoarthritis or heart disease, the odds of death were about four times greater for Medicare recipients over 65. Patients who were 65 and older had a 30-day mortality rate of nearly 5 percent. The risk of death at 90 days was 1.6 times higher for patients whose doctors had less experience with this particular type of surgery.

“Our goal for this study was to help inform patients, clinicians, insurers and others involved in medical decision-making about the risk of early post-surgical death in the general community and among higher risk patients,” Flum said. “Although Medicare pays for some of these operations, there is no national insurance coverage decision so far, and no consensus on the efficacy and safety of bariatric surgery in older patients.”

He added, “Most adults in the United States are overweight or obese, and obesity will likely soon become the leading cause of death. For patients with extreme obesity, bariatric surgery is so far the only intervention that consistently helps patients achieve significant and sustained weight loss, but bariatric surgery is not for everyone. This research is helping us to understand which groups of patients are particularly high-risk. Those considering this surgery, particularly older adults, should balance the risk of bad outcomes against the anticipated benefits of the procedure.”

The School of Public Health and Community Medicine has been chosen to receive $3.8 million to develop a Center of Excellence in Public Health Informatics from the Centers for Disease Control and Prevention (CDC). The director of the CDC, Dr. Julie Gerberding, made the announcement Sept. 30 at a Washington, D.C., news conference.

The emerging field of informatics involves the application of information and computer science technology to improve public health practice and population health. One of the goals of public health informatics is to improve the ability of communities to detect and respond to health threats from disasters such as Hurricane Katrina or the 9/11 terrorist attacks.

Dr. Mark Oberle, assistant dean of the School of Public Health, is the principal investigator for the Center of Excellence. Dr. Sherilynne Fuller, director of Health Sciences Libraries and professor of biomedical informatics, is the project co-director.

“This award will position the 91探花as an academic leader in public health informatics research and training,” Oberle said. “It will greatly expand the existing Center for Public Health Informatics.”

The CDC grant will fund two major research projects that focus on improving public health surveillance and epidemic detection methods, and on the development of an interactive digital knowledge management system. That system will include concept mapping services that will provide rapid access to answers from a variety of key resources.

The Center’s research will bring together faculty from the School of Public Health, the Department of Medical Education and Biomedical Informatics and the 91探花Department of Technical Communication.

In addition to the award from the CDC, the 91探花recently received National Library of Medicine funds to train leaders in public health informatics.

The 91探花shares the Center of Excellence award with Harvard University.

To learn more about the center, visit .  

Drug-involved deaths increased by more than a third in 2004, due primarily to cocaine, heroin, prescription opiates and prescription and over-the-counter depressants, according to the latest report on drug abuse trends in the Seattle-King county area. The twice-yearly report is compiled by Caleb Banta-Green, research scientist at the 91探花Alcohol and Drug Abuse Institute.

鈥淪treet drugs are still around at relatively high levels,鈥� Banta-Green said, 鈥渨hile prescription and over-the-counter-drugs are now in full force.鈥�

Cocaine-involved deaths are at their highest level in at least 10 years, numbering 92 in 2004. Cocaine continues to be the most common illegal drug mentioned in emergency department reports. Deaths involving depressants, such as Valium and Benadryl, were up 15 percent, and prescription opiates, such oxycodone and methadone, were up 40 percent in 2004 compared with 2003. It should be noted that more people obtain methadone for pain than for opiate addiction treatment.

Other findings include:

Treatment admissions for heroin are began to increase as treatment capacity expanded in 2004. Approximately 2,500 people in King County were in opiate treatment programs, mostly utilizing methadone treatment. Heroin-involved deaths totaled 75 in 2004, up a bit from 2003 but well below the peak of 144 in 1998.

• Deaths and treatment admissions involving prescription opiates continue to rise steadily. Those entering methadone treatment cited prescription opiates as their primary drug of use increased from three percent to 12 percent of admissions between 1999 and 2004. Prescription opiate-involved deaths totaled 118 in 2004, up from 84 in 2003 and 28 in 1997.
  
• Methamphetamine-involved deaths totaled 18 deaths per year in 2003 and 2004, up from three in 1997.
  
• In 2004, one in every five drug-related deaths involved the combination of prescription opiates and depressants, and usually other drugs as well.
  
• Negative consequences related to prescription stimulants appear low, but the number of prescriptions has increased substantially. Anecdotal reports of youth and young adult misuse are common.
  
• Marijuana is widely used, particularly by youth.
  
• The vast majority of injection drug users are infected with hepatitis B and C.
  
• HIV among injection drug users is generally low, with the exception of methamphetamine-injecting men who have sex with men. The complete report is available on the publications page of the ADAI at .

91探花researchers have discovered that genetic variations may influence how individuals respond to a common coumarin-based anticoagulant called warfarin, according to an article published in the June 2 edition of the New England Journal of Medicine.

Research by Dr. Allan E. Rettie, professor and chair of medicinal chemistry in the School of Pharmacy, Dr. Mark Rieder, research assistant professor in genome sciences, and their colleagues shows that warfarin response is highly dependent on the gene encoding vitamin K epoxide reductase complex 1 (VKORC1).

Millions of people use warfarin to prevent blood clotting after a heart attack, stroke or major surgery. However, the oral anticoagulant dose has to be carefully titrated, as too much of the drug can cause excessive bleeding and too little results in no therapeutic benefit. A retrospective study of the medical records of patients on long-term warfarin therapy showed that VKORC1 haplotypes can be used to stratify patients into low, intermediate and high-dose warfarin groups, and may explain differences in dose requirements among patients of different ancestries.

The research helps set the stage for the development of what is often called personalized or designer drug therapy, in which a person鈥檚 genetic makeup is used to individualize and optimize drug therapy.

鈥淯sed in conjunction with the clinical data that physicians routinely gather, this information should help guide selection of the correct dose for patients because VKORC1 alone accounts for a large portion of the dose variability,鈥� said Rettie.

Rieder added, 鈥淕enetic variations in VKORC1 turn the gene up or down, which affects the amount of warfarin required to provide the desired anticoagulant response.鈥�

The study means that physicians have another tool to help better dose patients in need of anticoagulants. Typically, a patient needs numerous clinic visits before a stabilizing dose of the drug is achieved.

鈥淲e think this gene test could help them get to the appropriate dose more quickly,鈥� Rettie said. 鈥淗owever, prospective clinical studies on this are needed, now that the dominant genetic mechanisms that cause this variability have been established.鈥�

The National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, is awarding two seven-year research grants totaling $22 million to researchers in the 91探花 School of Dentistry. The grants, the largest ever received by the School, will establish a 150-dentist network across Washington, Oregon, Idaho, Montana and Utah, and develop a coordinating center to enroll patients in clinical trials through local dentist offices. The network will be called the Northwest Practice-Based Research Collaborative in Evidence-Based Dentistry, or Northwest PRECEDENT.

Of the funds, $14,700,000 will be used to develop the research network and pay for 15 to 20 studies over the course of seven years, according to Dr. Timothy DeRouen, executive associate dean for research and administrative affairs at the 91探花 School of Dentistry, professor of biostatistics in the School of Public Health and Community Medicine (SPHCM), and the principal investigator and chair for the network.

“Practice-based networks are intended to generate timely information that’s relevant to the practice of dentistry,” DeRouen said. “By working with state dental associations, dental alumni groups, and local dental study clubs, we’ll recruit practitioners to participate in the network.” Five regional coordinators will share oversight duties across the broad geographic region served by the network. An educational program will be offered to participating dentists.

The remaining $7,500,000 will be used to establish the data coordinating center (DCC) for the network.

Dr. Brian Leroux, associate professor for dental public health sciences in the 91探花School of Dentistry and of biostatistics in the SPHCM as well as principal investigator and director of coordinating, said, “The DCC will build on the strengths of an existing biostatistics group here at the UW. It will provide scientific leadership in design and implementation of clinical research and the infrastructure needed for the conduct of clinical trials and other studies to address important oral health care questions.”

“Together, these grants represent the largest in our School’s history, a true milestone,” said Dr. Martha Somerman, dean of the School of Dentistry.

“The NIDCR has afforded us a tremendous opportunity to collaborate with our colleagues in the community and generate timely information that’s relevant to the practice of dentistry, and to their patients. Ultimately patients are the ones who will be better-served because of these studies.”

The 91探花will collaborate with the School of Dentistry at Oregon Health Sciences University and use the Washington Dental Service database to answer questions facing dental practitioners in the five state region.

Northwest PRECEDENT is one of only three practice-based networks funded by NIDCR. The other two are centered at New York University, New York City, and University of Alabama-Birmingham.

Established in 1945, The 91探花School of Dentistry is dedicated to excellence in dental education, research and community care. As the leading provider of dental care in the Pacific Northwest, the School also has educated three-quarters of all the dentists now practicing in Washington state. The School receives more research grants from the National Institutes of Health than any other dental school in the nation.

In otherwise healthy obese women, weight loss is associated with significant decreases in biomarkers associated with cardiovascular risk, according to an article printed in the April 6 edition of the Journal of Clinical Endocrinology and Metabolism.

The article is based on research by Dr. Kevin O’Brien, associate professor of medicine at the 91探花 and colleagues at the University of Cincinnati; the researchers noted that these effects were proportional to the amount of weight lost, but did not depend on what kind of diet the women in the study used to lose weight.

“We measured levels of serum amyloid A (SAA) and C-reactive protein (CRP) in the study subjects, since elevated levels of these inflammatory markers are associated with increased cardiovascular risk,” O’Brien said.

“These proteins are also associated with inflammation. We knew prior to this study that levels of CRP decrease with weight loss, but it was not known whether SAA also goes down with weight loss.”

The researchers were also investigating whether the composition of the weight loss diets themselves would affect SAA and CRP levels. Blood levels of the chemicals were measured at the beginning of the study. The 41 participants were then placed on either a low fat diet or a very low carbohydrate, Atkins-type diet. After three months, the study participants who lost weight had significant decreases in both SAA and CRP. The decreases in SAA also correlated with reduction of insulin resistance.

“The dieters on the very low-carbohydrate diet had a significantly greater decrease in SAA, but their weight loss was also significantly greater,” O’Brien said. “The effects on the inflammatory markers were proportional to the amount of weight lost.”

Weight loss among the obese study participants was also associated with improvement in blood pressure readings: a reduction of about a point in both systolic and diastolic pressure for each kilogram of weight lost. Blood triglycerides went down about five points for every kilogram lost, emphasizing that the benefits of even modest weight loss extend to more traditional cardiovascular risk factors.

O’Brien pointed out that concerns persist about the long-term safety of very low carbohydrate diets.

“We were surprised that the levels of the inflammatory markers declined among the women who were on the very low-carbohydrate, high-fat and high-cholesterol diet, which we had expected would raise these markers,” O’Brien said. “Since the participants in this study were obese, the results may be quite different for someone who is only 10 to 15 pounds overweight, as their metabolic response to dietary fat and cholesterol may differ.”

He cautions that losing weight on extreme diets may, in the long run, work against people trying to improve levels of inflammatory markers, triglycerides and blood pressure if they are not able to sustain these dietary changes. Achieving sustained weight loss and its accompanying health improvements requires changes that can be maintained for the long haul.

“The findings of this research suggest that longer-term studies of the effects of weight loss and dietary composition on inflammatory markers are warranted,” O’Brien added.

The party was delightful, the wine was fine, the music was great and the potluck buffet was so tasty that you got back in line twice. Unfortunately, you and a lot of your friends awoke with an ailment that鈥檚 a great deal more uncomfortable than a hangover.

You suffered from nausea, vomiting and diarrhea for from one to several days and told people at work that you鈥檇 had the stomach flu.

It鈥檚 more likely that you were suffering from a norovirus, once referred to as Norwalk virus. Dr. Jeff Duchin, the chief of communicable disease control at Public Health Seattle & King County, says actual flu virus rarely strikes the stomach in adults, while noroviruses are the most common form of food-borne illness in the United States, resulting in over 20 million cases a year.

Norovirus is the term used for a group of closely related, highly infectious viruses that are transmitted through the fecal-oral route and that cause acute gastroenteritis. Incubation is usually 24 to 48 hours, although onset can be as fast as 12 hours. It was dubbed Norwalk virus after a 1968 outbreak in Norwalk, Ohio, led to the virus鈥� identification.

鈥淚t鈥檚 sometimes called winter vomiting disease, although it is present year round,鈥� Duchin says. 鈥淪ummer camps are a big norovirus setting, although it can crop up at any time you have large numbers of people sharing common meals. We鈥檝e had outbreaks on cruise ships as well, but the virus is more prevalent in the wintertime.鈥�

Most people feel miserable for a couple of days, and then recover, but dehydration can be a threat for some patients.

鈥淭hat can be serious for elderly people and those who have cardiovascular problems, as well as young infants who can鈥檛 take in fluids very well,鈥� Duchin says. 鈥淢ost people can take enough by mouth that they don鈥檛 become dehydrated.鈥�

Once the virus finds its way into the house, you can take steps to prevent the spread of the disease from person to person.

鈥淚t is highly contagious, spreading when a sick person or someone who was recently ill doesn鈥檛 practice good, frequent hand-washing. It also spreads when people who are ill or recently recovered prepare food for others and don鈥檛 use good food preparation practices or wash their hands frequently,鈥� Duchin says. 鈥淣orovirus can also spread to people and objects in the vicinity of vomiting people.鈥�

To control norovirus outbreaks, Duchin emphasizes simple steps:

• Frequent hand washing, before and after preparing food and after using the toilet.
  
• Thorough, prompt clean-up of any vomit on floors or other surfaces, using household disinfectants.
  
• Good hygiene and safe food preparation techniques in preparing and serving meals and snacks.

The discouraging part of a bout of norovirus is that people don鈥檛 develop a long-lasting immunity.

鈥淵ou don鈥檛 develop protection just because you鈥檝e had it once and people shouldn鈥檛 feel they can relax good hygiene measures that are necessary to prevent infection from noroviruses just because they鈥檝e had an episode,鈥� Duchin says. 鈥淵ou need to stay on your guard to prevent food-borne illness and person-to-person transmission of the infection.鈥�

Recent testing throughout the Seattle Public School District revealed that many schools have at least one drinking fountain with lead levels that exceed the Environmental Protection Agency guideline for lead in school drinking water. In a new report, the Northwest Pediatric Environmental Health Specialty Unit (NW PEHSU), based at the 91探花 School of Medicine, says that it is extremely unlikely that any child will have a blood lead level that would require follow-up medical testing and care. The report also recommends that the school district set up an independent task force to formulate a district policy for dealing with lead in drinking water.

Dr. Catherine Karr, director of the NW PEHSU, says the unit became concerned when stories began appearing in Seattle media about lead levels in school water fountains.

“We recognized that there was a lack of available information about how these lead levels might affect children’s health,” Karr said. “We did this study because, as a regional resource for expertise on children’s environmental health, we felt a responsibility to have the answers to questions concerned parents, educators and others may have about the possible effects of these lead levels in the school water supply.”

The report says that some children are at higher risk than others to have high blood lead levels, and may require both blood tests and medical care if they are also drinking water from drinking fountains with comparatively high lead levels:

• Children under 6 years of age who drink from school water that consistently exceeds a lead level of 200 to 300 parts per billion.
  
• Children under 6 years old who have medical conditions, such as nutritional deficiencies like anemia, calcium or vitamin D deficiencies that may increase their absorption of lead.
  
• Children who have pre-existing neurological problems like autism, seizure disorders or attention deficit hyperactivity disorder may be more vulnerable to the toxic effects of lead. Karr adds, “There is currently no clear evidence to support or refute this, however.”
  
• Children who have pre-existing blood lead levels that are higher than expected due to other significant lead exposures, from living with family members who work with lead on the job in manufacturing or who participate in hobbies that result in lead exposure, such as working with stained glass or using lead-based glazes on pottery.

Based on its review, NW PEHSU doesn’t recommend routine blood lead screening for all Seattle school children. However, if individual families have special concerns about children’s lead exposure, they can request testing from a health care provider or with the help of NW PEHSU.

The unit strongly supports efforts to keep children’s lead exposure as low as possible, and endorses the School District’s adoption of EPA guidelines calling for less than 20 parts per billion. The NW PEHSU recommends that the district form an independent task force charged with formulating a school lead and water policy, and urges that members of the task force should represent parents, the school board, local public health officials, district administrators and the Parent-Teacher-Student Association.

The NW PEHSU is based in the 91探花Occupational and Environmental Health Program.

Translating the latest advances in research into better health care for the average patient is challenging: the explosive growth of biological knowledge and technology currently moves very slowly, if at all, into the health care practitioner鈥檚 office and into the community. The new multidisciplinary clinical research career development program at the UW, recently funded with a $13 million grant over five years from the National Institutes of Health (NIH), aims to help resolve this problem by training clinical research scholars. The program is a collaborative effort of all the 91探花health sciences schools.

鈥淥ur aims are to train investigators who have depth in a specific research area, but also breadth of knowledge about the full spectrum of clinical investigation, and provide them with the knowledge and practical skills for conducting integrative clinical research,鈥� said Dr. Richard Deyo, professor of medicine and health services and project director. 鈥淚t鈥檚 important, too, that we create an environment that infuses them with the excitement of clinical research, while nurturing their early career development.鈥�

The program will involve faculty from the 91探花Schools of Medicine, Public Health and Community Medicine, Pharmacy, Nursing, Dentistry and Social Work, as well as from the Fred Hutchinson Cancer Research Center, the Veterans Affairs Puget Sound Health Care System and Group Health Cooperative鈥檚 Center for Health Studies. Each year, approximately seven doctoral level scholars will be recruited, drawing from all health professions. Clinical research scholar candidates may be people who are already working on postdoctoral research or at the junior faculty level in their careers.

鈥淭he intent is that the scholars will be able to stay in the program for two years, but they could stay for as long as five years,鈥� Deyo said. 鈥淭he first year, they will learn the curriculum that we feel is important for most people doing research with human subjects. The scholars will be learning about research design, biostatistics and the ethics of clinical research.鈥�

During the second year, and continuing for as long as four more years, the scholars will work on mentored research. The program will provide some funding for the scholars鈥� research projects. Additionally, the grant will fund a training program for research coordinators who will provide support to the scholars and also help train additional coordinators working with researchers throughout the system.

The grant is part of an NIH-wide initiative to accelerate and strengthen the clinical research process. Six other institutions are also receiving awards: Case Western Reserve University/Cleveland Clinic Foundation; Johns Hopkins University; Mayo Clinic; University of California, San Francisco; University of Pittsburgh; and University of Wisconsin.