The Morning Drill: June 20, 2011

A collection of dentistry and health related links/comments to start your day.

In U.S., Employer-Based Health Insurance Declines Further

Diet Appears to Modulate Alzheimer's Biomarker

Results of a new study provide more evidence that diet may modulate the risk for Alzheimer's disease.

In a 4-week diet intervention study, healthy cognitively intact older adults who stuck to a low-saturated-fat, low-glycemic-index diet experienced decreases in cerebrospinal fluid (CSF) levels of β-amyloid 42, a biomarker of Alzheimer's disease risk.

But in a group of older adults with amnestic mild cognitive impairment (aMCI), the healthy diet had the opposite effect, raising CSF levels of this protein.

These observations "made sense to us," Suzanne Craft, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, Washington, who worked on the study, told Medscape Medical News.

"That's because in patients with Alzheimer's disease," she explained, "β-amyloid 42 sticks in the brain and so levels are lower in the CSF, and something that is going to reverse that process is going to raise levels in the spinal fluid."

"But for a healthy adult," she said, "it looks like levels get higher and higher over the course of life until, for some people, they reach a tipping point where [β-amyloid 42] begins to stick in the brain. In healthy adults, having levels decrease is actually a healthy pattern."

"It looks like a healthy diet that contains a lot of fruits and vegetables and healthy fats would be important for people who have Alzheimer's disease or conditions that put them at risk for developing Alzheimer's disease," Dr. Craft said.

The study appears in the June issue of the Archives of Neurology.

Prostate Cancer Kills More Men in the UK Than in the US

New data from the United Kingdom show that prostate cancer was the cause of half the deaths of men diagnosed with this disease, and challenge the notion that prostate cancer patients "are more likely to die with, rather than of, their disease," according to the researchers. Their data suggest that prostate-cancer-specific mortality was around 20%.

The situation is different in the United States, where recent estimates suggest that about 15% of men diagnosed with prostate cancer die from this disease.

The main reason for this difference is the high uptake of testing for prostate-specific antigen (PSA) in asymptomatic men in the United States, and the low uptake in the United Kingdom, say experts on both sides of the Atlantic.

Both situations are described as extreme by those on the other side. British researchers say that routine PSA testing in the United States is picking up disease that might be clinically insignificant, leading to overdiagnosis and overtreatment of prostate cancer. American researchers argue that PSA testing is picking up prostate cancer at an earlier stage of disease, when it is still treatable and curable, which results in the lower mortality rates.

"If you are screening too aggressively, there is no question that you will overtreat, but the other end of the spectrum is that you have a cancer that is very curable but you still end up having half of the patients dying of the disease because they are presenting at late stages" said Brantley Thrasher, MD, FACS, professor of urology at the University of Kansas in Kansas City, who acts as a spokesperson for the American Urological Association.

"I would rather have the potential — and I emphasize the potential — for overtreating than swing the other way and lose all of these patients to a disease that is curable," Dr. Thrasher explained in an interview with Medscape Medical News.

Why Disparities in Dental Care Persist for African-Americans Even When They Have Insurance Coverage

African Americans receive poorer dental care than white Americans, even when they have some dental insurance coverage. To better understand why this is so, researchers at Columbia University's Mailman School of Public Health and the College of Dental Medicine, surveyed African American adults with recent oral health symptoms, including toothaches and gum disease. Their findings provide insights into why disparities persist even among those with dental insurance and suggest strategies to removing barriers to dental care.

The findings are published online ahead of print in the American Journal of Public Health.

The study is a qualitative survey of 118 men and women intercepted on the street in Central Harlem. Although the majority (75%) of adults in the study reported at least some type of dental insurance coverage, this was largely limited to Medicaid (50%) rather than private coverage (21%) or other types of dental insurance (4%).

The findings indicated that insured participants reported insurance-related difficulties, such as insufficient coverage for needed treatments, inability to find a dentist who accepts their insurance, and having to wait for coverage to take effect.

"For the 25% of respondents who reported having no dental insurance coverage, the costs of dental care and the lack of insurance coverage were consistently noted as critical barriers to obtaining quality dental treatment of their dental symptoms," said Eric Schrimshaw, PhD, assistant professor of Sociomedical Sciences at the Mailman School, and first author. "Even among those who had some dental insurance -- such as Medicaid -- it was often not enough to eliminate the obstacles to obtaining needed dental treatment," noted Dr. Schrimshaw.

For instance, one 58-year-old man with a toothache described his difficulty paying for out-of-pocket costs despite having dental coverage. Consequently, he sought only emergency dental care during the 5 years before his interview:

"The dental plan is only going to pay for so much. And then there are a lot of out-of-pocket expenses… If you don't have that dental care, you just go to the dentist on emergency when that teeth need to be come out or whatever. That's the only time you go."

Enjoy your morning drill!