Lake County health officials are alerting the public to "a dramatic increase" in the number of pertussis cases this year, particularly among school-aged children.
As of Nov. 20, health officials reported 82 confirmed or probable cases of pertussis so far this year, with the majority of cases occurring in children between 5 and 11 years old.
"I'd say it's a dramatic increase," said Victor Plotkin, an epidemiologist for the Lake County Health Department.
Pertussis is often known as "whooping cough" because the symptoms include a cough with a high-pitched whooping sound. Symptoms are similar to those of a common cold accompanied by coughing. Symptoms usually appear within five to 10 days of exposure but can last as long as 21 days.
Plotkin said the health department started to see an increase in pertussis cases in late spring with 11 cases in May. The number of cases reached a high of 18 cases in July, before leveling off and then spiking again this fall.
There were 10 reported pertussis cases in September, 14 in October, and 7 so far in November, he said.
"We had another wave of increase in October, especially at Townline (Elementary) School in Vernon Hills," said Plotkin. "But it's spread out throughout Lake County."
Townline Elementary School has posted a notice to parents about pertussis on the school's Web site.
"Cases of pertussis (also known as whooping cough), are cropping up around the area, including at Townline," the school's Web site states. "Parents are urged to be extra vigilant when students show symptoms, which are often similar to that of a common cold."
In addition to Vernon Hills, Plotkin said there have also been pertussis cases include Grayslake, Round Lake, Highland Park, Mundelein, Libertyville, Antioch, Waukegan, Beach Park and other areas.
"Basically, it's everywhere," he said.
The Illinois Department of Public Health reports that Lake County and Chicago are seeing an increased number of pertussis cases this year, while suburban Cook, McHenry, Stephenson, Whiteside and Winnebago counties are reporting clusters of pertussis cases in school-aged children.
Plotkin said the 82 cases in Lake County so far this year is well above normal. In 2007, there were 20 cases of pertussis and there were 68 in 2006.
Plotkin said the county did see very high numbers of cases during a nationwide outbreak of pertussis in 2004 and 2005. In 2004, there were 152 cases of pertussis and 135 cases in 2005. However, before that, pertussis cases in the county had averaged about 8 to 10 a year for many years.
Plotkin said the 2004 and 2005 pertussis outbreak appears that it may have been attributed to waning immunity among older children and adults who had not received booster shots. He said the most recent outbreak is a bit more puzzling because many of the children who are becoming ill are younger children who were recently vaccinated.
"Unfortunately, during this outbreak, even people that have been recently vaccinated are becoming sick anyway," he said. "Their symptoms are milder, but they still can pass the bacteria along to others and make others sick."
Plotkin said there have been no deaths reported because of pertussis in the county this year. However, three babies were hospitalized over the summer.
Health officials urge anyone who has a cough lasting more than a week to consult their physicians, especially if the cough becomes worse at night and has a different sound than a typical respiratory cough. Pertussis can be treated with antibiotics, which will alleviate the symptoms and help prevent its spread to others.
"People need to be especially aware because of the upcoming holidays," he said. "If they are sick or have suspicious symptoms, they should stay home."
Persons who are interested in pertussis vaccinations should call Healthy Trust Immediate Medical Care at (847) 243-0333.
Thursday, November 20, 2008
Tuesday, September 16, 2008
Healthy Trust Can Diagnose Deep Vein Thrombosis
Far too many Americans are dying of dangerous blood clots that can masquerade as simple leg pain, says a major new government effort to get both patients and their doctors to recognize the emergency in time.
"It's a silent killer. It's hard to diagnose," said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. "I don't think most people understand that this is a serious medical problem or what can be done to prevent it."
At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.
These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the invasion of Iraq.
But that provides a skewed vision of the problem. While there aren't good statistics, the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.
There are a host of risk factors and triggers: Recent surgery or a broken bone; a fall or car crash; pregnancy or taking birth control pills or menopause hormones; being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are obese.
And some people have genetic conditions that cause no other symptoms but increase their risk, making it vital to tell your doctor if a relative has ever suffered a blood clot.
People with those factors should have "a very low threshold" for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a "call to action" for better education of both consumers and doctors, plus more research.
Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.
But here's the rub: Doctors are ill-informed, too. For example, studies suggest a third of patients who need protective blood thinners when they enter the hospital for major surgery don't get them. And patients can even be turned away despite telltale symptoms, like happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn.
Ruffin made repeated visits to doctors and emergency rooms for growing pain in her leg and groin in December 2003 and January 2004, but was told it must be her healing Caesarean section scar.
Finally one night, Ruffin's husband ran her a really hot bath for pain relief - only to have her climb out minutes later with her leg swollen three to four times its normal size, and then pass out.
"I like to call that my miracle bath," Ruffin said, because the sudden swelling proved the tip-off for doctors.
Pieces of a giant clot in her right leg had broken off and floated to her lung. The ER doctor "said if I hadn't made it in when I did, I may not have lived through the rest of the night," recalled Ruffin, now 32, who spent a month in the hospital and required extensive physical therapy to walk normally again.
These clots "tend to fall through the cracks" because they cross so many areas of medicine, said Dr. Samuel Goldhaber, chairman of the Venous Disease Coalition and a cardiologist at Boston's Brigham & Women's Hospital.
With the surgeon general's campaign, "DVT after all these years will finally get the national spotlight like cigarette smoking did in the mid-60s," he said.
In addition to Galson's report:
-The Agency for Healthcare Research and Quality is issuing a 12-page booklet to help consumers tell if they're at risk for DVTs and what to do - and a 60-page DVT treatment-and-prevention guide for doctors and hospitals.
-As a prevention incentive, starting Oct. 1 Medicare will withhold payment from hospitals when patients develop the clots after knee- or hip-replacement surgery.
Healthy Trust Immediate Medical Care can diagnose DVT right in the office using ultrasound in only a few minutes without an appointment.
"It's a silent killer. It's hard to diagnose," said acting Surgeon General Dr. Steven Galson, who announced the new campaign Monday. "I don't think most people understand that this is a serious medical problem or what can be done to prevent it."
At issue are clots with cumbersome names: A deep vein thrombosis, or DVT, forms in large veins, usually a leg or the groin. It can quickly kill if it moves up to the lungs, where it goes by the name pulmonary embolism, or PE.
These clots make headlines every few years when seemingly healthy people collapse after long airplane flights or being in similarly cramped quarters. Vice President Cheney suffered one after a long trip last year. NBC correspondent David Bloom died of one in 2003 after spending days inside a tank while covering the invasion of Iraq.
But that provides a skewed vision of the problem. While there aren't good statistics, the new surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.
There are a host of risk factors and triggers: Recent surgery or a broken bone; a fall or car crash; pregnancy or taking birth control pills or menopause hormones; being immobile for long periods. The risk rises with age, especially over 65, and among people who smoke or are obese.
And some people have genetic conditions that cause no other symptoms but increase their risk, making it vital to tell your doctor if a relative has ever suffered a blood clot.
People with those factors should have "a very low threshold" for calling a doctor or even going to the emergency room if they have symptoms of a clot, said Galson, who issued a "call to action" for better education of both consumers and doctors, plus more research.
Symptoms include swelling; pain, especially in the calf; or a warm spot or red or discolored skin on the leg; shortness of breath or pain when breathing deeply.
But here's the rub: Doctors are ill-informed, too. For example, studies suggest a third of patients who need protective blood thinners when they enter the hospital for major surgery don't get them. And patients can even be turned away despite telltale symptoms, like happened to Le Keisha Ruffin just weeks after the birth of her daughter, Caitlyn.
Ruffin made repeated visits to doctors and emergency rooms for growing pain in her leg and groin in December 2003 and January 2004, but was told it must be her healing Caesarean section scar.
Finally one night, Ruffin's husband ran her a really hot bath for pain relief - only to have her climb out minutes later with her leg swollen three to four times its normal size, and then pass out.
"I like to call that my miracle bath," Ruffin said, because the sudden swelling proved the tip-off for doctors.
Pieces of a giant clot in her right leg had broken off and floated to her lung. The ER doctor "said if I hadn't made it in when I did, I may not have lived through the rest of the night," recalled Ruffin, now 32, who spent a month in the hospital and required extensive physical therapy to walk normally again.
These clots "tend to fall through the cracks" because they cross so many areas of medicine, said Dr. Samuel Goldhaber, chairman of the Venous Disease Coalition and a cardiologist at Boston's Brigham & Women's Hospital.
With the surgeon general's campaign, "DVT after all these years will finally get the national spotlight like cigarette smoking did in the mid-60s," he said.
In addition to Galson's report:
-The Agency for Healthcare Research and Quality is issuing a 12-page booklet to help consumers tell if they're at risk for DVTs and what to do - and a 60-page DVT treatment-and-prevention guide for doctors and hospitals.
-As a prevention incentive, starting Oct. 1 Medicare will withhold payment from hospitals when patients develop the clots after knee- or hip-replacement surgery.
Healthy Trust Immediate Medical Care can diagnose DVT right in the office using ultrasound in only a few minutes without an appointment.
Monday, September 15, 2008
Get ready for the 2008-2009 Flu Season
Healthy Trust Immediate Medical Care is your official Chicago North Shore Flu Clinic. We provide low cost flu vaccinations to help make sure you will stay healthy this winter.
If you do happen to get the flu this year we use the latest techniques to make sure that you will recover and get back to your daily routine quicker.
Influenza is a viral infection that sickens millions of people each year and can cause serious complications, especially in children and older adults. Fortunately, the flu vaccine available in the form of a flu shot or a nasal spray offers protection against the flu.
When is the flu vaccine available?
The flu vaccine is generally offered between September and mid-November, which is typically before the late-fall or early winter start to flu season.
What kind of protection does the flu vaccine offer?
A flu shot is between 70 percent and 90 percent effective in warding off illness, depending on the length and intensity of a given flu season and your overall health. In a few cases, people who get a flu shot may still get the flu, but they'll get a much less virulent form of the illness and, most important, they'll have a decreased risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.
A study published in 2006 showed that the nasal spray flu vaccine (FluMist) was only between 30 percent and 57 percent effective in preventing the flu in adults. However, another study in 2006 found that giving nasal spray vaccine to school-age children helped reduce the spread of flu in the community. And in 2007, researchers compared the effectiveness of FluMist with the flu shot in children ages 6 months to 5 years. The children treated with FluMist experienced about half as many cases of flu as did those who received the shot. However, FluMist increases the risk of wheezing in this age group especially in those who already have asthma or recurrent wheezing and in all children under age 2. In 2007, the Food and Drug Administration (FDA) therefore approved FluMist for children older than 2 years who don't have asthma or recurrent wheezing. Consult with your doctor about which form of vaccination may be best for you or your child.
Why do I need to get vaccinated every year?
You need annual flu protection because the vaccine changes from year to year. The flu vaccine you got last year wasn't designed to fight the virus strains in circulation this 2008-2009 flu season.
Influenza viruses mutate so quickly that they can render one season's vaccine ineffective by the next season. A Centers for Disease Control and Prevention (CDC) advisory committee meets early in the year to estimate which strains of influenza virus will be most prevalent during the upcoming flu season, and manufacturers produce vaccine based on those recommendations.
Will this year's vaccine protect me against the flu?
The flu vaccine protects against the three main flu strains that research indicates will cause the most illness during the flu season. This years influenza vaccine contains three new influenza virus strains.
They are:
A/Brisbane/59/2007(H1N1)-like virus
A/Brisbane/10/2007 (H3N2)-like virus
B/Florida/4/2006-like virus.
The 2008-09 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different strain of flu virus.
What are my options for the flu vaccine?
The flu vaccine comes in two forms:
A shot
A flu shot contains an inactivated vaccine made of killed virus. The shot is usually given in the arm. Because the viruses in the vaccine are killed (inactivated), the shot won't cause you to get the flu, but it will enable your body to develop the antibodies necessary to ward off influenza viruses. You may have a slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever. Reactions usually last one to two days and are more likely to occur in children who have never been exposed to the flu virus.
A nasal spray
Administered through your nose, the nasal spray vaccine (FluMist) consists of a low dose of live, but weakened, flu viruses. The vaccine doesn't cause the flu, but it does prompt an immune response in your nose and upper airways as well as throughout your body.
Who should get the flu vaccine?
Most people who want to reduce the risk of having influenza can get a flu shot. The CDC recommends the flu vaccine in particular if you:
Are age 6 months to 4 years
Are a child on long-term aspirin therapy
Are pregnant
Are 50 years old or older
Have a chronic medical condition such as asthma, diabetes or heart, kidney or lung disease
Have a weakened immune system such as from medications or HIV infection
Are a resident of a nursing home or other long term care facility
Are a child care worker or health care worker or live with or care for someone at high risk of complications from the flu
Who shouldn't get the flu shot?
Don't get a flu shot if you:
Have had an allergic reaction to the vaccine in the past.
Are allergic to chicken eggs.
Developed Guillain-Barre syndrome, a serious autoimmune disease affecting the nerves outside the brain and spinal cord, within six weeks of receiving the vaccine in the past. People who have experienced Guillain-Barre after the flu vaccine are at higher risk than are others of developing it again.
Have a fever. Wait until your symptoms improve before getting vaccinated.
Why do children need two doses of the flu vaccine?
Children younger than 9 years old require two doses of the flu vaccine if it's the first time they've been vaccinated for influenza. That's because children don't develop an adequate antibody level the first time they get the vaccine. Antibodies help fight the virus if it enters your child's system. If a flu vaccine shortage was to occur and your child couldn't get two doses of vaccine, one dose might still offer some protection.
I heard the flu shot isn't very effective for older adults. Is it worth getting vaccinated if you're over 65?
If you're over age 65, the vaccine doesn't offer as much protection as it would to someone younger because older adults produce fewer antibodies in response to the virus. Still, the vaccine offers more protection than does skipping the shot altogether. More important, the flu vaccine decreases the risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.
Will the flu shot protect against bird flu if there's an outbreak among humans?
An annual flu shot won't protect you specifically from bird flu, but it will reduce the risk of simultaneous infection with human and bird flu viruses. This is important because simultaneous infections are the main way that viruses swap genes and create new strains that potentially can cause flu pandemics.
Can I lower my risk of the flu without getting a flu shot?
With or without a flu shot, you can take steps to help protect yourself from the flu and other viruses.
Practice good hygiene Good hygiene remains your primary defense against contagious illnesses.
Wash your hands thoroughly and often with soap and water or an alcohol-based sanitizer containing at least 60 percent alcohol.
Avoid touching your eyes, nose or mouth whenever possible.
Avoid crowds when the flu is most prevalent in your area.
Cover your mouth and nose with a tissue when you cough or sneeze.
If I've already had the flu, can I get it again?
Once you've had the flu, you develop antibodies to the viral strain that caused it. But those antibodies won't protect you from new or mutated strains of influenza or other viruses.
What should I do if I get the flu?
First of all, don't go to work or school you'll risk spreading this contagious disease to others.
To relieve your symptoms:
Drink plenty of fluids.
Avoid alcohol and tobacco.
Consider over-the-counter medicine such as acetaminophen (Tylenol, others) to ease the discomfort associated with muscle aches or fever, but don't give aspirin to children or teenagers because of the risk of the rare but serious disease, Reye's syndrome. And keep in mind that acetaminophen can cause severe liver damage if taken in excess.
Use antiviral medications if prescribed by your doctor, but no longer than recommended. Be sure to monitor yourself. If you start feeling worse, consult your doctor to make sure you're not developing a flu-related complication.
What kind of complications can arise from the flu?
Complications include bacterial infection, pneumonia and dehydration. If you have a chronic medical condition, you may experience a worsening of that condition. Children can develop sinus and ear infections.
Is there any medicine to treat the flu?
Antivirals work both to prevent the flu and to help reduce the severity and duration of the illness by a day or two. Antiviral medications must be taken within 48 hours of the onset of your symptoms and are available only by prescription. Ask your doctor about getting a rapid flu test that can verify within a few hours whether you have the flu.
These two antivirals are recommended for treating the flu virus:
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
Each of these drugs can cause side effects, including lightheadedness, nausea, loss of appetite and difficulty breathing. They can also lead to the development of antiviral-resistant viruses.
People with the flu, particularly children, who take Tamiflu may be at increased risk of self-injury and confusion. The FDA recommends that individuals with the flu who take Tamiflu be closely monitored for signs of unusual behavior. In July 2007, the FDA approved two lower dose versions of Tamiflu for children. Still, discuss possible side effects with your doctor before starting any antiviral medication.
Your best bet for treating flu symptoms remains the tried and true:
Rest.
Get plenty of fluids.
Take acetaminophen or ibuprofen (Advil, Motrin, others) for aches and pains.
Come see the doctors at Healthy Trust Immediate Medical Care.
It's also important to eat healthy and get some daily activity to help keep your immune system in top form.
Healthy Trust Immediate Medical Care is the official flu clinic of the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.
If you do happen to get the flu this year we use the latest techniques to make sure that you will recover and get back to your daily routine quicker.
Influenza is a viral infection that sickens millions of people each year and can cause serious complications, especially in children and older adults. Fortunately, the flu vaccine available in the form of a flu shot or a nasal spray offers protection against the flu.
When is the flu vaccine available?
The flu vaccine is generally offered between September and mid-November, which is typically before the late-fall or early winter start to flu season.
What kind of protection does the flu vaccine offer?
A flu shot is between 70 percent and 90 percent effective in warding off illness, depending on the length and intensity of a given flu season and your overall health. In a few cases, people who get a flu shot may still get the flu, but they'll get a much less virulent form of the illness and, most important, they'll have a decreased risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.
A study published in 2006 showed that the nasal spray flu vaccine (FluMist) was only between 30 percent and 57 percent effective in preventing the flu in adults. However, another study in 2006 found that giving nasal spray vaccine to school-age children helped reduce the spread of flu in the community. And in 2007, researchers compared the effectiveness of FluMist with the flu shot in children ages 6 months to 5 years. The children treated with FluMist experienced about half as many cases of flu as did those who received the shot. However, FluMist increases the risk of wheezing in this age group especially in those who already have asthma or recurrent wheezing and in all children under age 2. In 2007, the Food and Drug Administration (FDA) therefore approved FluMist for children older than 2 years who don't have asthma or recurrent wheezing. Consult with your doctor about which form of vaccination may be best for you or your child.
Why do I need to get vaccinated every year?
You need annual flu protection because the vaccine changes from year to year. The flu vaccine you got last year wasn't designed to fight the virus strains in circulation this 2008-2009 flu season.
Influenza viruses mutate so quickly that they can render one season's vaccine ineffective by the next season. A Centers for Disease Control and Prevention (CDC) advisory committee meets early in the year to estimate which strains of influenza virus will be most prevalent during the upcoming flu season, and manufacturers produce vaccine based on those recommendations.
Will this year's vaccine protect me against the flu?
The flu vaccine protects against the three main flu strains that research indicates will cause the most illness during the flu season. This years influenza vaccine contains three new influenza virus strains.
They are:
A/Brisbane/59/2007(H1N1)-like virus
A/Brisbane/10/2007 (H3N2)-like virus
B/Florida/4/2006-like virus.
The 2008-09 influenza vaccine can protect you from getting sick from these three viruses, or it can make your illness milder if you get a related but different strain of flu virus.
What are my options for the flu vaccine?
The flu vaccine comes in two forms:
A shot
A flu shot contains an inactivated vaccine made of killed virus. The shot is usually given in the arm. Because the viruses in the vaccine are killed (inactivated), the shot won't cause you to get the flu, but it will enable your body to develop the antibodies necessary to ward off influenza viruses. You may have a slight reaction to the shot, such as soreness at the injection site, mild muscle ache or fever. Reactions usually last one to two days and are more likely to occur in children who have never been exposed to the flu virus.
A nasal spray
Administered through your nose, the nasal spray vaccine (FluMist) consists of a low dose of live, but weakened, flu viruses. The vaccine doesn't cause the flu, but it does prompt an immune response in your nose and upper airways as well as throughout your body.
Who should get the flu vaccine?
Most people who want to reduce the risk of having influenza can get a flu shot. The CDC recommends the flu vaccine in particular if you:
Are age 6 months to 4 years
Are a child on long-term aspirin therapy
Are pregnant
Are 50 years old or older
Have a chronic medical condition such as asthma, diabetes or heart, kidney or lung disease
Have a weakened immune system such as from medications or HIV infection
Are a resident of a nursing home or other long term care facility
Are a child care worker or health care worker or live with or care for someone at high risk of complications from the flu
Who shouldn't get the flu shot?
Don't get a flu shot if you:
Have had an allergic reaction to the vaccine in the past.
Are allergic to chicken eggs.
Developed Guillain-Barre syndrome, a serious autoimmune disease affecting the nerves outside the brain and spinal cord, within six weeks of receiving the vaccine in the past. People who have experienced Guillain-Barre after the flu vaccine are at higher risk than are others of developing it again.
Have a fever. Wait until your symptoms improve before getting vaccinated.
Why do children need two doses of the flu vaccine?
Children younger than 9 years old require two doses of the flu vaccine if it's the first time they've been vaccinated for influenza. That's because children don't develop an adequate antibody level the first time they get the vaccine. Antibodies help fight the virus if it enters your child's system. If a flu vaccine shortage was to occur and your child couldn't get two doses of vaccine, one dose might still offer some protection.
I heard the flu shot isn't very effective for older adults. Is it worth getting vaccinated if you're over 65?
If you're over age 65, the vaccine doesn't offer as much protection as it would to someone younger because older adults produce fewer antibodies in response to the virus. Still, the vaccine offers more protection than does skipping the shot altogether. More important, the flu vaccine decreases the risk of flu-related complications especially pneumonia, heart attack, stroke and death to which older adults are especially vulnerable.
Will the flu shot protect against bird flu if there's an outbreak among humans?
An annual flu shot won't protect you specifically from bird flu, but it will reduce the risk of simultaneous infection with human and bird flu viruses. This is important because simultaneous infections are the main way that viruses swap genes and create new strains that potentially can cause flu pandemics.
Can I lower my risk of the flu without getting a flu shot?
With or without a flu shot, you can take steps to help protect yourself from the flu and other viruses.
Practice good hygiene Good hygiene remains your primary defense against contagious illnesses.
Wash your hands thoroughly and often with soap and water or an alcohol-based sanitizer containing at least 60 percent alcohol.
Avoid touching your eyes, nose or mouth whenever possible.
Avoid crowds when the flu is most prevalent in your area.
Cover your mouth and nose with a tissue when you cough or sneeze.
If I've already had the flu, can I get it again?
Once you've had the flu, you develop antibodies to the viral strain that caused it. But those antibodies won't protect you from new or mutated strains of influenza or other viruses.
What should I do if I get the flu?
First of all, don't go to work or school you'll risk spreading this contagious disease to others.
To relieve your symptoms:
Drink plenty of fluids.
Avoid alcohol and tobacco.
Consider over-the-counter medicine such as acetaminophen (Tylenol, others) to ease the discomfort associated with muscle aches or fever, but don't give aspirin to children or teenagers because of the risk of the rare but serious disease, Reye's syndrome. And keep in mind that acetaminophen can cause severe liver damage if taken in excess.
Use antiviral medications if prescribed by your doctor, but no longer than recommended. Be sure to monitor yourself. If you start feeling worse, consult your doctor to make sure you're not developing a flu-related complication.
What kind of complications can arise from the flu?
Complications include bacterial infection, pneumonia and dehydration. If you have a chronic medical condition, you may experience a worsening of that condition. Children can develop sinus and ear infections.
Is there any medicine to treat the flu?
Antivirals work both to prevent the flu and to help reduce the severity and duration of the illness by a day or two. Antiviral medications must be taken within 48 hours of the onset of your symptoms and are available only by prescription. Ask your doctor about getting a rapid flu test that can verify within a few hours whether you have the flu.
These two antivirals are recommended for treating the flu virus:
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
Each of these drugs can cause side effects, including lightheadedness, nausea, loss of appetite and difficulty breathing. They can also lead to the development of antiviral-resistant viruses.
People with the flu, particularly children, who take Tamiflu may be at increased risk of self-injury and confusion. The FDA recommends that individuals with the flu who take Tamiflu be closely monitored for signs of unusual behavior. In July 2007, the FDA approved two lower dose versions of Tamiflu for children. Still, discuss possible side effects with your doctor before starting any antiviral medication.
Your best bet for treating flu symptoms remains the tried and true:
Rest.
Get plenty of fluids.
Take acetaminophen or ibuprofen (Advil, Motrin, others) for aches and pains.
Come see the doctors at Healthy Trust Immediate Medical Care.
It's also important to eat healthy and get some daily activity to help keep your immune system in top form.
Healthy Trust Immediate Medical Care is the official flu clinic of the Chicago North Shore Communities of Lake County, Wheeling, Prospect Heights, Lincolnshire, Deerfield, Buffalo Grove, Northbrook, Highland Park, Long Grove, Riverwoods, Des Plaines, Palatine, Glenview, Highwood, Northfield, Libertyville, Winnetka, Arlington Heights, Mount Prospect, Lake Bluff, Lake Forest, Mundelein, and Bannockburn.
Sunday, September 7, 2008
Popcorn safe for bowel condition
Men with abnormal pouches in their bowels can safely eat nuts and popcorn, and those foods may even lower the chance of intestinal flare-ups, a study found.
The University of Washington research, published in the Journal of the American Medical Association, contradicts the advice of doctors who have told people with the condition known as diverticulosis to avoid those products. No studies have shown that to be true, the researchers said.
One-third of the U.S. population will develop the condition by age 60, the researchers said. Inflammation, bleeding and obstructions may result, and treatment costs about $2.4 billion a year. While diverticulosis remains little understood, it may be linked to too little fiber in a diet, doctors say. Nuts and popcorn are high in fiber.
"For many doctors, hopefully they will not tell their patients that they can't have some of the foods that they enjoy and may actually be good for them, such as nuts," said Jennifer Christie, an Emory University gastroenterologist in Atlanta who wasn't involved in the study.
Diverticulosis, occurs when a person has many small pouches in the lining of the large intestine, or colon, that bulge out through weak spots, causing discomfort like bloating or abdominal pain, according to the U.S. National Institutes of Health. When those pouches become inflamed, diverticulitis develops, which can lead to rectal bleeding, infection or an intestinal obstruction from scarring.
Between 10 percent and 25 percent of people with diverticulosis develop diverticulitis, according to the U.S. government.
A lack of fiber can lead to constipation, which may make people strain on the toilet, increasing pressure on the colon and causing the colon lining to bulge out through weak spots. These bulges or pouches may then become inflamed when bacteria or stool are caught in them.
Patients with the condition have been told to avoid nuts, popcorn and seeds because doctors thought particles from the foods may become lodged in the pouches, causing inflammation or bleeding, according to the study.
Researchers analyzed data collected from an 18-year study that included 47,228 men ages 40 to 75 who filled out medical questionnaires about their health and diet every few years. The men didn't have diverticulosis at the start of the study.
Twenty-seven percent of men in the study ate nuts at least twice a week, and 15 percent ate corn or popcorn at least twice a week. Over the 18 years, 801 men developed diverticulitis and 383 diverticular bleeding.
The researchers found that men who ate nuts at least twice a week had a 20 percent lower risk of diverticulitis than those who ate nuts once a month. And those who ate popcorn at least twice a week had a 28 percent lower risk of the condition, compared with those who ate popcorn less than once a month.
The high amounts of fiber in nuts and popcorn may be one reason men who ate more of those foods had fewer complications from diverticulosis, said the lead author, Lisa Strate, an assistant professor of medicine at the University of Washington in Seattle. Nuts also may help reduce inflammation, she said yesterday in a telephone interview.
The study was presented last year at Digestive Disease Week, a meeting of gastroenterologists, in Washington.
Strate is studying other reasons, such as obesity and physical inactivity, that people may develop complications from diverticulosis. Future studies should look at whether high-fiber diets help, and whether a diet high in red meat contributes to complications, she said.
The University of Washington research, published in the Journal of the American Medical Association, contradicts the advice of doctors who have told people with the condition known as diverticulosis to avoid those products. No studies have shown that to be true, the researchers said.
One-third of the U.S. population will develop the condition by age 60, the researchers said. Inflammation, bleeding and obstructions may result, and treatment costs about $2.4 billion a year. While diverticulosis remains little understood, it may be linked to too little fiber in a diet, doctors say. Nuts and popcorn are high in fiber.
"For many doctors, hopefully they will not tell their patients that they can't have some of the foods that they enjoy and may actually be good for them, such as nuts," said Jennifer Christie, an Emory University gastroenterologist in Atlanta who wasn't involved in the study.
Diverticulosis, occurs when a person has many small pouches in the lining of the large intestine, or colon, that bulge out through weak spots, causing discomfort like bloating or abdominal pain, according to the U.S. National Institutes of Health. When those pouches become inflamed, diverticulitis develops, which can lead to rectal bleeding, infection or an intestinal obstruction from scarring.
Between 10 percent and 25 percent of people with diverticulosis develop diverticulitis, according to the U.S. government.
A lack of fiber can lead to constipation, which may make people strain on the toilet, increasing pressure on the colon and causing the colon lining to bulge out through weak spots. These bulges or pouches may then become inflamed when bacteria or stool are caught in them.
Patients with the condition have been told to avoid nuts, popcorn and seeds because doctors thought particles from the foods may become lodged in the pouches, causing inflammation or bleeding, according to the study.
Researchers analyzed data collected from an 18-year study that included 47,228 men ages 40 to 75 who filled out medical questionnaires about their health and diet every few years. The men didn't have diverticulosis at the start of the study.
Twenty-seven percent of men in the study ate nuts at least twice a week, and 15 percent ate corn or popcorn at least twice a week. Over the 18 years, 801 men developed diverticulitis and 383 diverticular bleeding.
The researchers found that men who ate nuts at least twice a week had a 20 percent lower risk of diverticulitis than those who ate nuts once a month. And those who ate popcorn at least twice a week had a 28 percent lower risk of the condition, compared with those who ate popcorn less than once a month.
The high amounts of fiber in nuts and popcorn may be one reason men who ate more of those foods had fewer complications from diverticulosis, said the lead author, Lisa Strate, an assistant professor of medicine at the University of Washington in Seattle. Nuts also may help reduce inflammation, she said yesterday in a telephone interview.
The study was presented last year at Digestive Disease Week, a meeting of gastroenterologists, in Washington.
Strate is studying other reasons, such as obesity and physical inactivity, that people may develop complications from diverticulosis. Future studies should look at whether high-fiber diets help, and whether a diet high in red meat contributes to complications, she said.
Saturday, September 6, 2008
Does morning sickness indicate a girl?
THE BELIEF:
Morning sickness means a baby girl is more likely.
THE FACTS:
Old wives' tales about predicting a baby's sex -- relying on clues like the way the woman carries and the fetal heart rate -- are usually more fantasy than fact.
But the notion that morning sickness can sometimes indicate that a girl is on the way may be an exception. A number of large studies in various countries have examined the claim, and almost all have found it to be true, with caveats. Specifically, studies have found that it applies to women with morning sickness in the first trimester, and with symptoms so severe that it leads to hospitalization, a condition known as hyperemesis gravidarum.
One of the most recent studies was conducted by epidemiologists at the University of Washington. The scientists compared 2,110 pregnant women who were hospitalized with morning sickness in their first trimester and a control group of 9,783 women who did not get severely ill. They found that the women in the first group were more likely to deliver a girl, and that those who were the sickest -- hospitalized for three days or more -- had the greatest odds: an increase of 80 percent compared with the control women.
Other studies in The Lancet and the journal Epidemiology, among others, have repeated the findings. It is thought that certain hormones produced by female fetuses may be the culprit.
THE BOTTOM LINE:
Severe morning sickness may indicate a higher likelihood that the baby will be a girl.
Morning sickness means a baby girl is more likely.
THE FACTS:
Old wives' tales about predicting a baby's sex -- relying on clues like the way the woman carries and the fetal heart rate -- are usually more fantasy than fact.
But the notion that morning sickness can sometimes indicate that a girl is on the way may be an exception. A number of large studies in various countries have examined the claim, and almost all have found it to be true, with caveats. Specifically, studies have found that it applies to women with morning sickness in the first trimester, and with symptoms so severe that it leads to hospitalization, a condition known as hyperemesis gravidarum.
One of the most recent studies was conducted by epidemiologists at the University of Washington. The scientists compared 2,110 pregnant women who were hospitalized with morning sickness in their first trimester and a control group of 9,783 women who did not get severely ill. They found that the women in the first group were more likely to deliver a girl, and that those who were the sickest -- hospitalized for three days or more -- had the greatest odds: an increase of 80 percent compared with the control women.
Other studies in The Lancet and the journal Epidemiology, among others, have repeated the findings. It is thought that certain hormones produced by female fetuses may be the culprit.
THE BOTTOM LINE:
Severe morning sickness may indicate a higher likelihood that the baby will be a girl.
Friday, September 5, 2008
Can manipulating your neck lead to a stroke?
THE BELIEF:
Manipulating your neck could lead to a stroke.
THE FACTS:
Manipulating your neck is supposed to relieve pain, not cause it. But years ago neurologists noticed a strange pattern of people suffering strokes shortly after seeing chiropractors, specifically for neck adjustments.
Their hypothesis was that a chiropractic technique called cervical spinal manipulation, involving a forceful twisting of the neck, could damage two major arteries that lead through the neck to the back of the brain. Strokes in people under age 45 are relatively rare, but these cervical arterial dissections are a leading cause of them.
Studies that followed suggested a link. One at Stanford that surveyed 177 neurologists found 55 patients who suffered strokes after seeing chiropractors. Another, published in the journal Neurologist, said young stroke patients were five times more likely to have had neck adjustments within a week of their strokes than a control group. It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments.
But other studies have cast doubt. One published this year examined 818 cases of stroke linked to arterial dissections at the back of the neck. Before their strokes, younger patients who saw chiropractors were more likely to have complained beforehand of head and neck pain -- symptoms often preceding a stroke -- suggesting they had undiagnosed dissections and had sought out chiropractors for relief, not realizing a stroke was imminent.
THE BOTTOM LINE:
Forceful neck manipulation seems to carry a small risk of arterial tears.
Manipulating your neck could lead to a stroke.
THE FACTS:
Manipulating your neck is supposed to relieve pain, not cause it. But years ago neurologists noticed a strange pattern of people suffering strokes shortly after seeing chiropractors, specifically for neck adjustments.
Their hypothesis was that a chiropractic technique called cervical spinal manipulation, involving a forceful twisting of the neck, could damage two major arteries that lead through the neck to the back of the brain. Strokes in people under age 45 are relatively rare, but these cervical arterial dissections are a leading cause of them.
Studies that followed suggested a link. One at Stanford that surveyed 177 neurologists found 55 patients who suffered strokes after seeing chiropractors. Another, published in the journal Neurologist, said young stroke patients were five times more likely to have had neck adjustments within a week of their strokes than a control group. It estimated an incidence of 1.3 cases for every 100,000 people under 45 receiving neck adjustments.
But other studies have cast doubt. One published this year examined 818 cases of stroke linked to arterial dissections at the back of the neck. Before their strokes, younger patients who saw chiropractors were more likely to have complained beforehand of head and neck pain -- symptoms often preceding a stroke -- suggesting they had undiagnosed dissections and had sought out chiropractors for relief, not realizing a stroke was imminent.
THE BOTTOM LINE:
Forceful neck manipulation seems to carry a small risk of arterial tears.
Thursday, September 4, 2008
High risk from energy drinks
When researcher Kathleen Miller persuaded the federal government to give her nearly a half-million dollars, the plan was to study "toxic jock identity." That's her term for the "hyper-attraction" some college-level male athletes have to masculinity and high-risk behaviors such as substance abuse and violence.
As an afterthought, her questionnaire asked about consumption of highly caffeinated energy drinks such as Red Bull, Monster and Rockstar.
"I threw in a few questions about energy drinks, mostly because of what I observed in a nephew of mine. He was drinking a lot of energy drinks and suddenly becoming explosive, blowing up at his family when he was never that way before. I wondered if the caffeine was part of it," said Miller, a Ph.D. researcher at the University of Buffalo's Research Institute on Addictions.
That's because the typical energy drink contains three times more caffeine than a soda pop and sometimes up to 10 times as much. A 12-ounce Coke or Pepsi has about 34 to 38 milligrams of caffeine, while the same amount of Red Bull or Monster rings up 116 to 120 milligrams.
In comparison, an espresso shot has about 75 milligrams and 12 ounces of regularly brewed coffee has roughly 250 milligrams. One difference, though, said Miller, is coffee is usually served hot so we sip it but "energy drinks you can slam right back."
The drinks are marketed primarily to 18- to 25-year-olds -- yet increasingly used by younger teens -- and have annual sales of more than $3 billion.
The more days in the past month a college student consumes an energy drink, the higher the probability of high-risk behavior, according to two Miller studies published this year. For example, students whoconsume an energy drink six or more days a month are three times more likely to smoke, abuse prescription drugs or have been in a serious fight during the previous year. Those frequent energy-drink consumers are twice as likely to experience alcohol-related problems or use marijuana, plus the energy-drink crowd will be more likely to practice unsafe sex or neglect to use a seat belt.
"This research doesn't mean the energy drinks cause the behavior," said Miller, but she does propose "frequent energy drink consumption may be a red flag or warning sign for identifying a young person at higher risk for health-compromising behavior."
Should parents be worried? Probably, and certainly more aware of the energy-drink hold on even younger people. There have been media reports of nausea, abnormal heart rhythms, profuse sweating, caffeine highs and emergency room visits at high schools and middle schools during the past academic year.
Maybe France, Turkey, Denmark, Norway, Uruguay and Iceland are onto something. These countries have all banned high-caffeine energy drinks, and Sweden only permits use with a prescription. Canada banned energy drinks until 2004 and now requires warning label cautioning against use by children or pregnant women, use in large quantities by anyone and in combination with alcohol.
What's more, Miller found two-thirds of energy drink consumers have combined energy drinks with alcohol, typically vodka, gin, whiskey or, yikes, Jagermeister.
"College kids have the misconception that you don't get a drunk with the caffeine from energy drinks," said Miller. "Their speech isn't as slurred and they have less fatigue, so they can dance until 3 but still wrap a car around a tree on the way home. And bartenders can't tell as easily who to stop serving."
Dr. Mary Claire O'Brien of Wake Forest University Baptist Medical Center has described the energy-drink cocktail effect as "you're every bit as drunk, you're just an awake drunk."
O'Brien surveyed students at 10 North Carolina universities about energy drink and alcohol trends. She published a 2007 study showing that students who mix energy drinks with liquor got drunk twice as often as those who consumed alcohol only and were far more likely to be injured or require medical attention. Energy drink users were additionally more likely to be perpetrators or victims of aggressive sexual behavior.
Miller said that she has appeared on call-in radio shows in which students have provided a range of responses from "no problem" to "horror stories."
"Some teens, as you might expect, called assuring me they drink lots of energy drink with no problems," said Miller, who has a grant proposal with the National Institutes of Health to find out where energy drinks users will be five years from now. "But other young callers talked about drinking three or four energy drinks in a row, then not being able to drive a car or feeling bad enough to go to an emergency room."
As an afterthought, her questionnaire asked about consumption of highly caffeinated energy drinks such as Red Bull, Monster and Rockstar.
"I threw in a few questions about energy drinks, mostly because of what I observed in a nephew of mine. He was drinking a lot of energy drinks and suddenly becoming explosive, blowing up at his family when he was never that way before. I wondered if the caffeine was part of it," said Miller, a Ph.D. researcher at the University of Buffalo's Research Institute on Addictions.
That's because the typical energy drink contains three times more caffeine than a soda pop and sometimes up to 10 times as much. A 12-ounce Coke or Pepsi has about 34 to 38 milligrams of caffeine, while the same amount of Red Bull or Monster rings up 116 to 120 milligrams.
In comparison, an espresso shot has about 75 milligrams and 12 ounces of regularly brewed coffee has roughly 250 milligrams. One difference, though, said Miller, is coffee is usually served hot so we sip it but "energy drinks you can slam right back."
The drinks are marketed primarily to 18- to 25-year-olds -- yet increasingly used by younger teens -- and have annual sales of more than $3 billion.
The more days in the past month a college student consumes an energy drink, the higher the probability of high-risk behavior, according to two Miller studies published this year. For example, students whoconsume an energy drink six or more days a month are three times more likely to smoke, abuse prescription drugs or have been in a serious fight during the previous year. Those frequent energy-drink consumers are twice as likely to experience alcohol-related problems or use marijuana, plus the energy-drink crowd will be more likely to practice unsafe sex or neglect to use a seat belt.
"This research doesn't mean the energy drinks cause the behavior," said Miller, but she does propose "frequent energy drink consumption may be a red flag or warning sign for identifying a young person at higher risk for health-compromising behavior."
Should parents be worried? Probably, and certainly more aware of the energy-drink hold on even younger people. There have been media reports of nausea, abnormal heart rhythms, profuse sweating, caffeine highs and emergency room visits at high schools and middle schools during the past academic year.
Maybe France, Turkey, Denmark, Norway, Uruguay and Iceland are onto something. These countries have all banned high-caffeine energy drinks, and Sweden only permits use with a prescription. Canada banned energy drinks until 2004 and now requires warning label cautioning against use by children or pregnant women, use in large quantities by anyone and in combination with alcohol.
What's more, Miller found two-thirds of energy drink consumers have combined energy drinks with alcohol, typically vodka, gin, whiskey or, yikes, Jagermeister.
"College kids have the misconception that you don't get a drunk with the caffeine from energy drinks," said Miller. "Their speech isn't as slurred and they have less fatigue, so they can dance until 3 but still wrap a car around a tree on the way home. And bartenders can't tell as easily who to stop serving."
Dr. Mary Claire O'Brien of Wake Forest University Baptist Medical Center has described the energy-drink cocktail effect as "you're every bit as drunk, you're just an awake drunk."
O'Brien surveyed students at 10 North Carolina universities about energy drink and alcohol trends. She published a 2007 study showing that students who mix energy drinks with liquor got drunk twice as often as those who consumed alcohol only and were far more likely to be injured or require medical attention. Energy drink users were additionally more likely to be perpetrators or victims of aggressive sexual behavior.
Miller said that she has appeared on call-in radio shows in which students have provided a range of responses from "no problem" to "horror stories."
"Some teens, as you might expect, called assuring me they drink lots of energy drink with no problems," said Miller, who has a grant proposal with the National Institutes of Health to find out where energy drinks users will be five years from now. "But other young callers talked about drinking three or four energy drinks in a row, then not being able to drive a car or feeling bad enough to go to an emergency room."
Wednesday, September 3, 2008
Breast-feeding may cut risk of aggressive cancer
Science has proved that mothers and babies benefit from breast-feeding in all sorts of ways, and now researchers at the Fred Hutchinson Cancer Research Center have shown that this practice can reduce the risk of a particularly aggressive form of breast cancer.
"It's a form more common among younger women and African-American women," said Amanda Phipps, a scientist in the public health division of the Seattle cancer center and lead author of a report published Monday in the journal Cancer. "We wanted to find out what puts women at risk for this."
The aggressive cancer type is called "triple negative" breast cancer because the tumor doesn't respond to a critical regulatory protein known as "HER2" or two key hormones, estrogen and progestin, which also are fundamental to many hormone-based treatments for breast cancer.
"That's why we can't use hormonal treatments on these tumors," Phipps said.
Triple-negative breast cancer is an aggressive cancer estimated to be involved in anywhere from 15 percent to 30 percent of all breast cancers, she said. Little is known about why some women are at higher risk of developing this form of cancer.
Phipps and her colleagues at Fred Hutchinson examined two groups of women from 55 to 79 years old with and without a diagnosis of breast cancer. They compared 1,476 women without the cancer with 1,140 women with several different forms of breast cancer including the "triple negative," the most common "luminal" form and another subtype associated only with the HER2 protein.
The researchers then examined these women with respect to their reproductive health histories including breast-feeding practices, onset of menstruation and menopause. All of these, Phipps said, provide indicators of the hormone levels over time for these women.
"We've known for a long time that breast-feeding reduces your risk of breast cancer, and that it was probably related to hormones," she said. But there has been little specific research, she said, on which hormones might affect the risk of these more aggressive forms of breast cancer.
By comparing the molecular nature of these breast cancer types with each woman's reproductive history, Phipps and her colleagues found that breast-feeding for at least six months corresponded with a lower risk of both the common luminal form as well as the triple-negative form of breast cancer. They also found that early onset of menstruation (before age 13) was associated with a higher risk of the HER2 breast cancer.
Late onset of menopause and the use of hormone treatments were found to increase the risk of luminal breast cancer. They found no risk differences associated with the number of children or the mother's age at first birth.
While it is common knowledge that female hormone levels change with the onset of menstruation or menopause, and so may be related to hormonally influenced cancer risks, it is not fully understood why breast-feeding would be correlated with this cancer-hormone link.
"One possible explanation is that while women are breast-feeding, they aren't menstruating and so their hormones aren't cycling," Phipps said.
So the more women breast-feed, she said, the less chance their hormones may have to trigger a cancer. Another theory, she said, is that breast-feeding alters breast cell structures in ways that make them less prone to develop into cancer cells.
The findings support the overall view that breast-feeding can reduce a woman's risk of cancer, Phipps said. More importantly for scientists, she said, it shows that different reproductive health behaviors have different effects on various forms of breast cancer.
"It helps explain why some women are at higher risk and also why certain therapies are not effective against these more aggressive forms of breast cancer," she said.
"It's a form more common among younger women and African-American women," said Amanda Phipps, a scientist in the public health division of the Seattle cancer center and lead author of a report published Monday in the journal Cancer. "We wanted to find out what puts women at risk for this."
The aggressive cancer type is called "triple negative" breast cancer because the tumor doesn't respond to a critical regulatory protein known as "HER2" or two key hormones, estrogen and progestin, which also are fundamental to many hormone-based treatments for breast cancer.
"That's why we can't use hormonal treatments on these tumors," Phipps said.
Triple-negative breast cancer is an aggressive cancer estimated to be involved in anywhere from 15 percent to 30 percent of all breast cancers, she said. Little is known about why some women are at higher risk of developing this form of cancer.
Phipps and her colleagues at Fred Hutchinson examined two groups of women from 55 to 79 years old with and without a diagnosis of breast cancer. They compared 1,476 women without the cancer with 1,140 women with several different forms of breast cancer including the "triple negative," the most common "luminal" form and another subtype associated only with the HER2 protein.
The researchers then examined these women with respect to their reproductive health histories including breast-feeding practices, onset of menstruation and menopause. All of these, Phipps said, provide indicators of the hormone levels over time for these women.
"We've known for a long time that breast-feeding reduces your risk of breast cancer, and that it was probably related to hormones," she said. But there has been little specific research, she said, on which hormones might affect the risk of these more aggressive forms of breast cancer.
By comparing the molecular nature of these breast cancer types with each woman's reproductive history, Phipps and her colleagues found that breast-feeding for at least six months corresponded with a lower risk of both the common luminal form as well as the triple-negative form of breast cancer. They also found that early onset of menstruation (before age 13) was associated with a higher risk of the HER2 breast cancer.
Late onset of menopause and the use of hormone treatments were found to increase the risk of luminal breast cancer. They found no risk differences associated with the number of children or the mother's age at first birth.
While it is common knowledge that female hormone levels change with the onset of menstruation or menopause, and so may be related to hormonally influenced cancer risks, it is not fully understood why breast-feeding would be correlated with this cancer-hormone link.
"One possible explanation is that while women are breast-feeding, they aren't menstruating and so their hormones aren't cycling," Phipps said.
So the more women breast-feed, she said, the less chance their hormones may have to trigger a cancer. Another theory, she said, is that breast-feeding alters breast cell structures in ways that make them less prone to develop into cancer cells.
The findings support the overall view that breast-feeding can reduce a woman's risk of cancer, Phipps said. More importantly for scientists, she said, it shows that different reproductive health behaviors have different effects on various forms of breast cancer.
"It helps explain why some women are at higher risk and also why certain therapies are not effective against these more aggressive forms of breast cancer," she said.
Tuesday, September 2, 2008
Brisk walking can help memory
Brisk walking led to slight improvements on mental tests for older people with memory problems in what is billed as the first rigorous test of exercise on the aging brain. The results from the small Australian study were only modest. But they back up observational studies showing potential mental benefits from physical activity.
The effects of exercise were at least as good, if not better, than those seen with drugs approved to aid mental function in Alzheimer's disease, according to experts not involved in the study.
Still, the study authors cautioned that the results don't prove that exercise will produce meaningful improvement in brain function or memory. They also said the results should not be used to imply that exercise reduces the risk of dementia or Alzheimer's - that can't be determined from this type of study.
The authors said it's not clear how exercise might affect brain function; one theory is that it improves blood flow to the brain. Their study did not involve brain imaging that would have shown any changes in blood flow associated with exercise.
Results appear in Wednesday's Journal of the American Medical Association.
Study participants included 85 Australian adults aged 50 and older assigned to do at least 2 1/2 hours of weekly physical activity, mainly brisk walking, for six months. They recorded their exercise in diaries and also got phone calls and newsletters encouraging them to stick with it.
They were urged to remain active even after the initial six months, and were compared with a control group of 85 people who were not asked to exercise.
The exercise group engaged in about 20 minutes more activity a day than the control group.
After six months, the exercise group performed 1.3 points better on a 70-point scale of brain function than the non-exercise group. The effects remained at 18 months, though the difference by then, about 0.7 points, was minimal.
"To our knowledge, this is the first randomized clinical trial being published" on exercise and brain function in older adults with problems, said the lead author Dr. Nicola Lautenschlager of the University of Melbourne.
"It's an important piece in that it's the first intervention in people with memory complaints that's showing some potential benefit," said Dr. Raj Shah, director of the memory clinic at Rush University Medical Center. He was not involved in the study.
Shah said larger studies are needed before physical exercise would be prescribed to treat memory problems in older adults.
Dr. Ron Petersen of the Alzheimer's Association agreed that the study should not be "overhyped," but said he will use the results in discussing potential benefits of exercise with patients.
The effects of exercise were at least as good, if not better, than those seen with drugs approved to aid mental function in Alzheimer's disease, according to experts not involved in the study.
Still, the study authors cautioned that the results don't prove that exercise will produce meaningful improvement in brain function or memory. They also said the results should not be used to imply that exercise reduces the risk of dementia or Alzheimer's - that can't be determined from this type of study.
The authors said it's not clear how exercise might affect brain function; one theory is that it improves blood flow to the brain. Their study did not involve brain imaging that would have shown any changes in blood flow associated with exercise.
Results appear in Wednesday's Journal of the American Medical Association.
Study participants included 85 Australian adults aged 50 and older assigned to do at least 2 1/2 hours of weekly physical activity, mainly brisk walking, for six months. They recorded their exercise in diaries and also got phone calls and newsletters encouraging them to stick with it.
They were urged to remain active even after the initial six months, and were compared with a control group of 85 people who were not asked to exercise.
The exercise group engaged in about 20 minutes more activity a day than the control group.
After six months, the exercise group performed 1.3 points better on a 70-point scale of brain function than the non-exercise group. The effects remained at 18 months, though the difference by then, about 0.7 points, was minimal.
"To our knowledge, this is the first randomized clinical trial being published" on exercise and brain function in older adults with problems, said the lead author Dr. Nicola Lautenschlager of the University of Melbourne.
"It's an important piece in that it's the first intervention in people with memory complaints that's showing some potential benefit," said Dr. Raj Shah, director of the memory clinic at Rush University Medical Center. He was not involved in the study.
Shah said larger studies are needed before physical exercise would be prescribed to treat memory problems in older adults.
Dr. Ron Petersen of the Alzheimer's Association agreed that the study should not be "overhyped," but said he will use the results in discussing potential benefits of exercise with patients.
Monday, September 1, 2008
Study: No link between measles vaccine and autism
New research further debunks any link between measles vaccine and autism, work that comes as the nation is experiencing a surge in measles cases fueled by children left unvaccinated.
Years of research with the measles, mumps and rubella vaccine, better known as MMR, have concluded that it doesn't cause autism. Still, some parents' fears persist, in part because of one 1998 British study that linked the vaccine with a subgroup of autistic children who also have serious gastrointestinal problems. That study reported that measles virus was lingering in the children's bowels.
Only now have researchers rigorously retested that finding, taking samples of youngsters' intestines to hunt for signs of virus with the most modern genetic technology. There is no evidence that MMR plays any role, the international team - which included researchers who first raised the issue - reported Wednesday.
"Although in fact there was evidence that this vaccine was safe in the bulk of the population, it had not been previously assessed with respect to kids with autism and GI complaints," said Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work published in PLoS One, the online journal of the Public Library of Science.
"We are confident there is no link between MMR and autism," Lipkin said.
Added co-author Dr. Larry Pickering of the Centers for Disease Control and Prevention: "I feel very certain that it is a safe vaccine."
Measles, a highly infectious virus best known for its red skin rash, once routinely sickened thousands of children a year and killed hundreds, until childhood vaccinations made it a rarity in this country. But so far this year, the U.S. has counted 131 measles cases, the most in a decade. Most patients were unvaccinated. Some were infants too young for their first MMR shot, but nearly half involved children whose parents rejected vaccination, the CDC reported last month.
No one knows just how many autism patients also suffer gastrointestinal disorders, pain that they may not be able to communicate. But Lipkin said that by some estimates, up to a quarter may be affected.
The MMR fear was that the vaccine's weakened measles virus somehow lodged in and inflamed intestines, allowing waste products to escape and reach the central nervous system, Lipkin said. So his team had two questions: Does measles virus really persist in children with both disorders and not other youngsters? And did vaccination precede the GI complaints which in turn preceded autism?
Researchers studied 25 children with both autism and GI disorders, and another 13 children with the same GI disorders but no neurologic problems. The youngsters - the average age was 5 - all were undergoing colonoscopies for their GI conditions anyway, allowing tissue samples to be tested for genetic traces of measles virus. All had been vaccinated at younger ages.
The tests uncovered traces of measles genetic material in the bowels of one boy with autism - and one boy without autism. That doesn't prove virus never temporarily lodged in more children, but it contradicts the earlier study that raised concern.
Nor was there a relationship with vaccine timing: Just five of the 25 autistic children had MMR precede GI complaints that in turn preceded autism symptoms.
Researchers consulted some prominent vaccine critics in designing the study. California advocate Rick Rollens praised the work but said it didn't eliminate other vaccine concerns that deserve similar study. Meanwhile, he said it should draw much-needed attention to the suffering of patients like his son, who has both autism and GI disorders.
"No longer can mainstream medicine ignore the parents' claims of significant GI distress," he said.
Years of research with the measles, mumps and rubella vaccine, better known as MMR, have concluded that it doesn't cause autism. Still, some parents' fears persist, in part because of one 1998 British study that linked the vaccine with a subgroup of autistic children who also have serious gastrointestinal problems. That study reported that measles virus was lingering in the children's bowels.
Only now have researchers rigorously retested that finding, taking samples of youngsters' intestines to hunt for signs of virus with the most modern genetic technology. There is no evidence that MMR plays any role, the international team - which included researchers who first raised the issue - reported Wednesday.
"Although in fact there was evidence that this vaccine was safe in the bulk of the population, it had not been previously assessed with respect to kids with autism and GI complaints," said Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work published in PLoS One, the online journal of the Public Library of Science.
"We are confident there is no link between MMR and autism," Lipkin said.
Added co-author Dr. Larry Pickering of the Centers for Disease Control and Prevention: "I feel very certain that it is a safe vaccine."
Measles, a highly infectious virus best known for its red skin rash, once routinely sickened thousands of children a year and killed hundreds, until childhood vaccinations made it a rarity in this country. But so far this year, the U.S. has counted 131 measles cases, the most in a decade. Most patients were unvaccinated. Some were infants too young for their first MMR shot, but nearly half involved children whose parents rejected vaccination, the CDC reported last month.
No one knows just how many autism patients also suffer gastrointestinal disorders, pain that they may not be able to communicate. But Lipkin said that by some estimates, up to a quarter may be affected.
The MMR fear was that the vaccine's weakened measles virus somehow lodged in and inflamed intestines, allowing waste products to escape and reach the central nervous system, Lipkin said. So his team had two questions: Does measles virus really persist in children with both disorders and not other youngsters? And did vaccination precede the GI complaints which in turn preceded autism?
Researchers studied 25 children with both autism and GI disorders, and another 13 children with the same GI disorders but no neurologic problems. The youngsters - the average age was 5 - all were undergoing colonoscopies for their GI conditions anyway, allowing tissue samples to be tested for genetic traces of measles virus. All had been vaccinated at younger ages.
The tests uncovered traces of measles genetic material in the bowels of one boy with autism - and one boy without autism. That doesn't prove virus never temporarily lodged in more children, but it contradicts the earlier study that raised concern.
Nor was there a relationship with vaccine timing: Just five of the 25 autistic children had MMR precede GI complaints that in turn preceded autism symptoms.
Researchers consulted some prominent vaccine critics in designing the study. California advocate Rick Rollens praised the work but said it didn't eliminate other vaccine concerns that deserve similar study. Meanwhile, he said it should draw much-needed attention to the suffering of patients like his son, who has both autism and GI disorders.
"No longer can mainstream medicine ignore the parents' claims of significant GI distress," he said.
Sunday, August 31, 2008
Smoking riskier for women's hearts
Women typically get heart disease much later than men, but not if they smoke, researchers said Tuesday.
In fact, women who smoke have heart attacks more than a dozen years earlier than women who don't smoke, Norwegian doctors reported in a study presented to the European Society of Cardiology. For men, the gap is not so dramatic; male smokers have heart attacks about six years earlier than men who don't smoke.
"This is not a minor difference," said Dr. Silvia Priori, a cardiologist at the Scientific Institute in Pavia, Italy. "Women need to realize they are losing much more than men when they smoke," she said. Priori was not connected to the research.
Dr. Morten Grundtvig and colleagues from the Innlandet Hospital Trust in Lillehammer, Norway, based their study on data from 1,784 patients admitted for a first heart attack at a hospital in Lillehammer.
Their study found that the men on average had their first heart attack at age 72 if they didn't smoke, and at 64 if they did. Women in the study had their first heart attack at age 81 if they didn't smoke, and at age 66 if they did.
That works out to eight and 15 years, respectively, for men and women. After adjusting for other heart risk factors like blood pressure, cholesterol and diabetes, researchers found that the difference for men was about six years for women about 14 years.
Previous studies looking at a possible gender difference have been inconclusive.
Doctors have long suspected that female hormones protect women against heart disease. Estrogen is thought to raise the levels of good cholesterol as well as enabling blood vessel walls to relax more easily, thus lowering the chances of a blockage.
Grundtvig said that smoking might make women go through menopause earlier, leaving them less protected against a heart attack. With rising rates of smoking in women - compared with falling rates in men - Grundtvig said that doctors expect to see increased heart disease in women.
"Smoking might erase the natural advantage that women have," said Dr. Robert Harrington, a professor of medicine at Duke University and spokesman for the American College of Cardiology.
Doctors aren't yet sure if other cardiac risk factors like cholesterol and obesity also affect women differently.
"The difference in how smoking affects women and men is profound," Harrington said. "Unless women don't smoke or quit, they risk ending up with the same terrible diseases as men, only at a much earlier age."
In fact, women who smoke have heart attacks more than a dozen years earlier than women who don't smoke, Norwegian doctors reported in a study presented to the European Society of Cardiology. For men, the gap is not so dramatic; male smokers have heart attacks about six years earlier than men who don't smoke.
"This is not a minor difference," said Dr. Silvia Priori, a cardiologist at the Scientific Institute in Pavia, Italy. "Women need to realize they are losing much more than men when they smoke," she said. Priori was not connected to the research.
Dr. Morten Grundtvig and colleagues from the Innlandet Hospital Trust in Lillehammer, Norway, based their study on data from 1,784 patients admitted for a first heart attack at a hospital in Lillehammer.
Their study found that the men on average had their first heart attack at age 72 if they didn't smoke, and at 64 if they did. Women in the study had their first heart attack at age 81 if they didn't smoke, and at age 66 if they did.
That works out to eight and 15 years, respectively, for men and women. After adjusting for other heart risk factors like blood pressure, cholesterol and diabetes, researchers found that the difference for men was about six years for women about 14 years.
Previous studies looking at a possible gender difference have been inconclusive.
Doctors have long suspected that female hormones protect women against heart disease. Estrogen is thought to raise the levels of good cholesterol as well as enabling blood vessel walls to relax more easily, thus lowering the chances of a blockage.
Grundtvig said that smoking might make women go through menopause earlier, leaving them less protected against a heart attack. With rising rates of smoking in women - compared with falling rates in men - Grundtvig said that doctors expect to see increased heart disease in women.
"Smoking might erase the natural advantage that women have," said Dr. Robert Harrington, a professor of medicine at Duke University and spokesman for the American College of Cardiology.
Doctors aren't yet sure if other cardiac risk factors like cholesterol and obesity also affect women differently.
"The difference in how smoking affects women and men is profound," Harrington said. "Unless women don't smoke or quit, they risk ending up with the same terrible diseases as men, only at a much earlier age."
Saturday, August 30, 2008
Gene domino effect behind brain, pancreatic tumors
Scientists have mapped the cascade of genetic changes that turn normal cells in the brain and pancreas into two of the most lethal cancers. The result points to a new approach for fighting tumors and maybe even catching them sooner. Genes blamed for one person's brain tumor were different from the culprits for the next patient, making the puzzle of cancer genetics even more complicated.
But Friday's research also found that clusters of seemingly disparate genes all work along the same pathways. So instead of today's hunt for drugs that target a single gene, the idea is to target entire pathways that most patients share. Think of delivering the mail to a single box at the end of the cul-de-sac instead of at every doorstep.
The three studies, published in the journals Science and Nature, mark a milestone in cancer genetics.
"This is the next wave," said Dr. Phillip Febbo of Duke University's Institute for Genome Sciences and Policy, who was not involved with the new research. "What's really important is that finding those common elements within the landscape suggests there are therapeutic interventions that can help the whole group."
Despite 30 years of laborious work, scientists until now have found only a fraction of the genetic alterations required to cause any of the 200 diseases that collectively are called cancer. Different tumors require a different domino effect of genetic changes to arise, and to determine their severity and even which treatments will work.
The new maps do not include just mutated genes. They cite missing ones, extra ones, and overactive or underactive ones, too, in the most comprehensive look ever at human tumors.
Teams led by Johns Hopkins University examined more than 20,000 genes in tumors taken from 24 pancreatic cancer patients and 22 patients with the most dangerous brain tumor, called glioblastoma multiforme. Separately, The Cancer Genome Atlas project - a government-funded network of 18 medical centers - analyzed 600 genes in glioblastomas from 206 patients.
The Hopkins teams found hundreds of genetic changes, including a particularly intriguing gene named IDH1. Twelve percent of glioblastoma patients, mostly young ones, harbored a mutated version that brought longer survival: a median of 3.8 years compared with the 1.1 years for patients without the mutation.
If additional study proves that effect, doctors soon might use an IDH1 test to help determine prognosis, said Hopkins' Dr. Victor Velculescu, who led the glioblastoma work. If so, the next question is whether certain drugs work better in those patients as well.
The bigger discovery involved cancer's genetic chaos. No tumors were identical. The typical pancreatic cancer contained 63 genetic alterations and the average brain tumor 60, Hopkins researchers reported in Science.
Fortunately, "genes don't work alone," said Hopkin's Dr. Kenneth Kinzler, who led the pancreatic work. Figure out which genes cluster in which pathways and "a simpler picture emerges."
The Hopkins team identified 12 core pathways that were abnormal in most pancreatic tumors.
In Nature, The Cancer Genome Atlas researchers reported three core pathways at work in most glioblastomas.
The pathways do different things. Some allow damaged DNA to escape repair. Some switched off protective factors meant to suppress tumors.
Finding drugs that block those pathways will not be easy, said Dr. Bert Vogelstein of Hopkins and the Howard Hughes Medical Institute, who oversaw the research. They also may cause more side effects than current "targeted therapies" that work against only a specific gene defect.
But companies already are researching drugs to block a particular enzyme pathway implicated in the studies.
Also, pathway blockers should work in larger groups of patients, Vogelstein said. One particular pancreatic cancer pathway contains a variety of genes mutated in only a few people, but regardless of which gene ran amok, the whole pathway was broken in every tumor studied.
"Even though it sounds complex, it's actually allowing us to simplify the complex into pathways that will allow us, I think, to truly understand cancer for the first time and take a much more rational approach to treatment," said Dr. Anna Barker of the National Cancer Institute, who co-directs the cancer atlas project. "I'm more optimistic."
Moreover, the work suggests possible ways to catch cancer earlier, by tracing mutant DNA floating through the bloodstream well before tumors themselves start to spread, Vogelstein added. "I don't think that's any longer science fiction."
But Friday's research also found that clusters of seemingly disparate genes all work along the same pathways. So instead of today's hunt for drugs that target a single gene, the idea is to target entire pathways that most patients share. Think of delivering the mail to a single box at the end of the cul-de-sac instead of at every doorstep.
The three studies, published in the journals Science and Nature, mark a milestone in cancer genetics.
"This is the next wave," said Dr. Phillip Febbo of Duke University's Institute for Genome Sciences and Policy, who was not involved with the new research. "What's really important is that finding those common elements within the landscape suggests there are therapeutic interventions that can help the whole group."
Despite 30 years of laborious work, scientists until now have found only a fraction of the genetic alterations required to cause any of the 200 diseases that collectively are called cancer. Different tumors require a different domino effect of genetic changes to arise, and to determine their severity and even which treatments will work.
The new maps do not include just mutated genes. They cite missing ones, extra ones, and overactive or underactive ones, too, in the most comprehensive look ever at human tumors.
Teams led by Johns Hopkins University examined more than 20,000 genes in tumors taken from 24 pancreatic cancer patients and 22 patients with the most dangerous brain tumor, called glioblastoma multiforme. Separately, The Cancer Genome Atlas project - a government-funded network of 18 medical centers - analyzed 600 genes in glioblastomas from 206 patients.
The Hopkins teams found hundreds of genetic changes, including a particularly intriguing gene named IDH1. Twelve percent of glioblastoma patients, mostly young ones, harbored a mutated version that brought longer survival: a median of 3.8 years compared with the 1.1 years for patients without the mutation.
If additional study proves that effect, doctors soon might use an IDH1 test to help determine prognosis, said Hopkins' Dr. Victor Velculescu, who led the glioblastoma work. If so, the next question is whether certain drugs work better in those patients as well.
The bigger discovery involved cancer's genetic chaos. No tumors were identical. The typical pancreatic cancer contained 63 genetic alterations and the average brain tumor 60, Hopkins researchers reported in Science.
Fortunately, "genes don't work alone," said Hopkin's Dr. Kenneth Kinzler, who led the pancreatic work. Figure out which genes cluster in which pathways and "a simpler picture emerges."
The Hopkins team identified 12 core pathways that were abnormal in most pancreatic tumors.
In Nature, The Cancer Genome Atlas researchers reported three core pathways at work in most glioblastomas.
The pathways do different things. Some allow damaged DNA to escape repair. Some switched off protective factors meant to suppress tumors.
Finding drugs that block those pathways will not be easy, said Dr. Bert Vogelstein of Hopkins and the Howard Hughes Medical Institute, who oversaw the research. They also may cause more side effects than current "targeted therapies" that work against only a specific gene defect.
But companies already are researching drugs to block a particular enzyme pathway implicated in the studies.
Also, pathway blockers should work in larger groups of patients, Vogelstein said. One particular pancreatic cancer pathway contains a variety of genes mutated in only a few people, but regardless of which gene ran amok, the whole pathway was broken in every tumor studied.
"Even though it sounds complex, it's actually allowing us to simplify the complex into pathways that will allow us, I think, to truly understand cancer for the first time and take a much more rational approach to treatment," said Dr. Anna Barker of the National Cancer Institute, who co-directs the cancer atlas project. "I'm more optimistic."
Moreover, the work suggests possible ways to catch cancer earlier, by tracing mutant DNA floating through the bloodstream well before tumors themselves start to spread, Vogelstein added. "I don't think that's any longer science fiction."
Friday, August 29, 2008
Exercise can help memory
Adding even a small amount of exercise to a person's daily routine can reduce the risk of developing Alzheimer's disease, according to a study published in Wednesday's Journal of the American Medical Association.
The study, by Australian researchers, showed that six months of physical activity -- averaging about 20 minutes a day -- in volunteers 50 and older modestly improved memory and cognition.
"This is the first time anybody has shown that a modest exercise program seemed to slow the rate of Alzheimer's disease," said Dr. Eric Larson, executive director of the Seattle-based Group Health Center for Health Studies, who wrote an editorial accompanying the study.
"In the United States, pharmaceutical direct-to-consumer advertising has sensitized patients and the public to using cholinesterase inhibitors for Alzheimer's disease," Larson wrote. "This illustrates the appeal of 'doing something -- anything' that might help prevent a dreaded disease, even if its value is minimal. Promoting habitual exercise for aging patients seems more worthy."
The researchers randomly engaged 170 volunteers in 24 weeks of physical activity, including walking and swimming, and compared them with a similar group that didn't exercise. The volunteers all reported having memory problems, but none suffered from dementia. They each wore a pedometer and kept a diary of their physical activity.
Participants were asked to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions. They averaged 142 extra minutes of exercise.
Researchers used an 11-test Alzheimer's scale to assess memory, language and skill application over 18 months. Scores range from zero to 70 -- the higher the number the more severe the impairment.
By the end of the study, participants in the exercise group had better scores and less delayed recall. The exercisers also had lower dementia scores.
The study showed an average improvement of 1.3 points on the Alzheimer's scale after six months of enhanced exercise, and 0.69 points after 18 months. That's a tiny boost, researchers admit, but "potentially important when one considers the small amount of physical activity undertaken by participants of the study."
The results are encouraging, said Nancy Dapper, executive director of the Alzheimer's Association's Western and Central Washington chapter.
"With Alzheimer's we don't often have a lot to turn to, and with this study, the amount of exercise is manageable for most people," she said. "The studies are building on each other about the benefits of exercise to the brain.
"The next question might be: Is it worthy to do more studies looking at more vigorous exercise or different types of exercise?"
Researchers don't yet know why exercise makes a difference, but the added benefits can go beyond brain improvements.
Larson said one explanation could be that exercise improves blood flow to the brain. That allows people to better handle the stress that can damage parts of the brain.
"If you ask doctors what disease they fear the most, it's Alzheimer's," said Larson, who writes exercise prescriptions for some of his patients to prod them into getting needed workouts.
"This is a potential motivator to our society to design more walkable and bikeable communities," he said of the study. "It gives people yet another reason to exercise."
The study, by Australian researchers, showed that six months of physical activity -- averaging about 20 minutes a day -- in volunteers 50 and older modestly improved memory and cognition.
"This is the first time anybody has shown that a modest exercise program seemed to slow the rate of Alzheimer's disease," said Dr. Eric Larson, executive director of the Seattle-based Group Health Center for Health Studies, who wrote an editorial accompanying the study.
"In the United States, pharmaceutical direct-to-consumer advertising has sensitized patients and the public to using cholinesterase inhibitors for Alzheimer's disease," Larson wrote. "This illustrates the appeal of 'doing something -- anything' that might help prevent a dreaded disease, even if its value is minimal. Promoting habitual exercise for aging patients seems more worthy."
The researchers randomly engaged 170 volunteers in 24 weeks of physical activity, including walking and swimming, and compared them with a similar group that didn't exercise. The volunteers all reported having memory problems, but none suffered from dementia. They each wore a pedometer and kept a diary of their physical activity.
Participants were asked to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions. They averaged 142 extra minutes of exercise.
Researchers used an 11-test Alzheimer's scale to assess memory, language and skill application over 18 months. Scores range from zero to 70 -- the higher the number the more severe the impairment.
By the end of the study, participants in the exercise group had better scores and less delayed recall. The exercisers also had lower dementia scores.
The study showed an average improvement of 1.3 points on the Alzheimer's scale after six months of enhanced exercise, and 0.69 points after 18 months. That's a tiny boost, researchers admit, but "potentially important when one considers the small amount of physical activity undertaken by participants of the study."
The results are encouraging, said Nancy Dapper, executive director of the Alzheimer's Association's Western and Central Washington chapter.
"With Alzheimer's we don't often have a lot to turn to, and with this study, the amount of exercise is manageable for most people," she said. "The studies are building on each other about the benefits of exercise to the brain.
"The next question might be: Is it worthy to do more studies looking at more vigorous exercise or different types of exercise?"
Researchers don't yet know why exercise makes a difference, but the added benefits can go beyond brain improvements.
Larson said one explanation could be that exercise improves blood flow to the brain. That allows people to better handle the stress that can damage parts of the brain.
"If you ask doctors what disease they fear the most, it's Alzheimer's," said Larson, who writes exercise prescriptions for some of his patients to prod them into getting needed workouts.
"This is a potential motivator to our society to design more walkable and bikeable communities," he said of the study. "It gives people yet another reason to exercise."
Thursday, August 28, 2008
Heart defibrillator shock can signal more trouble
A lifesaving shock from an implanted heart defibrillator provides relief that a crisis was avoided, but new research suggests it can also be a sign that more trouble is ahead.
A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.
Experts said patients should promptly tell their doctors if their defibrillator triggers. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.
"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.
The findings are in Thursday's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.
About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.
Previous research found that the devices cut the risk of death by 23 percent. The new reports come from that same study of 2,500 heart failure patients - their weakened hearts didn't pump efficiently - who hadn't yet had a life-threatening irregular heartbeat.
The new government-funded reports show that a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."
In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.
The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.
Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the defibrillators used in the study are a generation-old, and that newer devices can often correct a high heartbeat through painless pacing techniques, before a shock would be needed.
"The frequency of shocks would be considerably less with contemporary devices," said Estes, of Tufts Medical Center in Boston. He had no role in the studies but has been involved in others.
For the quality of life study, participants were questioned four times over 2 1/2 years about their activities and well-being to see how the defibrillator was affecting their lives. There was no difference between the groups treated with defibrillators, medication or dummy pills, the researchers said.
"We found no evidence that the patients who got the defibrillator were feeling any worse for having received that therapy," said Dr. Daniel Mark, lead author of the study from Duke University Medical Center.
A patient at Duke, John McKinnon, said he was initially reluctant to get a defibrillator about two years but has had no concerns since. Months ago, the 65-year-old pastor got a shock, which he described as a strong kick. Since then he's had a procedure to treat an abnormal heartbeat.
"I'm getting my energy back, doing some walking, getting some exercise," said McKinnon.
Medtronic Inc. provided the defibrillators used in the research and Wyeth provided the medicine. Many of the researchers and the editorial writers have received lecture fees or grants from makers of defibrillators.
A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.
Experts said patients should promptly tell their doctors if their defibrillator triggers. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.
"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.
The findings are in Thursday's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.
About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.
Previous research found that the devices cut the risk of death by 23 percent. The new reports come from that same study of 2,500 heart failure patients - their weakened hearts didn't pump efficiently - who hadn't yet had a life-threatening irregular heartbeat.
The new government-funded reports show that a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."
In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.
The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.
Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the defibrillators used in the study are a generation-old, and that newer devices can often correct a high heartbeat through painless pacing techniques, before a shock would be needed.
"The frequency of shocks would be considerably less with contemporary devices," said Estes, of Tufts Medical Center in Boston. He had no role in the studies but has been involved in others.
For the quality of life study, participants were questioned four times over 2 1/2 years about their activities and well-being to see how the defibrillator was affecting their lives. There was no difference between the groups treated with defibrillators, medication or dummy pills, the researchers said.
"We found no evidence that the patients who got the defibrillator were feeling any worse for having received that therapy," said Dr. Daniel Mark, lead author of the study from Duke University Medical Center.
A patient at Duke, John McKinnon, said he was initially reluctant to get a defibrillator about two years but has had no concerns since. Months ago, the 65-year-old pastor got a shock, which he described as a strong kick. Since then he's had a procedure to treat an abnormal heartbeat.
"I'm getting my energy back, doing some walking, getting some exercise," said McKinnon.
Medtronic Inc. provided the defibrillators used in the research and Wyeth provided the medicine. Many of the researchers and the editorial writers have received lecture fees or grants from makers of defibrillators.
Wednesday, August 27, 2008
Check your Balance
There are times in your life when feeling a little off-balance may actually be a good thing. Take it from the experts.
Although there are some changes you can't avoid as you get older, including deterioration of your hearing, vision and coordination, research suggests that it's worth taking steps — even risking a few missteps — to slow the decline in your balance.
Loss of balance makes us vulnerable to falls, which can be dangerous at any age but is the fifth-leading cause of death for people 65 and older, according to the Centers for Disease Control and Prevention.
The CDC makes a number of recommendations to prevent falls, including exercising regularly to maintain muscle and getting enough vitamin D and calcium to preserve bone strength.
But a growing number of physicians, physical therapists and personal trainers go further, advocating exercises designed to challenge the complex system of reflexes that governs our stability and spatial orientation.
And, as Roger Yasin, a personal trainer in Arlington, Va., puts it, it's smart for younger people to start doing these exercises.
Yasin said many of his clients are surprised to find out how their balance declines over time, and they often underestimate how important balance is to navigating the hazards in their daily lives, from escalators to uneven sidewalks and grassy hills.
"Many people don't think of balance when they think of personal training; they think of diet and weight loss, or they want to get ready for a wedding or reunion."
Whether you're preparing for an event or doing your regular workout routine, Yasin and others recommend including exercises that address your balance.
Doing so has the added advantage of helping you lose weight. "Since you are trying to stabilize your body, you're using multiple muscle groups and can burn so many more calories," he said.
Yasin said everyone should start by balancing on the floor with one foot, before progressing to challenging equipment.
The following are a few of the many products aimed at different levels of fitness and expertise. Consult your trainer or doctor before choosing one that's right for you.
Balance pads look like thick gymnastics mats but feel much softer. The feeling of instability created by the pad's foam surface increases as the user puts more weight on it. It can be used for rehabilitation, exercise and coordination training. Performing lunges, push-ups or sit-ups on a balance pad improves overall strength and stability. By stacking two pads on top of one another, the user can create greater instability for a tougher workout.
Bosu ball. The Bosu, whose name stands for "Both Sides Utilized," resembles half a ball, with one flat and one domed side; it can be used for cardio, balance-building workouts or yoga. Users can sit, stand or squat on the curved side and sit or try push-ups on the flat side, all while trying to maintain balance as the body shifts to compensate for the movement of the ball.
Dyna-Disc. Yasin says the squishy surface of this circular, air-filled mat makes his clients feel as if they're stepping on a deflated football. People of all ages can sit, stand or lie on the disks to improve posture and balance in the lower body. The Dyna-Disc is made from the same material as a gym ball but is more stable since it can't roll away. It comes in different sizes suitable for a variety of exercises. Users can perform curls or other moves standing on the disk to strengthen core muscles. They can change the inflation level of the disk or stand with one under each foot to increase exercise difficulty.
Bongo board. This skateboardlike board is the most difficult of these products to use. It's designed to improve coordination by challenging the user to keep the board stable over a rolling wheel. The Bongo board is for more-advanced users and can also be used for push-ups to strengthen core muscles.
Other products are being created for people whose balance has decreased, whether through age or illness, and are geared toward preventing falls.
Insoles inspired by NASA technology that help astronauts keep their balance in space use sensors to record information about a person's ability to balance. Erez Liebermann, a graduate student at the Harvard-MIT Division of Health Sciences and Technology, began working on the iShoe insole as a NASA intern; it could be available in 18 months and cost about $100, according to the division's Web site.
Another product in development is the vibrating insole, or "noise-enhanced sensory function." Its inventor, Jim Collins, says it is intended to help elderly people detect changes in their environment, increase sensitivity to their surroundings and improve their balance. Collins said the insole is beginning the process of winning approval from the Food and Drug Administration.
If you don't frequent the gym but would still like to avoid falls, Scott McCredie, author of "Balance: In Search of the Lost Sense," says you don't need gadgets to improve your stability or core strength.
"All you need to do is stand on one leg in various poses, and you can do that anywhere," McCredie said, whether "waiting for the bus or brushing your teeth in the bathroom."
Physical therapist Kristine Legters takes this low-tech approach by incorporating balance training into her clients' everyday lives.
"Standing on a pillow, walking on grass as opposed to concrete, or looking around and moving your head while walking as opposed to looking straight challenges and improves your balance," said Legters, who works in Pennsylvania.
The takeaway message is clear: To maintain your stability as you get older, you need to throw yourself off-balance once in a while.
Although there are some changes you can't avoid as you get older, including deterioration of your hearing, vision and coordination, research suggests that it's worth taking steps — even risking a few missteps — to slow the decline in your balance.
Loss of balance makes us vulnerable to falls, which can be dangerous at any age but is the fifth-leading cause of death for people 65 and older, according to the Centers for Disease Control and Prevention.
The CDC makes a number of recommendations to prevent falls, including exercising regularly to maintain muscle and getting enough vitamin D and calcium to preserve bone strength.
But a growing number of physicians, physical therapists and personal trainers go further, advocating exercises designed to challenge the complex system of reflexes that governs our stability and spatial orientation.
And, as Roger Yasin, a personal trainer in Arlington, Va., puts it, it's smart for younger people to start doing these exercises.
Yasin said many of his clients are surprised to find out how their balance declines over time, and they often underestimate how important balance is to navigating the hazards in their daily lives, from escalators to uneven sidewalks and grassy hills.
"Many people don't think of balance when they think of personal training; they think of diet and weight loss, or they want to get ready for a wedding or reunion."
Whether you're preparing for an event or doing your regular workout routine, Yasin and others recommend including exercises that address your balance.
Doing so has the added advantage of helping you lose weight. "Since you are trying to stabilize your body, you're using multiple muscle groups and can burn so many more calories," he said.
Yasin said everyone should start by balancing on the floor with one foot, before progressing to challenging equipment.
The following are a few of the many products aimed at different levels of fitness and expertise. Consult your trainer or doctor before choosing one that's right for you.
Balance pads look like thick gymnastics mats but feel much softer. The feeling of instability created by the pad's foam surface increases as the user puts more weight on it. It can be used for rehabilitation, exercise and coordination training. Performing lunges, push-ups or sit-ups on a balance pad improves overall strength and stability. By stacking two pads on top of one another, the user can create greater instability for a tougher workout.
Bosu ball. The Bosu, whose name stands for "Both Sides Utilized," resembles half a ball, with one flat and one domed side; it can be used for cardio, balance-building workouts or yoga. Users can sit, stand or squat on the curved side and sit or try push-ups on the flat side, all while trying to maintain balance as the body shifts to compensate for the movement of the ball.
Dyna-Disc. Yasin says the squishy surface of this circular, air-filled mat makes his clients feel as if they're stepping on a deflated football. People of all ages can sit, stand or lie on the disks to improve posture and balance in the lower body. The Dyna-Disc is made from the same material as a gym ball but is more stable since it can't roll away. It comes in different sizes suitable for a variety of exercises. Users can perform curls or other moves standing on the disk to strengthen core muscles. They can change the inflation level of the disk or stand with one under each foot to increase exercise difficulty.
Bongo board. This skateboardlike board is the most difficult of these products to use. It's designed to improve coordination by challenging the user to keep the board stable over a rolling wheel. The Bongo board is for more-advanced users and can also be used for push-ups to strengthen core muscles.
Other products are being created for people whose balance has decreased, whether through age or illness, and are geared toward preventing falls.
Insoles inspired by NASA technology that help astronauts keep their balance in space use sensors to record information about a person's ability to balance. Erez Liebermann, a graduate student at the Harvard-MIT Division of Health Sciences and Technology, began working on the iShoe insole as a NASA intern; it could be available in 18 months and cost about $100, according to the division's Web site.
Another product in development is the vibrating insole, or "noise-enhanced sensory function." Its inventor, Jim Collins, says it is intended to help elderly people detect changes in their environment, increase sensitivity to their surroundings and improve their balance. Collins said the insole is beginning the process of winning approval from the Food and Drug Administration.
If you don't frequent the gym but would still like to avoid falls, Scott McCredie, author of "Balance: In Search of the Lost Sense," says you don't need gadgets to improve your stability or core strength.
"All you need to do is stand on one leg in various poses, and you can do that anywhere," McCredie said, whether "waiting for the bus or brushing your teeth in the bathroom."
Physical therapist Kristine Legters takes this low-tech approach by incorporating balance training into her clients' everyday lives.
"Standing on a pillow, walking on grass as opposed to concrete, or looking around and moving your head while walking as opposed to looking straight challenges and improves your balance," said Legters, who works in Pennsylvania.
The takeaway message is clear: To maintain your stability as you get older, you need to throw yourself off-balance once in a while.
Tuesday, August 26, 2008
Does Cholesterol Drug Increase Chance of Cancer?
Federal drug-safety regulators said Thursday they are investigating whether the cholesterol-lowering drug Vytorin can increase patients' risk of developing cancer.
However, Food and Drug Administration (FDA) officials said patients should not stop taking Vytorin, because the evidence of a cancer link is unclear. While one recent clinical trial indicated higher rates of cancer for patients taking the medication, two current studies have shown no increased risk, agency officials said.
Meanwhile, senior lawmakers in Congress demanded data on the clinical trial that indicated a cancer risk.
Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia, has been heavily promoted as a novel way to reduce cholesterol. Zocor, a statin, reduces the amount of cholesterol produced by the liver. Zetia limits the cholesterol absorbed through the digestive system. But the combination became a focus of controversy after a study this year showed it was no better at reducing the buildup of plaque in the arteries than simvastatin, the much cheaper generic form of Zocor.
Separately Thursday, leaders of the House Energy and Commerce Committee asked the companies for extensive data on the clinical trial that indicated a possible cancer risk for Vytorin.
Merck and Schering-Plough said they would cooperate with the panel. The companies defend the drug, saying it is effective at reducing cholesterol, its approved use.
Committee Chairman Rep. John Dingell and Rep. Bart Stupak, both Michigan Democrats, sent a letter to the chief executives of the drug companies, giving them two weeks to supply detailed information. The study showing a link to cancer was originally designed to determine whether Vytorin could help prevent a worsening of heart-valve disease, but found that it did not.
The FDA officials anticipate the agency's investigation and analysis will take about nine months.
However, Food and Drug Administration (FDA) officials said patients should not stop taking Vytorin, because the evidence of a cancer link is unclear. While one recent clinical trial indicated higher rates of cancer for patients taking the medication, two current studies have shown no increased risk, agency officials said.
Meanwhile, senior lawmakers in Congress demanded data on the clinical trial that indicated a cancer risk.
Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia, has been heavily promoted as a novel way to reduce cholesterol. Zocor, a statin, reduces the amount of cholesterol produced by the liver. Zetia limits the cholesterol absorbed through the digestive system. But the combination became a focus of controversy after a study this year showed it was no better at reducing the buildup of plaque in the arteries than simvastatin, the much cheaper generic form of Zocor.
Separately Thursday, leaders of the House Energy and Commerce Committee asked the companies for extensive data on the clinical trial that indicated a possible cancer risk for Vytorin.
Merck and Schering-Plough said they would cooperate with the panel. The companies defend the drug, saying it is effective at reducing cholesterol, its approved use.
Committee Chairman Rep. John Dingell and Rep. Bart Stupak, both Michigan Democrats, sent a letter to the chief executives of the drug companies, giving them two weeks to supply detailed information. The study showing a link to cancer was originally designed to determine whether Vytorin could help prevent a worsening of heart-valve disease, but found that it did not.
The FDA officials anticipate the agency's investigation and analysis will take about nine months.
Monday, August 25, 2008
Critics question cervical cancer vaccine
In two years, cervical cancer has gone from obscure killer confined mostly to poor nations to the West's disease of the moment.
Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.
One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the U.S. government of more than $1 billion. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school in September.
The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.
The vaccines, which offer some protection against infection from sexually transmitted viruses, are more expensive than earlier vaccines against other diseases. Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits, and is often only partially covered by health insurance.
"One less statistic"
Advertising has promoted the vaccines. In ads on shows such as "Law & Order," a multiethnic cast urges girls to become "one less statistic" by getting vaccinated.
The vaccine makers also brought attention to cervical cancer by providing money for activities by patients and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease.
Even critics of the marketing recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.
But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them.
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer.
"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention (CDC) that recommended the vaccine for all girls once they reached 11 or 12.
"This big push is making people crazy, thinking they're bad moms if they don't get their kids vaccinated," said Dr. Abby Lippman, a professor at McGill University in Montreal and policy director of the Canadian Women's Health Network. Canada will spend $300 million on a cervical-cancer-vaccine program.
Merck's vaccine was studied in clinical trials for five years, and Glaxo's for nearly 6 1/2, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?
Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.
And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive to use, cervical cancer is classified as rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment.
Because the vaccines prevent only 70 percent of cervical cancers, Pap-smear screening must continue.
"Merck lobbied every opinion leader, women's group, medical society, politicians, and went directly to the people; it created a sense of panic that says you have to have this vaccine now," said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Harper was a principal investigator on the clinical trials of Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical-cancer-vaccine programs around the world.
"Because Merck was so aggressive, it went too fast," Harper said. "I would have liked to see it go much slower."
In receiving expedited consideration from the Food and Drug Administration (FDA), Gardasil took six months from application to approval and was recommended by the CDC weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Harper said, and then five to 10 more for universal acceptance.
Dr. Richard Haupt, medical director at Merck, said five years in clinical trails was normal before applying for licensing. He said Merck educated people about the new vaccine to "accelerate and facilitate access."
Spokesmen for Merck and Glaxo said all indications are that their vaccines are safe and effective, and there is no evidence a booster shot will be needed.
Need greater elsewhere?
Health economists estimated that depending on how they are used, the two cervical-cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries.
Looked at another way, countries that pay for the vaccines will have less money for other health needs. "This kind of money could be better used to solve so many other problems in women's health," said Lippman at McGill. "I'm not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer."
By contrast, if the vaccine were to become cheap enough to be used in the developing world, it would revolutionize women's health. Charities such as the Global Alliance for Vaccine and Immunizations, backed by the Bill & Melinda Gates Foundation, are trying to devise a solution.
The vaccines offer partial protection against infection from human papillomavirus, or HPV. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.
Cervical cancer is the second-leading cause of cancer death in women, with 500,000 new cases worldwide each year. More than 90 percent are in developing countries, according to the World Health Organization; 274,000 women died of this cancer in 2006.
Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.
One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the U.S. government of more than $1 billion. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school in September.
The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.
The vaccines, which offer some protection against infection from sexually transmitted viruses, are more expensive than earlier vaccines against other diseases. Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits, and is often only partially covered by health insurance.
"One less statistic"
Advertising has promoted the vaccines. In ads on shows such as "Law & Order," a multiethnic cast urges girls to become "one less statistic" by getting vaccinated.
The vaccine makers also brought attention to cervical cancer by providing money for activities by patients and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease.
Even critics of the marketing recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.
But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them.
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer.
"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention (CDC) that recommended the vaccine for all girls once they reached 11 or 12.
"This big push is making people crazy, thinking they're bad moms if they don't get their kids vaccinated," said Dr. Abby Lippman, a professor at McGill University in Montreal and policy director of the Canadian Women's Health Network. Canada will spend $300 million on a cervical-cancer-vaccine program.
Merck's vaccine was studied in clinical trials for five years, and Glaxo's for nearly 6 1/2, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?
Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.
And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive to use, cervical cancer is classified as rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment.
Because the vaccines prevent only 70 percent of cervical cancers, Pap-smear screening must continue.
"Merck lobbied every opinion leader, women's group, medical society, politicians, and went directly to the people; it created a sense of panic that says you have to have this vaccine now," said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Harper was a principal investigator on the clinical trials of Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical-cancer-vaccine programs around the world.
"Because Merck was so aggressive, it went too fast," Harper said. "I would have liked to see it go much slower."
In receiving expedited consideration from the Food and Drug Administration (FDA), Gardasil took six months from application to approval and was recommended by the CDC weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Harper said, and then five to 10 more for universal acceptance.
Dr. Richard Haupt, medical director at Merck, said five years in clinical trails was normal before applying for licensing. He said Merck educated people about the new vaccine to "accelerate and facilitate access."
Spokesmen for Merck and Glaxo said all indications are that their vaccines are safe and effective, and there is no evidence a booster shot will be needed.
Need greater elsewhere?
Health economists estimated that depending on how they are used, the two cervical-cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries.
Looked at another way, countries that pay for the vaccines will have less money for other health needs. "This kind of money could be better used to solve so many other problems in women's health," said Lippman at McGill. "I'm not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer."
By contrast, if the vaccine were to become cheap enough to be used in the developing world, it would revolutionize women's health. Charities such as the Global Alliance for Vaccine and Immunizations, backed by the Bill & Melinda Gates Foundation, are trying to devise a solution.
The vaccines offer partial protection against infection from human papillomavirus, or HPV. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.
Cervical cancer is the second-leading cause of cancer death in women, with 500,000 new cases worldwide each year. More than 90 percent are in developing countries, according to the World Health Organization; 274,000 women died of this cancer in 2006.
Sunday, August 24, 2008
New ways to repell Mosquito's
This has been a particularly bad year for mosquito's in Northern Illinois. We love to do a lot of outdoor entertaining in warm months. This year most of those gatherings have come to rapid end after the sunset when the voracious mosquitos come out to feed.
We have found that bug sprays, and we have tried quite a few of them this year are not really that effective against these blood thirsty little guys. Unless you dip yourself head to toe before coming outside it seems they find an unprotected place to snack.
We did find unexpected relief from a couple of products that seemed at first like the snake oil mosquito fad of the year. The first one is Johnson and Johnsons "OFF" mosquito lantern. It consists of a cheesy looking plastic lantern with a votive candle inside. On the top you slide a repellant pad into the top, light the candle and you are protected in a 15 x 15 area. We have been pretty surprised because everytime we have used it the patio has been protected.
The second device out there is called the ThermaCell. It is a little fan shaped device that would fit in the palm of your hand. It also uses a pad similar to what "OFF" uses. The difference is it is powered by a small butane fuel cell that last 12 hours. The pads still have to be replaced every four hours.
Both of these products work extremely well. If you are having a large dinner party outside just put one of the lanterns or ThermaCell's on each table and you are ready to go.
The only drawback is cost. Both require replacement insect repellant pads which last only four hours. With "Off" you need to replace the votive candle when it burns out.
On the ThermaCell you must replace the tiny butane cylinder every twelve hours which is more expensive but more reliable than a candle. The advantage of the ThermaCell is it is very portable which makes it perfect for camping or going to the beach. It ignites with a click and you don't have to mess with a cheesey looking candle.
ThermaCell devices run between ten to twenty dollars depending on the model you choose. One 12 hour use including butane and three pads is going to run you $6.50.
The "Off" Lanterns are all around ten to fifteen dollars retail. A refill that includes votive candles and three pads goes for $5.50.
With both systems you can save quite a bit of money if you buy your supplies in bulk quantities which is available on line from Amazon.
If you were to use each of these units 90 days during the summer season for four hours per day it would cost you appproximately $130-$150 per season depending on the product you use.
We have found that bug sprays, and we have tried quite a few of them this year are not really that effective against these blood thirsty little guys. Unless you dip yourself head to toe before coming outside it seems they find an unprotected place to snack.
We did find unexpected relief from a couple of products that seemed at first like the snake oil mosquito fad of the year. The first one is Johnson and Johnsons "OFF" mosquito lantern. It consists of a cheesy looking plastic lantern with a votive candle inside. On the top you slide a repellant pad into the top, light the candle and you are protected in a 15 x 15 area. We have been pretty surprised because everytime we have used it the patio has been protected.
The second device out there is called the ThermaCell. It is a little fan shaped device that would fit in the palm of your hand. It also uses a pad similar to what "OFF" uses. The difference is it is powered by a small butane fuel cell that last 12 hours. The pads still have to be replaced every four hours.
Both of these products work extremely well. If you are having a large dinner party outside just put one of the lanterns or ThermaCell's on each table and you are ready to go.
The only drawback is cost. Both require replacement insect repellant pads which last only four hours. With "Off" you need to replace the votive candle when it burns out.
On the ThermaCell you must replace the tiny butane cylinder every twelve hours which is more expensive but more reliable than a candle. The advantage of the ThermaCell is it is very portable which makes it perfect for camping or going to the beach. It ignites with a click and you don't have to mess with a cheesey looking candle.
ThermaCell devices run between ten to twenty dollars depending on the model you choose. One 12 hour use including butane and three pads is going to run you $6.50.
The "Off" Lanterns are all around ten to fifteen dollars retail. A refill that includes votive candles and three pads goes for $5.50.
With both systems you can save quite a bit of money if you buy your supplies in bulk quantities which is available on line from Amazon.
If you were to use each of these units 90 days during the summer season for four hours per day it would cost you appproximately $130-$150 per season depending on the product you use.
Friday, August 22, 2008
Preparing For a Possible Pandemic
The 1918 influenza pandemic killed more than 50 million people worldwide including an estimated 675,000 people in the United States, and it is one of the touchstones for today’s public health preparedness initiatives. To put it in perspective, that’s more people than all those who died (both military personnel and civilians) during World War I (1914–1918).
The 1957 Influenza Pandemic caused at least 70,000 U.S. deaths and 1–2 million deaths worldwide. Improvements in scientific technology made it possible to more quickly identify that pandemic when compared with the 1918 event. These first-person and family accounts contained herein provide an intimate, personal view of the 1918 and 1957 pandemics that goes beyond the staggering statistics associated with those events and, therefore, can help planners re-energize their efforts and fight preparedness fatigue and apathy.
The need for the Pandemic Influenza Storybook became evident as the Centers for Disease Control and Prevention (CDC) conducted Crisis and Emergency Risk Communication (CERC) throughout the country for public health professionals involved with a variety of emergency response communications activities. The “Basic” CERC course debuted in 2002 and two additional modules have been added; “Leaders for Leaders” and “Pandemic Influenza”. The storybook is a resource tool for the latter module for certified CERC trainers and trainees. The online storybook contains narratives from survivors, families, and friends who lived through the 1918 and 1957 pandemics. Additionally, stories from the 1968 pandemic will be added to this resource as they become available.
The 1957 Influenza Pandemic caused at least 70,000 U.S. deaths and 1–2 million deaths worldwide. Improvements in scientific technology made it possible to more quickly identify that pandemic when compared with the 1918 event. These first-person and family accounts contained herein provide an intimate, personal view of the 1918 and 1957 pandemics that goes beyond the staggering statistics associated with those events and, therefore, can help planners re-energize their efforts and fight preparedness fatigue and apathy.
The need for the Pandemic Influenza Storybook became evident as the Centers for Disease Control and Prevention (CDC) conducted Crisis and Emergency Risk Communication (CERC) throughout the country for public health professionals involved with a variety of emergency response communications activities. The “Basic” CERC course debuted in 2002 and two additional modules have been added; “Leaders for Leaders” and “Pandemic Influenza”. The storybook is a resource tool for the latter module for certified CERC trainers and trainees. The online storybook contains narratives from survivors, families, and friends who lived through the 1918 and 1957 pandemics. Additionally, stories from the 1968 pandemic will be added to this resource as they become available.
Thursday, August 21, 2008
Problems with Byetta
Federal regulators are working on a stronger label for a widely used diabetes drug marketed by Amylin Pharmaceuticals Inc. and Eli Lilly & Co. after deaths were reported with the medication despite earlier government warnings.
The Food and Drug Administration said Monday it has received six new reports of patients developing a dangerous form of pancreatitis while taking Byetta. Two of the patients died and four were recovering.
Regulators stressed that patients should stop taking Byetta immediately if they develop signs of acute pancreatitis, a swelling of the pancreas that can cause nausea, vomiting and abdominal pain. The FDA warned that it is very difficult to distinguish acute pancreatitis from less dangerous forms of the condition.
The FDA announcement updated an October alert about 30 reports of Byetta patients developing pancreas problems. None of those cases were fatal, but Byetta's makers agreed to add information about the reports to the drug's label.
However, the FDA made clear Monday that it is seeking a stronger, more prominent warning about the risks.
Amylin and Eli Lilly said in a statement that patients taking Byetta have shown "very rare case reports of pancreatitis with complications or with a fatal outcome." The companies added that diabetes patients are already at increased risk of pancreatitis compared with healthy patients.
The pancreas produces several important biological fluids, including insulin - the sugar-regulating hormone that most diabetics lack.
The FDA said doctors should consider prescribing other medications to patients with a history of pancreas problems.
Byetta competes against blockbuster drugs from GlaxoSmithKline PLC and Takeda Pharmaceuticals in the $24 billion global market for diabetes medications, according to health care research firm IMS Health.
More than 700,000 patients with type 2 diabetes have used the injectable drug since it was launched in June 2005. It is jointly developed and manufactured by San Diego-based Amylin and Eli Lilly.
Byetta's $636 million in sales made up about 80 percent of Amylin's total revenue last year. The drug accounted for just 3 percent of Eli Lilly's sales. The companies are developing a long-lasting version of Byetta that could be injected once weekly, instead of twice daily.
Robert Baird & Co. analyst Thomas Russo cautioned investors that concerns about pancreatitis could affect the FDA's review and requirements for the new version. Russo rates Amylin "outperform," but said in a note to investors he could revise that rating as more information becomes available.
The Food and Drug Administration said Monday it has received six new reports of patients developing a dangerous form of pancreatitis while taking Byetta. Two of the patients died and four were recovering.
Regulators stressed that patients should stop taking Byetta immediately if they develop signs of acute pancreatitis, a swelling of the pancreas that can cause nausea, vomiting and abdominal pain. The FDA warned that it is very difficult to distinguish acute pancreatitis from less dangerous forms of the condition.
The FDA announcement updated an October alert about 30 reports of Byetta patients developing pancreas problems. None of those cases were fatal, but Byetta's makers agreed to add information about the reports to the drug's label.
However, the FDA made clear Monday that it is seeking a stronger, more prominent warning about the risks.
Amylin and Eli Lilly said in a statement that patients taking Byetta have shown "very rare case reports of pancreatitis with complications or with a fatal outcome." The companies added that diabetes patients are already at increased risk of pancreatitis compared with healthy patients.
The pancreas produces several important biological fluids, including insulin - the sugar-regulating hormone that most diabetics lack.
The FDA said doctors should consider prescribing other medications to patients with a history of pancreas problems.
Byetta competes against blockbuster drugs from GlaxoSmithKline PLC and Takeda Pharmaceuticals in the $24 billion global market for diabetes medications, according to health care research firm IMS Health.
More than 700,000 patients with type 2 diabetes have used the injectable drug since it was launched in June 2005. It is jointly developed and manufactured by San Diego-based Amylin and Eli Lilly.
Byetta's $636 million in sales made up about 80 percent of Amylin's total revenue last year. The drug accounted for just 3 percent of Eli Lilly's sales. The companies are developing a long-lasting version of Byetta that could be injected once weekly, instead of twice daily.
Robert Baird & Co. analyst Thomas Russo cautioned investors that concerns about pancreatitis could affect the FDA's review and requirements for the new version. Russo rates Amylin "outperform," but said in a note to investors he could revise that rating as more information becomes available.
Wednesday, August 20, 2008
Insurance Gap Hurting the Elderly
Many people in Medicare with diabetes, high blood pressure and other chronic conditions stop taking their medicine when faced with picking up the entire cost of their prescriptions, researchers say.
About 3.4 million older and disabled people hit a gap, known as the doughnut hole, in their Medicare drug coverage in 2007. When that happened, they had to pay the entire costs of their medicine until they spent $3,850 out of pocket. Then, insurance coverage would kick in again.
About 15 percent of those hitting the coverage gap stopped their treatment regimen. That rate varied depending upon illness. For example, about 10 percent of diabetes patients stopped buying the medicine, as did 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis.
The drug benefit, which began in 2006, has come in under budget. Most participants report they are satisfied with the program. But many lawmakers and health analysts say improvements could be made.
"If a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions," said Drew Altman, the chief executive officer and president of the Kaiser Family Foundation. The foundation conducted the study with researchers at Georgetown University and the University of Chicago.
The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.
The researchers based their findings on pharmacy claims data provided by IMS Health, a company specializing in collecting health care data. They excluded people who get extra help in paying for their drug coverage because of their income; they do not pay the full cost of medicine even when in the doughnut hole.
When looking at spending by people who did not receive the extra help, researchers could determine when they hit the coverage gap, which began at $2,400 in total drug spending. They also could determine when they passed through the gap and catastrophic coverage kicked in.
The researchers focused their analysis on eight categories of drugs. Those least likely to stop taking their medicine were Alzheimer's patients, at 8 percent. Those most likely, at 20 percent, were patients taking medicine for heartburn, ulcers and acid reflux disease, 20 percent.
Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the coverage gap kicks in after participants have saved about $1,600 on their drug costs, on average. He also noted that many plans offer some coverage when beneficiaries hit the doughnut hole. Those plans cost at little as $28.70 a month, and are available in every state for less than $50 a month.
"We urge beneficiaries to choose wisely when selecting their drug coverage," Nelligan said. "Again, we emphasize that any changes to the coverage gap would need to come from Congress."
The share of Medicare recipients who reached the doughnut hole varied widely by region. About one-third in Arkansas and seven states in the Northern Plains hit the coverage gap in 2007, but only 12 percent in Nevada did.
Researchers said such regional differences may occur because of physicians' prescribing patterns as well as overall health of the population. A separate factor may be enrollment in Medicare Advantage plans. Such plans offer comprehensive health coverage on top of the drug benefit. Regions where Medicare Advantage plans were most prevalent had fewer enrollees hit the coverage gap, which could reflect stronger management of drug use.
Democratic lawmakers have led efforts to let the government use its purchasing power to negotiate cheaper drug prices. They say the savings could be used to reduce the coverage gap, though the Congressional Budget Office projected that the legislation would not lead to any significant savings.
About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.
About 3.4 million older and disabled people hit a gap, known as the doughnut hole, in their Medicare drug coverage in 2007. When that happened, they had to pay the entire costs of their medicine until they spent $3,850 out of pocket. Then, insurance coverage would kick in again.
About 15 percent of those hitting the coverage gap stopped their treatment regimen. That rate varied depending upon illness. For example, about 10 percent of diabetes patients stopped buying the medicine, as did 16 percent of patients with high blood pressure and 18 percent of patients with osteoporosis.
The drug benefit, which began in 2006, has come in under budget. Most participants report they are satisfied with the program. But many lawmakers and health analysts say improvements could be made.
"If a new president and Congress consider changes to the drug benefit, it will be important to keep in mind that the coverage gap has consequences for some patients with serious health conditions," said Drew Altman, the chief executive officer and president of the Kaiser Family Foundation. The foundation conducted the study with researchers at Georgetown University and the University of Chicago.
The Republican-led Congress in 2003 crafted the doughnut hole as a way to make the drug benefit more affordable for the federal government.
The researchers based their findings on pharmacy claims data provided by IMS Health, a company specializing in collecting health care data. They excluded people who get extra help in paying for their drug coverage because of their income; they do not pay the full cost of medicine even when in the doughnut hole.
When looking at spending by people who did not receive the extra help, researchers could determine when they hit the coverage gap, which began at $2,400 in total drug spending. They also could determine when they passed through the gap and catastrophic coverage kicked in.
The researchers focused their analysis on eight categories of drugs. Those least likely to stop taking their medicine were Alzheimer's patients, at 8 percent. Those most likely, at 20 percent, were patients taking medicine for heartburn, ulcers and acid reflux disease, 20 percent.
Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the coverage gap kicks in after participants have saved about $1,600 on their drug costs, on average. He also noted that many plans offer some coverage when beneficiaries hit the doughnut hole. Those plans cost at little as $28.70 a month, and are available in every state for less than $50 a month.
"We urge beneficiaries to choose wisely when selecting their drug coverage," Nelligan said. "Again, we emphasize that any changes to the coverage gap would need to come from Congress."
The share of Medicare recipients who reached the doughnut hole varied widely by region. About one-third in Arkansas and seven states in the Northern Plains hit the coverage gap in 2007, but only 12 percent in Nevada did.
Researchers said such regional differences may occur because of physicians' prescribing patterns as well as overall health of the population. A separate factor may be enrollment in Medicare Advantage plans. Such plans offer comprehensive health coverage on top of the drug benefit. Regions where Medicare Advantage plans were most prevalent had fewer enrollees hit the coverage gap, which could reflect stronger management of drug use.
Democratic lawmakers have led efforts to let the government use its purchasing power to negotiate cheaper drug prices. They say the savings could be used to reduce the coverage gap, though the Congressional Budget Office projected that the legislation would not lead to any significant savings.
About 5 percent of the people who hit the Medicare coverage gap switched to another medication, most often a generic drug, while 1 percent reduced the number of medications they were taking in a particular class of drugs, the report said.
Tuesday, August 19, 2008
Can Vitamin B Ward off Mosquitoes?
THE BELIEF: Vitamin B can ward off mosquitoes.
THE FACTS: Mosquitoes are more attracted to some people than to others; that much is known from several studies.
But the Internet is full of advertisements for pills and supplements that are supposed to keep the pests away from walking mosquito magnets. One pervasive claim is that taking vitamin B, or wearing patches and other products that are infused with it, can do the trick. Studies dating to the 1960s suggest that taking small doses of the supplement three times a day during biting season helps to produce a skin odor that mosquitoes find repulsive.
But more recent studies have shown that assertion to be a myth. In a study published in 2005 in the Journal of the American Mosquito Control Association, scientists had a group of subjects take vitamin B supplements every day for eight weeks, while a second group took vitamin C and a third took no supplements. Once every two weeks, the scientists used swarms of mosquitoes to examine whether the supplements were having any effect. Although the subjects' attractiveness to the mosquitoes varied considerably, over all there was no evidence that vitamin B did anything to help.
Another study by scientists in Brazil tested it by administering vitamin B droplets to animals and exposing them to female mosquitoes (the only ones that bite). They found no difference in attractiveness between the vitamin B group and control groups.
THE BOTTOM LINE: Studies suggest that vitamin B is not an effective mosquito repellent.
THE FACTS: Mosquitoes are more attracted to some people than to others; that much is known from several studies.
But the Internet is full of advertisements for pills and supplements that are supposed to keep the pests away from walking mosquito magnets. One pervasive claim is that taking vitamin B, or wearing patches and other products that are infused with it, can do the trick. Studies dating to the 1960s suggest that taking small doses of the supplement three times a day during biting season helps to produce a skin odor that mosquitoes find repulsive.
But more recent studies have shown that assertion to be a myth. In a study published in 2005 in the Journal of the American Mosquito Control Association, scientists had a group of subjects take vitamin B supplements every day for eight weeks, while a second group took vitamin C and a third took no supplements. Once every two weeks, the scientists used swarms of mosquitoes to examine whether the supplements were having any effect. Although the subjects' attractiveness to the mosquitoes varied considerably, over all there was no evidence that vitamin B did anything to help.
Another study by scientists in Brazil tested it by administering vitamin B droplets to animals and exposing them to female mosquitoes (the only ones that bite). They found no difference in attractiveness between the vitamin B group and control groups.
THE BOTTOM LINE: Studies suggest that vitamin B is not an effective mosquito repellent.
Monday, August 18, 2008
Facts About Acupuncture
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine, acupuncture aims to restore and maintain health by maintaining balanced energy flow through the stimulation of specific points on the body.
Acupuncture has been practiced in China and other Asian countries for thousands of years. Today, scientists continue to study the effectiveness of acupuncture for a wide range of conditions. Here are two common myths and facts about acupuncture:
Myth: Acupuncture is dangerous.
Fact: According to the National Institutes of Health, relatively few complications from acupuncture have been reported to the U.S. Food and Drug Administration since it approved acupuncture for use by licensed practitioners in 1996.
This is particularly significant considering the millions of people treated and the number of acupuncture needles used each year. Nevertheless, it is important to choose a practitioner who graduated from an accredited program and who is certified by the National Commission for the Certification of Acupuncture.
Myth: Because acupuncture involves needles, it is painful.
Fact: Patients may or may not feel a very slight prick when the hair-thin needle is inserted, but it is much less than the sensation felt during an injection, because acupuncture needles are much thinner. Some may feel a heaviness, numbness, achiness, or soreness after the needles have been inserted. However, these sensations quickly subside. Most patients find the treatments pleasant and relaxing.
Acupuncture has been practiced in China and other Asian countries for thousands of years. Today, scientists continue to study the effectiveness of acupuncture for a wide range of conditions. Here are two common myths and facts about acupuncture:
Myth: Acupuncture is dangerous.
Fact: According to the National Institutes of Health, relatively few complications from acupuncture have been reported to the U.S. Food and Drug Administration since it approved acupuncture for use by licensed practitioners in 1996.
This is particularly significant considering the millions of people treated and the number of acupuncture needles used each year. Nevertheless, it is important to choose a practitioner who graduated from an accredited program and who is certified by the National Commission for the Certification of Acupuncture.
Myth: Because acupuncture involves needles, it is painful.
Fact: Patients may or may not feel a very slight prick when the hair-thin needle is inserted, but it is much less than the sensation felt during an injection, because acupuncture needles are much thinner. Some may feel a heaviness, numbness, achiness, or soreness after the needles have been inserted. However, these sensations quickly subside. Most patients find the treatments pleasant and relaxing.
Sunday, August 17, 2008
Be Careful With Similar Drug Names
Three years ago, Johnson & Johnson changed the name of its Alzheimer's drug Reminyl because doctors and pharmacists were confusing it with the diabetes medication Amaryl. Mix-ups were linked to two deaths.
Changing the name of a drug already on the market is unusual, but the case highlights a growing problem facing the drug industry, doctors, pharmacists and patients—drug names that look or sound so much alike they can lead to medication errors.
"This is a very urgent problem," said Diane Cousins of U.S. Pharmacopeia, the official standard-setting authority for prescription and over-the-counter medicines. "The number of reports of similar-named drugs is increasing, and the number of different products implicated in medication errors is increasing."The Food and Drug Administration is preparing to change the way it reviews and approves drug names in hopes of improving safety and streamlining the process.
The agency rejects 35 percent to 40 percent of the names proposed by drugmakers, but data show the system is badly flawed.
According to U.S. Pharmacopeia, nearly 1,500 brand-name and generic drugs have been implicated in medication errors because their names looked or sounded like another drug. The non-profit organization recently compiled 3,170 pairs of similarly named drugs, nearly double the count from a 2004 survey.
The drug most commonly confused with others, according to U.S. Pharmacopeia: Cefazolin, an antibiotic. It has been confused with 15 other drugs, with such names as Cephalexin, Ceftriaxone, Cefoxitin and Cefotaxime.
Changing the name of a drug already on the market is unusual, but the case highlights a growing problem facing the drug industry, doctors, pharmacists and patients—drug names that look or sound so much alike they can lead to medication errors.
"This is a very urgent problem," said Diane Cousins of U.S. Pharmacopeia, the official standard-setting authority for prescription and over-the-counter medicines. "The number of reports of similar-named drugs is increasing, and the number of different products implicated in medication errors is increasing."The Food and Drug Administration is preparing to change the way it reviews and approves drug names in hopes of improving safety and streamlining the process.
The agency rejects 35 percent to 40 percent of the names proposed by drugmakers, but data show the system is badly flawed.
According to U.S. Pharmacopeia, nearly 1,500 brand-name and generic drugs have been implicated in medication errors because their names looked or sounded like another drug. The non-profit organization recently compiled 3,170 pairs of similarly named drugs, nearly double the count from a 2004 survey.
The drug most commonly confused with others, according to U.S. Pharmacopeia: Cefazolin, an antibiotic. It has been confused with 15 other drugs, with such names as Cephalexin, Ceftriaxone, Cefoxitin and Cefotaxime.
Saturday, August 16, 2008
Synvisc and Orthovisc Injections for Osteoarthritis
Arthritis is one of the most common diseases in the world today. The total cost of this condition has been estimated to be as high as 1% of the gross national product in the United States. The knee is among the most commonly involved joints with arthritis, and can be one of the most serious affecting many aspects of an individual's quality of life. Patients with arthritis of the knee are susceptible to complications from other medical conditions, as they are more likely to live a sedentary lifestyle and are more often obese. Effective treatment for knee arthritis is a priority of orthopedic surgeons.
Motor Oil for the Knee Joint
One possible method for treating arthritis of the knee without performing surgery has been with an injectable medication called Synvisc (the generic name is Hylan, and sold under the trade name "Synvisc"). Hyaluronan, the name of the substance in Synvisc, is secreted by cells in the cartilage of joints. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid, also called synovial fluid, its viscous, slippery quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion. By injecting Synvisc in a knee, some people consider this a so-called joint lubrication. This is why you may hear of Syvisc as a 'motor oil' for the knee joint.
Thanks to Synvisc, and Orthovisc injections, chronic pain in your knees and other joints caused by osteoarthritis is no longer a fact of life. Arthritic joints can now be 'lubricated' using a technique called viscosupplementation.
Healthy Trust Immediate Medical Care uses ultrasound to give an accurate diagnosis and help guide the needle to the correct target area which helps provide the best results for the patient. Studies show that injections that are not guided by ultrasound have a much lower success rate.
Fast Facts About Synvisc Injections
Motor Oil for the Knee Joint
One possible method for treating arthritis of the knee without performing surgery has been with an injectable medication called Synvisc (the generic name is Hylan, and sold under the trade name "Synvisc"). Hyaluronan, the name of the substance in Synvisc, is secreted by cells in the cartilage of joints. Hyaluronan is one of the major molecular components of joint fluid, and it gives the joint fluid, also called synovial fluid, its viscous, slippery quality. The high viscosity of synovial fluid allows for the cartilage surfaces of joints to glide upon each other in a smooth fashion. By injecting Synvisc in a knee, some people consider this a so-called joint lubrication. This is why you may hear of Syvisc as a 'motor oil' for the knee joint.
Thanks to Synvisc, and Orthovisc injections, chronic pain in your knees and other joints caused by osteoarthritis is no longer a fact of life. Arthritic joints can now be 'lubricated' using a technique called viscosupplementation.
Healthy Trust Immediate Medical Care uses ultrasound to give an accurate diagnosis and help guide the needle to the correct target area which helps provide the best results for the patient. Studies show that injections that are not guided by ultrasound have a much lower success rate.
Fast Facts About Synvisc Injections
- Viscosupplementation has been studied for osteoarthritis treatment since the 1970s.
- Synvisc was FDA approved on 08/08/97.
- Synvisc injections are typically given once a week, 7 days apart, over a 15-day period, for a total of three injections.
- To get the best results, diseased osteoarthritic synovial fluid is typically removed from the knee before the first injection.
- Synvisc is considered a treatment or therapy, not a drug.
Kids can overcome strokes
Noticing that her daughter, Noelle, didn't reach with her right hand, Judy Bergman assumed the infant was left-handed. But an MRI taken when Noelle was 7 months old confirmed that she had suffered a stroke, most likely before she was born. "I had never heard of a child having a stroke," said the Grayslake mother of two, recalling her shock. She remembers thinking: "What is the future going to hold? What are her challenges going to be?
"The American Heart Association last month issued guidelines to physicians for the first time on the diagnosis and treatment of stroke in infants and children. The group said that strokes are far more common in children than previously thought and that the causes, risks and symptoms differ greatly from those in adults.The guidelines were developed because early diagnosis and therapy are critical to helping children recover the best they can.
'Challenges'
Childhood strokes are not increasing in prevalence, doctors emphasized. Instead, improved knowledge has led to greater recognition of it. For example, doctors now believe that cerebral palsy and intracranial bleeding are different forms of strokes.
And though a stroke can be devastating medically, researchers are finding that children have greater potential to recover and adapt than adults because of the plasticity of their brains, said Susan Levine, a professor of psychology at the University of Chicago.
For example, a stroke that injures the left hemisphere of the adult brain typically causes problems with speech. Children, on the other hand, continue to acquire language skills, although language development is usually delayed, Levine said."Up until age 13, there is the ability to transfer language processing from the left to the right hemisphere of the brain," said Dr. Deborah Gaebler-Spira, director of the cerebral palsy program at the Rehabilitation Institute of Chicago. "So our anticipation of recovery of certain very distinct brain functions is much more optimistic for children.
"Most children suffer strokes on one side of their brains (Noelle's was in the left hemisphere). The most common risk factors are sickle cell disease and birth defects of the heart.At least half of children who have strokes are left with residual impairment or disability, said Dr. Jose Biller, guidelines co-author and chairman of neurology at Loyola University Chicago Stritch School of Medicine.
As part of a research project funded by the National Institutes of Health, for five years Levine has been studying a group of 40 children as young as 14 months who have had a stroke and 60 children who have not. The researchers videotaped interactions between the children and their parents.
So far their research suggests that for children who have had a stroke, "there are slight delays in getting language off the ground, but their progress is pretty similar to the typically developing children," Levine said.
The researchers will continue to follow the children to determine if they have difficulty developing the more complex language skills needed to succeed in school.About 10 in every 100,000 children in the U.S. suffer a stroke in a given year. The risk is greatest in the first year of life, particularly in the first two months.Only people older than 65 have a higher stroke risk than babies younger than a month, said Dr. E. Steve Roach, chairman of the task force that developed the American Heart Association guidelines. Roach is neurologist in chief at Nationwide Children's Hospital in Columbus, Ohio.
SeizuresIn newborns and babies affected in utero, the first symptoms of a stroke often are seizures that involve a single limb. Such seizures are so common that stroke is believed to account for about 10 percent of seizures in full-term newborns, Roach said.
Bergman mentioned Noelle's preference for her left hand to the child's doctor during a routine exam. The MRI diagnosed the stroke. (Children generally do not show a hand preference before age 2.)
Noelle, now 5, has been undergoing physical and occupational therapy, and recently completed speech therapy. Casts, and later braces, were placed on her legs to increase her range of motion and correct her gait. Her biggest challenge now is improving her limited use of her right hand.
Said Bergman: "When we started on this journey I was shocked. I was heartbroken.
... Now I think because I see how well she's doing, I know truly in my heart, she will be able to do anything she wants to do."
"The American Heart Association last month issued guidelines to physicians for the first time on the diagnosis and treatment of stroke in infants and children. The group said that strokes are far more common in children than previously thought and that the causes, risks and symptoms differ greatly from those in adults.The guidelines were developed because early diagnosis and therapy are critical to helping children recover the best they can.
'Challenges'
Childhood strokes are not increasing in prevalence, doctors emphasized. Instead, improved knowledge has led to greater recognition of it. For example, doctors now believe that cerebral palsy and intracranial bleeding are different forms of strokes.
And though a stroke can be devastating medically, researchers are finding that children have greater potential to recover and adapt than adults because of the plasticity of their brains, said Susan Levine, a professor of psychology at the University of Chicago.
For example, a stroke that injures the left hemisphere of the adult brain typically causes problems with speech. Children, on the other hand, continue to acquire language skills, although language development is usually delayed, Levine said."Up until age 13, there is the ability to transfer language processing from the left to the right hemisphere of the brain," said Dr. Deborah Gaebler-Spira, director of the cerebral palsy program at the Rehabilitation Institute of Chicago. "So our anticipation of recovery of certain very distinct brain functions is much more optimistic for children.
"Most children suffer strokes on one side of their brains (Noelle's was in the left hemisphere). The most common risk factors are sickle cell disease and birth defects of the heart.At least half of children who have strokes are left with residual impairment or disability, said Dr. Jose Biller, guidelines co-author and chairman of neurology at Loyola University Chicago Stritch School of Medicine.
As part of a research project funded by the National Institutes of Health, for five years Levine has been studying a group of 40 children as young as 14 months who have had a stroke and 60 children who have not. The researchers videotaped interactions between the children and their parents.
So far their research suggests that for children who have had a stroke, "there are slight delays in getting language off the ground, but their progress is pretty similar to the typically developing children," Levine said.
The researchers will continue to follow the children to determine if they have difficulty developing the more complex language skills needed to succeed in school.About 10 in every 100,000 children in the U.S. suffer a stroke in a given year. The risk is greatest in the first year of life, particularly in the first two months.Only people older than 65 have a higher stroke risk than babies younger than a month, said Dr. E. Steve Roach, chairman of the task force that developed the American Heart Association guidelines. Roach is neurologist in chief at Nationwide Children's Hospital in Columbus, Ohio.
SeizuresIn newborns and babies affected in utero, the first symptoms of a stroke often are seizures that involve a single limb. Such seizures are so common that stroke is believed to account for about 10 percent of seizures in full-term newborns, Roach said.
Bergman mentioned Noelle's preference for her left hand to the child's doctor during a routine exam. The MRI diagnosed the stroke. (Children generally do not show a hand preference before age 2.)
Noelle, now 5, has been undergoing physical and occupational therapy, and recently completed speech therapy. Casts, and later braces, were placed on her legs to increase her range of motion and correct her gait. Her biggest challenge now is improving her limited use of her right hand.
Said Bergman: "When we started on this journey I was shocked. I was heartbroken.
... Now I think because I see how well she's doing, I know truly in my heart, she will be able to do anything she wants to do."
Friday, August 15, 2008
Taking a closer look at concussions
Your brain needs more of a time-out than just missing the next game to recover from a concussion. New research suggests student athletes who are too active - not just on the field, but at home and school - may hinder their recovery.
More puzzling, female athletes may take longer to recover than males.
It's part of growing evidence that healing from this common sports injury is more complicated than once thought, an important message for parents and coaches as school sports programs gear up for fall.
"No two concussions are the same," warns Kevin Guskiewicz, an athletic trainer who chairs the sports science department at the University of North Carolina at Chapel Hill. "We need to be cautious with what we're allowing someone to do, and at what point in their recovery they're allowed to do it."
Concussions are brain injuries and among the most difficult of sports injuries, starting with even identifying who's had one. Many athletes never lose consciousness, the most obvious symptom. Brain scans can't diagnose a concussion. Nor are other symptoms always apparent right away, and players can sometimes hide or minimize them: "Nope, no headaches, coach; put me back in."
Doing so has grave risks. A second concussion before recovering from the first can cause brain swelling that can trigger permanent damage, even death.
And there's mounting concern from studies of retired professional athletes that those who suffered multiple concussions over the years may be at increased risk for depression, memory problems and other neurological problems later in life.
The latest U.S. estimates suggest there are anywhere from 1.6 million to 3.8 million sports- and recreation-related concussions each year.
The good news: Awareness is growing, at least among college and professional athletes.
Guskiewicz says reports of concussions have risen 10 percent in the last three years - not that more athletes are being injured but that more who properly seek care.
But how much time is needed to heal, and how much activity is OK while recovering, remains uncertain.
The worry isn't just another bump. An injured brain undergoes metabolic changes that affect its energy levels, meaning physical and mental exertion might add more strain.
So researchers at the University of Pittsburgh and one of Guskiewicz's UNC colleagues tracked 95 high school athletes evaluated in a university-based program that gave a battery of memory, reaction time and other cognitive tests up to a month after the concussion. The researchers grouped patients by activities recorded in their medical records: No school; some schoolwork but no other activity; moderate activity described as schoolwork and some routine home chores; that plus sports practice; or schoolwork and playing some sports.
Those with moderate activity showed the best recovery, scoring better on brain tests than even the less active patients, researchers reported in the Journal of Athletic Training. The more active patients scored much worse - and although their allowed activity suggested they were thought to have a mild concussion, they ultimately performed as poorly as athletes initially diagnosed with a more serious concussion.
The goal is "to keep the brain stimulated but not enough to push it into overdrive," explains Guskiewicz.
Another Pittsburgh study of 234 soccer players found that two weeks after their concussion, female players scored worse on some brain-function tests than similarly injured males. Dr. Alexis Chiang Colvin found size differences didn't explain the discrepancy. She couldn't find an alternate explanation, and while the gender question is explored, urges coaches and athletes to be aware that female players may need a little extra time to recover.
Increasingly, professional and college athletes are given preseason tests of memory and other cognitive skills. After a concussion, retesting can help athletic trainers determine when athletes are ready to return to play.
That's far less common in high school sports. Are young athletes returning too soon? The only national study of high school injuries, run by Ohio State University, is analyzing that question now.
Meanwhile, what's the advice? A government campaign and concussion specialists urge that:
-Parents, players and coaches know the symptoms - from immediate signs, such as being dazed, amnesia, moving slowly or clumsily, to later symptoms such as dizziness, sleep problems, irritability and concentration problems.
-Athletes don't return to play until cleared by a health professional.
-Appropriate health officials be on site to assess concussion "whether it's Pop Warner football or soccer or high school teams," Guskiewicz says.
Teaching young players the seriousness is the big challenge, says Ohio State injury specialist Dawn Comstock: "It's difficult for them to realize this one game Friday night is not as important as my cognitive ability the rest of my life."
More puzzling, female athletes may take longer to recover than males.
It's part of growing evidence that healing from this common sports injury is more complicated than once thought, an important message for parents and coaches as school sports programs gear up for fall.
"No two concussions are the same," warns Kevin Guskiewicz, an athletic trainer who chairs the sports science department at the University of North Carolina at Chapel Hill. "We need to be cautious with what we're allowing someone to do, and at what point in their recovery they're allowed to do it."
Concussions are brain injuries and among the most difficult of sports injuries, starting with even identifying who's had one. Many athletes never lose consciousness, the most obvious symptom. Brain scans can't diagnose a concussion. Nor are other symptoms always apparent right away, and players can sometimes hide or minimize them: "Nope, no headaches, coach; put me back in."
Doing so has grave risks. A second concussion before recovering from the first can cause brain swelling that can trigger permanent damage, even death.
And there's mounting concern from studies of retired professional athletes that those who suffered multiple concussions over the years may be at increased risk for depression, memory problems and other neurological problems later in life.
The latest U.S. estimates suggest there are anywhere from 1.6 million to 3.8 million sports- and recreation-related concussions each year.
The good news: Awareness is growing, at least among college and professional athletes.
Guskiewicz says reports of concussions have risen 10 percent in the last three years - not that more athletes are being injured but that more who properly seek care.
But how much time is needed to heal, and how much activity is OK while recovering, remains uncertain.
The worry isn't just another bump. An injured brain undergoes metabolic changes that affect its energy levels, meaning physical and mental exertion might add more strain.
So researchers at the University of Pittsburgh and one of Guskiewicz's UNC colleagues tracked 95 high school athletes evaluated in a university-based program that gave a battery of memory, reaction time and other cognitive tests up to a month after the concussion. The researchers grouped patients by activities recorded in their medical records: No school; some schoolwork but no other activity; moderate activity described as schoolwork and some routine home chores; that plus sports practice; or schoolwork and playing some sports.
Those with moderate activity showed the best recovery, scoring better on brain tests than even the less active patients, researchers reported in the Journal of Athletic Training. The more active patients scored much worse - and although their allowed activity suggested they were thought to have a mild concussion, they ultimately performed as poorly as athletes initially diagnosed with a more serious concussion.
The goal is "to keep the brain stimulated but not enough to push it into overdrive," explains Guskiewicz.
Another Pittsburgh study of 234 soccer players found that two weeks after their concussion, female players scored worse on some brain-function tests than similarly injured males. Dr. Alexis Chiang Colvin found size differences didn't explain the discrepancy. She couldn't find an alternate explanation, and while the gender question is explored, urges coaches and athletes to be aware that female players may need a little extra time to recover.
Increasingly, professional and college athletes are given preseason tests of memory and other cognitive skills. After a concussion, retesting can help athletic trainers determine when athletes are ready to return to play.
That's far less common in high school sports. Are young athletes returning too soon? The only national study of high school injuries, run by Ohio State University, is analyzing that question now.
Meanwhile, what's the advice? A government campaign and concussion specialists urge that:
-Parents, players and coaches know the symptoms - from immediate signs, such as being dazed, amnesia, moving slowly or clumsily, to later symptoms such as dizziness, sleep problems, irritability and concentration problems.
-Athletes don't return to play until cleared by a health professional.
-Appropriate health officials be on site to assess concussion "whether it's Pop Warner football or soccer or high school teams," Guskiewicz says.
Teaching young players the seriousness is the big challenge, says Ohio State injury specialist Dawn Comstock: "It's difficult for them to realize this one game Friday night is not as important as my cognitive ability the rest of my life."
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