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This week’s topics include the benefits of running, guidelines for managing stable ischemic heart disease, the health benefits of consuming fruits and vegetables, and screening adolescents for substance abuse.

Program notes:

0:50 Can you reduce exercise time and maintain health benefits?
1:50 Five to ten minutes per day only, and not fast
2:54 Managing stable ischemic heart disease
3:55 Chelation therapy benefit is uncertain
4:55 Explain risks and benefits of stents and bypass
5:45 Fruits and vegetables and causes of death
6:45 Linear relationship to five servings
7:35 Screening teenagers for substance abuse
8:35 Physicians need to screen
9:36 Most people don’t admit to substance use
10:37 End

Related blog:

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Anchor lead:  How does a newly identified gene associated with suicide risk work? Elizabeth Tracey reports

How can a gene called SKA2 be associated with suicide risk, as shown recently by Johns Hopkins investigators?  Zachary Kaminsky, principal investigator, explains.

Kaminsky: Under normal circumstances what we think is happening is that the SKA2 gene that we’ve identified is helping the stress hormone receptor into the nucleus to allow it to shut down the normal stress response.  But now with this molecular mark we’ve identified we’re getting less SKA2  and so we’re getting less of an ability to help the glucocorticoid receptor shut down stress.  So when we get stressed out we can’t shut it off.  That’s what we think is happening on a molecular level.   :27

Kaminsky says this may well be a crucial element linking stress level to suicide, and may also help explain observations of suicide risk running in families. More work needs to be done, however, since additional modifications to the gene known as epigenetic changes are also involved.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Can we identify those at risk for suicide by their genes?  Elizabeth Tracey reports

Suicide claims the lives of thousands each year, leaving in its wake incomprehension and pain for many survivors, and in some populations more and more people are choosing this route to end their lives.  Now a gene identified by Zachary Kaminsky and colleagues at Johns Hopkins may help stem the tide.

Kaminsky: We have found what we believe to be really a new player on the scene, a gene called SKA2.  This molecular mark that we found, which acts a little bit like a dimmer switch to turn down levels of the gene in the brain, seems to be associated with the stress response pathways.  Stress response has been shown to be important in suicide, and so finding this gene really makes a lot of sense.  We’ve found a consistent change in three brain bank tissue cohorts and also three separate blood cohorts.  :30

Kaminsky says the finding points the way to development of a simple blood test that may help predict who’s at risk.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  People who are on medicines to prevent HIV infection don’t engage in more risky behavior, Elizabeth Tracey reports

When people are given medicines to prevent HIV infection, known as PrEP, they don’t take more risks than they did beforehand, a recent long terms study presented at the international HIV conference in Melbourne, Australia, found.  Joseph Cofrancesco, Jr, an HIV expert at Johns Hopkins, says the approach is multipronged.

Cofrancesco: It’s a program.  It’s give a pill, it’s work with the patient to help them to understand ways to keep themselves safe, to encourage condom use, to use ways to transition away from using drugs or to a safer way of using drugs, come in regularly for STD testing and making sure there’s no problems.  What was shown in the most recent conference is that a longer term follow up the patients on PrEP did not report any additional risky behavior or more partners than they might otherwise have.   :28

Cofrancesco says all persons at risk for HIV infection should be offered PrEP.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Providing HIV services to sex workers is critical to stopping spread of the disease, Elizabeth Tracey reports

Sex work must be decriminalized so that HIV services can be effectively provided to those who work in this area, many studies and position papers at the recent International HIV conference in Melbourne, Australia concluded.  Joesph Cofrancesco, Jr, an HIV expert at Johns Hopkins, concurs.

Cofrancesco: Whenever you criminalize an activity you tend to drive it underground and then individuals or patients tend not to feel comfortable or even able to report that activity to the healthcare system, and we lose healthcare.  That’s why all the issues about criminalization of men who have sex with men is such a big deal.  Certainly sex workers face lots of challenges in their lives, and this just adds to the likelihood that they’re not going to get the appropriate care they need.   :30

Cofrancesco says moral judgments must be laid aside and HIV transmission viewed as a medical and population health issue.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can HIV really be eliminated after someone is infected? Elizabeth Tracey reports

HIV infection returned recently in an infant thought to be cured of the virus.  Joseph Cofrancesco, Jr, an HIV expert at Johns Hopkins, describes the situation.

Cofrancesco:  The hope was that that baby would have had the virus eliminated before the latent reservoir was able to develop. When we were able to stop medications on that baby investigators found that there was no virus for almost two years.  That was very heartening. However in the end the virus returned.  What that does is confirm what many investigators have felt which is that very early on in infection HIV infects many cells and a reservoir is established of cells that go into a latent phase.  :31

Cofrancesco says newer strategies to eliminate HIV rely on waking up dormant virus in cell reservoirs so drugs can attack it, and notes that effective strategies to prevent maternal infant transmission are in place.  At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include morcellation dangers, a new clotting pathway identified, troubles with handoffs, and deep vein thrombosis and catheterization.

Program notes:

0:44 Morcellation of uterine fibroids
1:44 How often done when cancer isn’t suspected?
2:44 Evolved as a less invasive treatment
3:24 Handoffs and medical errors
4:24 Interviewers participated in rounds
5:24 Handover curriculum
6:01 Deep vein thrombosis and catheterization
7:01 Catheter infusion has increased
8:01Mortality better but not complications
8:12 Antiphospholipid antibody syndrome
9:15 Is this same pathway involved?
10:35 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/07/24/the-danger-of-handoffs/

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