JUNE 2001 - UCLA School of Public Health

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4 research highlights Mortality Rate Ratios UCLAPUBLIC HEALTH 100 10 RELATION BETWEEN ARSENIC EXPOSURE AND CANCER RISK MALES Skin Bladder Kidney Lung Liver 0 200 400 600 800 0 200 400 600 800 Well Water Arsenic Concentration (parts per billion) 100 Cancer mortality rate ratios, 1973-1986 (relative to rates in the Taiwanese general population), for the population of the blackfoot disease endemic area of Taiwan, according to well water arsenic concentration (parts per billion). 10 FEMALES Genetics Key to Arsenic’s Cancer-Causing Ability THE LATEST IN A DECADE-LONG SERIES OF STUDIES by Dr. John Froines on the carcinogenicity of arsenic suggests that certain individuals are more genetically susceptible than others to the cancer-causing effects of the compound. “Based on our results, the ability of humans to metabolize arsenic — that is, to detoxify it — varies within the population, and appears to be an important factor in the carcinogenesis of arsenic,” says Froines, Professor of Environmental Health Sciences at the UCLA School of Public Health. Arsenic is found in the drinking water of certain parts of the country, particularly in arid states in the West. Unsafe levels of the compound can cause cancer and other diseases. A 1999 report by the National Academy of Sciences linked high levels of arsenic to bladder, Bladder lung and skin cancer, and possibly kidney and liver cancer. Kidney The Bush Administration outraged many environmentalists and public Skin health leaders earlier this year when it announced it was rescinding a Clinton Administration decree lowering the Lung amount of arsenic allowed in the nation’s drinking water, declaring that more studies were needed to determine Liver safe levels. Current regulations allow arsenic in tap water at a level of 50 parts per billion. The Clinton Administration ruling lowered the level to 10 parts per billion, the standard also adopted by the European Union and the World Health Organization. Froines’ most recent study analyzed two years’ worth of data on animals exposed to different concentrations of arsenic. While some of the animals had regular diets, others consumed diets that were methyl-deficient — low in folic acid, methionine, and choline. In previous research, Froines had found that arsenic exposure changes animals’ methylation of DNA, affecting genes possibly related to cancer. Preliminary results from the follow-up study indicate that the arsenic-exposed animals on methyl-deficient diets developed liver cancer. In addition, the methyl deficiency alone was enough to produce lung cancer, regardless of whether there was arsenic exposure. Froines intends to continue looking at the role of DNA methylation and the mechanistic features of arsenic-related diseases. By performing molecular biology experiments on the animal tissues from the most recent studies, he hopes to shed light on the gene or genes involved in arsenic-related cancers. But while his work continues, Froines believes the evidence is already more than sufficient to lower the federal drinking water standard. “From a human health risk-assessment standpoint, the standard should probably be somewhere between 1 and 5 parts per billion,” he contends. “At the 10-20 parts per billion level being discussed, there is evidence for increased risk of cancer. Normally, one would want to set a standard considerably below that for public health protection.”
Chiropractic Care Appears Slightly More Effective Than Medical Care for Treating Low-Back Pain PRELIMINARY FINDINGS FROM A UCLA School of Public Health study comparing the effectiveness of medical and chiropractic care for low-back pain indicate that chiropractic care may be slightly more effective, and physical therapy may be marginally more effective than medical care alone for reducing disability in some patients. Physical modalities such as heat therapy, electrical muscle stimulation, and ultrasound do not appear to yield additional clinical benefit for chiropractic patients, though perceived treatment effectiveness was somewhat greater in these groups. Low-back pain affects the majority of Americans at some point in their lives, and thousands every year become disabled because of chronic pain. Moreover, the rate of disabling back pain has increased steadily in recent years. “Although back-pain sufferers have many treatment options available, there is little scientific evidence showing which of the most common approaches is most effective,” says Dr. Eric Hurwitz, who conducted the study along with his colleague in the Department of Epidemiology, Dr. Hal Morgenstern, and collaborators from the School of Public Health and School of Medicine. Hurwitz notes that back-pain sufferers may receive prescriptions for painkillers or muscle relaxants from conventional medical providers, or a referral to physical therapy. Still other patients may visit an alternative or complementary provider, such as a chiropractor or acupuncturist — indeed, more visits for back pain are to chiropractors than to any other type of health-care provider. The relative therapeutic benefits of each therapy, however, have not been known. From 1995 through 1998, a total of 681 low-back-pain patients were enrolled in the study and randomly assigned to one of four treatment protocols: medical care with and without physical therapy, and chiropractic care with and without physical modalities. Patients were followed up through 18 months. The researchers are now analyzing the data to address other objectives, including the cost effectiveness of low-back-pain care and the influence of occupational and psychosocial factors on low-back-pain prognosis. Patients’ satisfaction with care and their perceptions of treatment effectiveness and how these relate to clinical outcomes are also being investigated. Mental Health, Coordination of Care Reduce Health Costs for Elderly Veterans Group INTERDISCIPLINARY MENTAL HEALTH TREATMENT and care coordination can help to reduce health care costs for elderly veterans who have undiagnosed psychiatric conditions, according to a large randomized clinical trial involving more than 1,600 elderly veterans hospitalized in nine Veterans Administration sites across the country. Dr. Gerald F. Kominski and colleagues at the UCLA School of Public Health evaluated data from a national clinical demonstration project with the VA known as the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) program. The program, which took place from 1995 to 1998 and was headed by Dr. Lissy Jarvik of UCLA’s Neuropsychiatric Institute, provided individualized interdisciplinary mental health treatment and care coordination to elderly veterans with acute non-psychiatric conditions whose accompanying depression, anxiety, or alcohol abuse could result in overuse of inpatient services and underuse of outpatient services. continued on next page Low-back pain affects the majority of Americans at some point in their lives, and thousands every year become disabled because of chronic pain. 5 research UCLAPUBLIC HEALTH
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Page 3 and 4: When the Best Medicine Is Public He
Page 5: DEAN’S ADVISORY BOARD 3 ANDREW AL
Page 9 and 10: Disadvantaged Groups Less Likely to
Page 11 and 12: The Healthcare Collaborative at UCL
Page 13 and 14: 11 Why so much bickering over the r
Page 15 and 16: 13 There is a national shortage of
Page 17 and 18: measure it and find places to inter
Page 19 and 20: Left to right: Postdoctoral fellow
Page 21 and 22: Pillars of the Community FOUR YEARS
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Page 25 and 26: 2001 student awards 23 DAVID M. SOU
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JUNE 2001 - UCLA School of Public Health

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