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Week of October 3, 2011

Scholarship & Creative Work

Roads pave the way for the spread of superbugs

Antibiotic resistant E. coli was much more prevalent in villages situated along roads than in rural villages located away from roads, which suggests that roads play a major role in the spread or containment of antibiotic resistant bacteria, commonly called superbugs, a new study finds.

Many studies on various infectious diseases have shown that roads impact the spread of disease, however this is the first known study to show that roads also impact the spread of antibiotic resistant bacteria, says Joe Eisenberg, co-author and professor at the School of Public Health.

New roads facilitate movement along rivers and roads, which can in turn fuel the spread of superbugs. Photo by James Trostle.

Researchers at SPH and colleagues from Universidad San Francisco de Quito, and Trinity College studied a region in northwest Ecuador for five years, focusing on antibiotic resistant E. coli and the common antibiotic paring of ampicillin and sulfamethoxazole.

“Our results show it’s not just the individual’s antibiotic use that affects antibiotic resistance,” Eisenberg says. “Other important factors that affect the spread of antibiotic resistance are the rates at which people introduce new strains due to movement in and out of the region, as well as poor water quality and sanitation that allow for the transmission of antibiotic resistant strains.” Both of these factors are influenced by the presence of the roads.

“We focus so much on the individual, and if they do or don’t take antibiotics, but we’re learning more and more that there’s a broader environmental and social context in which antibiotic resistance happens,” Eisenberg says.

The paper, “In-roads to the spread of antibiotic resistance: regional patterns of microbial transmission in northern coastal Ecuador,” appears this month in the Journal of the Royal Society, Interface.

Who are you? People yearn for positive perception about themselves

People care about how others view them and will go to great lengths to repair negative perceptions, a new U-M study found.

For social acceptance, honesty and kindness — which researchers describe as communion traits — are more important for relationships than intelligence and ambition, both considered agency traits, says Oscar Ybarra, professor of psychology. Agency traits help people attain skills, talent and status.

“Social life pressures people to view themselves as possessing high levels of communion traits and to ensure that others have this perception as well,” he says.

The study also demonstrated that participants judged themselves as consistently maintaining their kindness and honesty traits across time, whereas they were more willing to judge their agency characteristics as varying more across time and situations.

The agency dimension deals with behaviors and characteristics that people develop over time and are associated with limited opportunities in which they can be expressed. Thus, there should be less pressure on people to judge themselves positively compared to the communion dimension, Ybarra says.

However, due to the importance people place on having social connections with others, judging the self as low on communion is risky, as is failing to address reputation concerns in this domain, he says. The social and moral aspects of one’s reputation appear to trump how intelligent, skilled and ambitious one reports being or wishes to be.

David Seungjae Lee of U-M also worked as a researcher on this project.

The findings appear in the European Journal of Social Psychology.

Non-verbal clues guide doctor-patient relationships, clinical judgments, U-M study finds

Subtle and unspoken clues exchanged by patients and doctors exert an influence on medical care, according to a new study by the U-M Health System. Researchers analyzed video recordings of routine checkups and conducted follow-up interviews with participants to help elucidate signals sent and received on both sides of the examination table.

The method shows promise for improving medical decision making by allowing doctors to better understand how they make judgments and what messages they unwittingly may be conveying to patients, the researchers explain.

The study found that patients relied on non-verbal clues to evaluate the doctor-patient relationship, focusing on whether the doctor seemed hurried or put them at ease. Doctors, on the other hand, reported that patients’ tacit clues influenced their medical judgments. The results were published Sept. 26 in the Journal of Evaluation in Clinical Practice.

“Our findings show that both doctors and patients identified tacit clues involving the behavior or appearance of the other, but they were not always able to articulate precisely how these clues informed their judgments and assessments,” says lead author Dr. Stephen G. Henry, a research fellow at the VA Ann Arbor Healthcare System and Department of Internal Medicine. “Not surprisingly, patients and doctors discussed these clues very differently.”

Additional U-M authors are Dr. Michael Fetters, associate professor of family medicine at the Medical School, and Jane Forman of the VA.

Moms’ lead exposure linked to higher blood pressure in their daughters

Prenatal lead exposure is linked to a greater risk of high blood pressure in teen girls, but not in boys, a new U-M study shows.

“This study suggests that a common chemical pollutant — lead — can build up in moms’ bones and then increase their daughters’ risk of developing hypertension, the most important risk factor for stroke and heart disease,” says Howard Hu, professor at the School of Public Health and lead study author. “It further increases the importance of reducing such exposures. It also significantly increases the pressure to study how such risks get transferred so we can develop better methods of treatment, including better drugs.”

Researchers used data from the Early Life Exposures in Mexico to Environmental Toxicants project to examine the relationship between prenatal lead exposure and blood pressure in 457 children ages 7-15. Researchers measured the lead accumulations in bone and in the umbilical cords of mothers in the study.

Among female offspring, a 13 ug/g increase in maternal tibia lead was associated with an increase of 2.11 mm Hg in systolic blood pressure, and an increase of 1.60 mm Hg in diastolic blood pressure. To put those numbers in perspective, Hu said, consider that previous studies have shown that a 2 mm Hg increase in systolic blood pressure results in a 7 percent increase in the risk of death due to ischemic heart disease and a 10 percent increase in the risk of death due to stroke.

This is the first study to examine the association of a mother’s bone lead levels with blood pressure in her children.

The study appears in advanced online publication in the journal Environmental Health Perspectives.

Doctor experience matters in carotid artery procedures

Preventing a stroke by placing a stent in the carotid artery, a major artery of the head and neck, is a procedure that’s skyrocketed in the United States, but new research shows the outcomes can be deadly if older patients are not in the right hands.

Older patients receiving carotid artery stenting from lesser-experienced physicians had an increased risk of death 30 days after stent placement, according to a study published in last week’s Journal of the American Medical Association.

An analysis of Medicare data showed a higher death risk if the stent was inserted by a doctor who performed less than six procedures a year, or if the procedure was conducted early in the physician’s career.

Carotid stenting is increasingly being used to treat severe carotid atherosclerosis, an important cause of ischemic stroke. Since approval of the first carotid stent system by the U.S. Food and Drug Administration in 2004, use of carotid stenting has more than doubled in Medicare beneficiaries.

Despite the promise of this procedure, its increasing use has raised potential concerns.

“Carotid stenting is a technically demanding procedure and earlier studies have demonstrated a substantial learning curve with it,” says lead study author Dr. Brahmajee Nallamothu, cardiologist at the Cardiovascular Center.

Compared with patients treated by operators performing 24 or more procedures per year, those treated by operators performing less than six procedures per year were nearly twice as likely to die within 30 days of the stent placement, the study showed.

Additional U-M authors are Dr. Hitinder Gurm, Dr. Justin Dimick, Dr. Eric Bates and John Birkmeyer, of UMHS and the U-M Center for Healthcare Outcomes and Policy.



Katherine Weider, creative arts producer, School of Art & Design, on offering advice for students: “You can’t always imagine your future. I think you have to trust that your loves and your interests will eventually lead you to the right place.”


“Photographer as Witness: Proof Enough?” with Jill Vexler, 7-8:30 p.m. Oct. 11, Harlan Hatcher Graduate Library Gallery in Room 100

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