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."
Sunday, August 31, 2008
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."
Thursday, August 14, 2008
Angioplasty's early advantage gone after 3 years, study says
People with chronic chest pain who are not in big danger of a heart attack now may have even less reason to rush into an artery-opening angioplasty: There's more evidence drugs should be tried first and often are just as effective.
The slim early advantage for angioplasty at relieving pain in these nonemergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study.
That is sooner than the five years doctors estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. Results are in Thursday's New England Journal of Medicine.
"This study should be enlightening and practice-changing for doctors and patients alike," and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University's Dr. Eric Peterson, who co-authored an editorial in the medical journal.
The number of angioplasties has been falling since the first results from this big study came out in 2007, according to new figures requested by The Associated Press from an American College of Cardiology database.
Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a clog and propping the artery open with a mesh tube called a stent.
However, at least a third of angioplasties are done on people not in imminent danger, to relieve chest pain. These patients are no more likely to die or suffer a heart attack if initially treated with drugs alone, the big 2,287-patient study revealed.
Still, angioplasty's fans tout it as a quick fix that improves quality of life. That benefit is fairly small and short-lived, compared with good medication use alone, the new report found.
Researchers did follow-up health surveys of about 70 percent of the study's participants. At the start, 78 percent had chest pain.
Three months after treatment, 53 percent of patients who had angioplasties plus drug treatment and 42 percent of the drugs-alone patients were free of chest pain. Both groups continued to improve, and the gap started to narrow within six months. After three years, their scores on chest pain, quality-of-life and treatment satisfaction did not significantly differ.
"Patients get better," regardless of which initial treatment they have, said study leader Dr. William Weintraub of Christiana Care Health System in Newark, Del.
One exception: Those who started out with more severe chest pain fared better with angioplasty. And not everyone did well on drugs alone - about one-third ultimately needed an angioplasty or heart bypass surgery.
The study was funded by the U.S. Department of Veterans Affairs, the Medical Research Council of Canada and a host of drug companies. Many of the researchers have consulted for drug makers, and many of the study's critics have consulted for stent makers.
People in the study were properly tested to ensure they were medically stable, said Dr. Spencer King, a cardiologist at St. Joseph's Heart and Vascular Institute in Atlanta and past president of the cardiology college. "My greatest fear" is that some patients now may be given medications without adequate testing to show angioplasty can safely be delayed, he said.
The study patients also received an ideal mix of medicines, potentially including aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers.
The slim early advantage for angioplasty at relieving pain in these nonemergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study.
That is sooner than the five years doctors estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. Results are in Thursday's New England Journal of Medicine.
"This study should be enlightening and practice-changing for doctors and patients alike," and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University's Dr. Eric Peterson, who co-authored an editorial in the medical journal.
The number of angioplasties has been falling since the first results from this big study came out in 2007, according to new figures requested by The Associated Press from an American College of Cardiology database.
Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a clog and propping the artery open with a mesh tube called a stent.
However, at least a third of angioplasties are done on people not in imminent danger, to relieve chest pain. These patients are no more likely to die or suffer a heart attack if initially treated with drugs alone, the big 2,287-patient study revealed.
Still, angioplasty's fans tout it as a quick fix that improves quality of life. That benefit is fairly small and short-lived, compared with good medication use alone, the new report found.
Researchers did follow-up health surveys of about 70 percent of the study's participants. At the start, 78 percent had chest pain.
Three months after treatment, 53 percent of patients who had angioplasties plus drug treatment and 42 percent of the drugs-alone patients were free of chest pain. Both groups continued to improve, and the gap started to narrow within six months. After three years, their scores on chest pain, quality-of-life and treatment satisfaction did not significantly differ.
"Patients get better," regardless of which initial treatment they have, said study leader Dr. William Weintraub of Christiana Care Health System in Newark, Del.
One exception: Those who started out with more severe chest pain fared better with angioplasty. And not everyone did well on drugs alone - about one-third ultimately needed an angioplasty or heart bypass surgery.
The study was funded by the U.S. Department of Veterans Affairs, the Medical Research Council of Canada and a host of drug companies. Many of the researchers have consulted for drug makers, and many of the study's critics have consulted for stent makers.
People in the study were properly tested to ensure they were medically stable, said Dr. Spencer King, a cardiologist at St. Joseph's Heart and Vascular Institute in Atlanta and past president of the cardiology college. "My greatest fear" is that some patients now may be given medications without adequate testing to show angioplasty can safely be delayed, he said.
The study patients also received an ideal mix of medicines, potentially including aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers.
Wednesday, August 13, 2008
Doctors debate when to declare organ donors dead
A report on three heart transplants involving babies is focusing attention on a touchy issue in the organ donation field: When and how can someone be declared dead?
For decades, organs have typically been removed only after doctors determine that a donor's brain has completely stopped working. In the case of the infants, all three were on life support and showed little brain function, but they didn't meet the criteria for brain death.
With their families' consent, the newborns were taken off ventilators and surgeons in Denver removed their hearts minutes after they stopped beating. The hearts were successfully transplanted, and the babies who got the hearts survived.
"It seemed like there was an unmet need in two situations," said Dr. Mark Boucek, who led the study at Children's Hospital in Denver. "Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren't able to do it."
The procedure - called donation after cardiac death - is being encouraged by the federal government, organ banks and others as a way to make more organs available and give more families the option to donate.
But the approach raises legal and ethical issues because it involves children and because, according to critics, it violates laws governing when organs may be removed.
As the method has gained acceptance, the number of cardiac-death donations has steadily increased. Last year, there were 793 cardiac-death donors, about 10 percent of all deceased donors, according to United Network for Organ Sharing. Most of those were adults donating kidneys or livers.
"It is a much more common scenario today that it would have been even five years ago," said Joel Newman, a spokesman for the network.
The heart is rarely removed after cardiac death because of worries it could be damaged from lack of oxygen. In brain-death donations, the donor is kept on a ventilator to keep oxygen-rich blood flowing to the organs until they are removed.
The Denver cases are detailed in Thursday's New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.
They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted "dead donor rule" and the waiting time between when the heart stops and when it is removed to make sure that it doesn't start again on its own.
In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.
State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn't meet the rule since it was possible to restart the transplanted hearts in the recipients.
"In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.
But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.
The Denver transplants were done over three years; one in 2004 and two last year. The three donor infants had all suffered brain damage from lack of oxygen when they were born. On average, they were about four days old when life support was ended.
In the first case, doctors waited for three minutes after the heart stopped before death was declared. Then the waiting time was reduced to 75 seconds on the recommendation of the ethics committee to reduce the chances of damage to the heart.
The authors said 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.
The hearts were given to three babies born with heart defects or heart disease. All three survived, and their outcomes were compared to 17 heart transplants done at the hospital during the same time but from pediatric donors declared brain dead.
"We couldn't tell the difference," said Boucek, who's now at Joe DiMaggio Children's Hospital in Hollywood, Fla.
There were nine other potential cardiac-death donors at the hospital during the same period, but there wasn't a suitable recipient in the area for their hearts, the report said.
The parents of one of the infants in the study, David Grooms and Jill Airington-Grooms, faced the devastating news on New Year's Day 2007 that their first child, Addison, had been born with little brain function and wouldn't survive.
After they decided to remove life support, they were asked about organ donation, and quickly agreed.
"The reality was Addison was not going to live," said Jill Airington-Grooms. "As difficult as that was to hear, this opportunity provided us with a ray of hope."
Three days later, Addison was taken off a ventilator and died. Her heart was given to another Denver-area baby, 2-month-old Zachary Apmann, who was born five weeks premature with an underdeveloped heart.
His parents, Rob and Mary Ann Apmann, said they were given several options and decided to wait for a transplant. They agreed they would accept a cardiac-death donation to increase Zachary's chances.
Mary Ann Apmann said she wasn't worried that the first available heart came from a cardiac-death donor.
"At that point, Zachary was so sick. We did have him at home. But we knew it wasn't much longer," she said.
After the transplant on Jan. 4, his condition quickly improved, and his blue lips disappeared.
Now, at 21 months: "He's just a crazy little kid who loves to play and swim and throw rocks," his mother said.
The two families haven't met yet but have been in touch through letters and calls.
Coincidentally, David Grooms said he had an older brother who died three days after he was born in the 1970s with the same heart condition as Zachary's. The Grooms now have an 8-month-old daughter, Harper.
"Addison did only live three days in this world, but because of this, she lives on," her mother said.
For decades, organs have typically been removed only after doctors determine that a donor's brain has completely stopped working. In the case of the infants, all three were on life support and showed little brain function, but they didn't meet the criteria for brain death.
With their families' consent, the newborns were taken off ventilators and surgeons in Denver removed their hearts minutes after they stopped beating. The hearts were successfully transplanted, and the babies who got the hearts survived.
"It seemed like there was an unmet need in two situations," said Dr. Mark Boucek, who led the study at Children's Hospital in Denver. "Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren't able to do it."
The procedure - called donation after cardiac death - is being encouraged by the federal government, organ banks and others as a way to make more organs available and give more families the option to donate.
But the approach raises legal and ethical issues because it involves children and because, according to critics, it violates laws governing when organs may be removed.
As the method has gained acceptance, the number of cardiac-death donations has steadily increased. Last year, there were 793 cardiac-death donors, about 10 percent of all deceased donors, according to United Network for Organ Sharing. Most of those were adults donating kidneys or livers.
"It is a much more common scenario today that it would have been even five years ago," said Joel Newman, a spokesman for the network.
The heart is rarely removed after cardiac death because of worries it could be damaged from lack of oxygen. In brain-death donations, the donor is kept on a ventilator to keep oxygen-rich blood flowing to the organs until they are removed.
The Denver cases are detailed in Thursday's New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.
They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted "dead donor rule" and the waiting time between when the heart stops and when it is removed to make sure that it doesn't start again on its own.
In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.
State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn't meet the rule since it was possible to restart the transplanted hearts in the recipients.
"In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.
But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.
The Denver transplants were done over three years; one in 2004 and two last year. The three donor infants had all suffered brain damage from lack of oxygen when they were born. On average, they were about four days old when life support was ended.
In the first case, doctors waited for three minutes after the heart stopped before death was declared. Then the waiting time was reduced to 75 seconds on the recommendation of the ethics committee to reduce the chances of damage to the heart.
The authors said 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.
The hearts were given to three babies born with heart defects or heart disease. All three survived, and their outcomes were compared to 17 heart transplants done at the hospital during the same time but from pediatric donors declared brain dead.
"We couldn't tell the difference," said Boucek, who's now at Joe DiMaggio Children's Hospital in Hollywood, Fla.
There were nine other potential cardiac-death donors at the hospital during the same period, but there wasn't a suitable recipient in the area for their hearts, the report said.
The parents of one of the infants in the study, David Grooms and Jill Airington-Grooms, faced the devastating news on New Year's Day 2007 that their first child, Addison, had been born with little brain function and wouldn't survive.
After they decided to remove life support, they were asked about organ donation, and quickly agreed.
"The reality was Addison was not going to live," said Jill Airington-Grooms. "As difficult as that was to hear, this opportunity provided us with a ray of hope."
Three days later, Addison was taken off a ventilator and died. Her heart was given to another Denver-area baby, 2-month-old Zachary Apmann, who was born five weeks premature with an underdeveloped heart.
His parents, Rob and Mary Ann Apmann, said they were given several options and decided to wait for a transplant. They agreed they would accept a cardiac-death donation to increase Zachary's chances.
Mary Ann Apmann said she wasn't worried that the first available heart came from a cardiac-death donor.
"At that point, Zachary was so sick. We did have him at home. But we knew it wasn't much longer," she said.
After the transplant on Jan. 4, his condition quickly improved, and his blue lips disappeared.
Now, at 21 months: "He's just a crazy little kid who loves to play and swim and throw rocks," his mother said.
The two families haven't met yet but have been in touch through letters and calls.
Coincidentally, David Grooms said he had an older brother who died three days after he was born in the 1970s with the same heart condition as Zachary's. The Grooms now have an 8-month-old daughter, Harper.
"Addison did only live three days in this world, but because of this, she lives on," her mother said.
Tuesday, August 12, 2008
Are you overweight and heart healthy?
You can look great in a swimsuit and still be a heart attack waiting to happen. And you can also be overweight and otherwise healthy. A new study suggests that a surprising number of overweight people - about half - have normal blood pressure and cholesterol levels, while an equally startling number of trim people suffer from some of the ills associated with obesity.
The first national estimate of its kind bolsters the argument that you can be hefty but still healthy, or at least healthier than has been believed.
The results also show that stereotypes about body size can be misleading, and that even "less voluptuous" people can have risk factors commonly associated with obesity, said study author MaryFran Sowers, a University of Michigan obesity researcher.
"We're really talking about taking a look with a very different lens" at weight and health risks, Sowers said.
In the study, about 51 percent of overweight adults, or roughly 36 million people nationwide, had mostly normal levels of blood pressure, cholesterol, blood fats called triglycerides and blood sugar.
Almost one-third of obese adults, or nearly 20 million people, also were in this healthy range, meaning that none or only one of those measures was abnormal.
Yet about a fourth of adults in the recommended-weight range had unhealthy levels of at least two of these measures. That means some 16 million of them are at risk for heart problems.
It's no secret that thin people can develop heart-related problems and that fat people often do not. But that millions defy the stereotypes will come as a surprise to many people, Sowers said.
Even so, there's growing debate about the accuracy of the standard method of calculating whether someone is overweight. Health officials rely on the body mass index, a weight-height ratio that does not distinguish between fat and lean tissue. The limits of that method were highlighted a few years ago when it was reported that the system would put nearly half of NBA players in the overweight category.
A number of experts say waist size is a more accurate way of determining someone's health risks, and the study results support that argument.
Dr. Robert Eckel, a former American Heart Association president and professor of medicine at the University of Colorado, said the new research may help dismiss some of the generalizations that are sometimes made about weight and health.
Study co-author Judith Wylie-Rosett emphasized that the study shouldn't send the message "that we don't need to worry about weight." That's because half of overweight people do face elevated risks for heart disease, explained Wylie-Rosett, a nutrition researcher at Albert Einstein College of Medicine in New York.
But, for those without elevated risks, losing weight "might be important only from a cosmetic perspective," she said.
To arrive at the estimates, scientists analyzed nationally representative government surveys involving 5,440 people age 20 and over, and extrapolated to calculate nationwide figures.
The new study, appearing in Monday's Archives of Internal Medicine, used government surveys from 1999 to 2004 that included lab tests and height and weight measurements. Participants reported on habits including smoking and physical activity.
In all weight categories, risk factors for heart problems were generally more common in older people, smokers and inactive people. Among obese people who were 50 to 64, just 20 percent were considered healthy compared with half of younger obese people.
The results underscore how important exercise is for staying healthy, even for people of healthy weight, Wylie-Rosett said.
The authors noted that fat tissue releases hormones and other substances that affect things like blood vessels, cholesterol and blood sugar. The results suggest this interaction varies among overweight and obese people, the authors said.
The results also add to mounting evidence that thick waists are linked with heart risks.
Among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies. This often signals internal fat deposits surrounding abdominal organs, which previous research has shown can be especially risky.
Similarly, among overweight and obese adults, those in the "healthy" category tended to have smaller waists than those with at least two risk factors.
Dr. Lewis Landsberg, a Northwestern University obesity expert, noted that the research didn't look at heart disease, and that not everyone with high risk factors develops heart problems.
Still, he said, the study shows that waist measurements can help assess health.
The first national estimate of its kind bolsters the argument that you can be hefty but still healthy, or at least healthier than has been believed.
The results also show that stereotypes about body size can be misleading, and that even "less voluptuous" people can have risk factors commonly associated with obesity, said study author MaryFran Sowers, a University of Michigan obesity researcher.
"We're really talking about taking a look with a very different lens" at weight and health risks, Sowers said.
In the study, about 51 percent of overweight adults, or roughly 36 million people nationwide, had mostly normal levels of blood pressure, cholesterol, blood fats called triglycerides and blood sugar.
Almost one-third of obese adults, or nearly 20 million people, also were in this healthy range, meaning that none or only one of those measures was abnormal.
Yet about a fourth of adults in the recommended-weight range had unhealthy levels of at least two of these measures. That means some 16 million of them are at risk for heart problems.
It's no secret that thin people can develop heart-related problems and that fat people often do not. But that millions defy the stereotypes will come as a surprise to many people, Sowers said.
Even so, there's growing debate about the accuracy of the standard method of calculating whether someone is overweight. Health officials rely on the body mass index, a weight-height ratio that does not distinguish between fat and lean tissue. The limits of that method were highlighted a few years ago when it was reported that the system would put nearly half of NBA players in the overweight category.
A number of experts say waist size is a more accurate way of determining someone's health risks, and the study results support that argument.
Dr. Robert Eckel, a former American Heart Association president and professor of medicine at the University of Colorado, said the new research may help dismiss some of the generalizations that are sometimes made about weight and health.
Study co-author Judith Wylie-Rosett emphasized that the study shouldn't send the message "that we don't need to worry about weight." That's because half of overweight people do face elevated risks for heart disease, explained Wylie-Rosett, a nutrition researcher at Albert Einstein College of Medicine in New York.
But, for those without elevated risks, losing weight "might be important only from a cosmetic perspective," she said.
To arrive at the estimates, scientists analyzed nationally representative government surveys involving 5,440 people age 20 and over, and extrapolated to calculate nationwide figures.
The new study, appearing in Monday's Archives of Internal Medicine, used government surveys from 1999 to 2004 that included lab tests and height and weight measurements. Participants reported on habits including smoking and physical activity.
In all weight categories, risk factors for heart problems were generally more common in older people, smokers and inactive people. Among obese people who were 50 to 64, just 20 percent were considered healthy compared with half of younger obese people.
The results underscore how important exercise is for staying healthy, even for people of healthy weight, Wylie-Rosett said.
The authors noted that fat tissue releases hormones and other substances that affect things like blood vessels, cholesterol and blood sugar. The results suggest this interaction varies among overweight and obese people, the authors said.
The results also add to mounting evidence that thick waists are linked with heart risks.
Among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies. This often signals internal fat deposits surrounding abdominal organs, which previous research has shown can be especially risky.
Similarly, among overweight and obese adults, those in the "healthy" category tended to have smaller waists than those with at least two risk factors.
Dr. Lewis Landsberg, a Northwestern University obesity expert, noted that the research didn't look at heart disease, and that not everyone with high risk factors develops heart problems.
Still, he said, the study shows that waist measurements can help assess health.
Monday, August 11, 2008
Can artificial sweetners speed the absorption of alcohol?
THE BELIEF:
Beware of drink mixers based on diet soda.
THE FACTS:
Usually it is solely the liquor component of a cocktail -- not the mixer -- that determines its inebriating effects. But some people contend the artificial sweeteners in diet soda speed the absorption of alcohol.
Odd, perhaps, but research suggests it's true. In a 2006 study, a team of scientists recruited healthy subjects and had them consume vodka cocktails. On some occasions, it was a 20-ounce drink mixed with a sugar-sweetened beverage, and on others it was a nearly identical drink mixed instead with a diet beverage.
In the diet-mixer conditions, the alcohol entered the subjects' bloodstream about 15 minutes faster, and their blood-alcohol concentration was higher, peaking at 0.05 percent, compared with 0.03 percent with the regular mixer.
One theory is that the alcohol is absorbed more quickly because there is no sugar to slow it down, which would mean that club soda would have a similar effect. A second study in 2007 also showed that alcohol was absorbed far more quickly when mixed with carbonated beverages than with flat mixers, possibly because of the effervescence. As a result, experts say, it's best to choose flat mixers like orange or cranberry juice over diet sodas or juices.
THE BOTTOM LINE:
Compared with sugar-sweetened drinks, artificial sweeteners can speed inebriation.
Beware of drink mixers based on diet soda.
THE FACTS:
Usually it is solely the liquor component of a cocktail -- not the mixer -- that determines its inebriating effects. But some people contend the artificial sweeteners in diet soda speed the absorption of alcohol.
Odd, perhaps, but research suggests it's true. In a 2006 study, a team of scientists recruited healthy subjects and had them consume vodka cocktails. On some occasions, it was a 20-ounce drink mixed with a sugar-sweetened beverage, and on others it was a nearly identical drink mixed instead with a diet beverage.
In the diet-mixer conditions, the alcohol entered the subjects' bloodstream about 15 minutes faster, and their blood-alcohol concentration was higher, peaking at 0.05 percent, compared with 0.03 percent with the regular mixer.
One theory is that the alcohol is absorbed more quickly because there is no sugar to slow it down, which would mean that club soda would have a similar effect. A second study in 2007 also showed that alcohol was absorbed far more quickly when mixed with carbonated beverages than with flat mixers, possibly because of the effervescence. As a result, experts say, it's best to choose flat mixers like orange or cranberry juice over diet sodas or juices.
THE BOTTOM LINE:
Compared with sugar-sweetened drinks, artificial sweeteners can speed inebriation.
Are Cholesterol Drugs Linked to Muscle Pain?
Q: I was on Lipitor for a number of years and have severe muscle and nerve damage to the extent that I am in a power wheelchair. Do you think Lipitor could be to blame?
A: Statin-type cholesterol-lowering drugs such as Crestor (rosuvastatin), Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin) are linked to muscle pain, weakness and nerve damage. Most physicians have assumed that muscle problems are an extremely rare side effect.
New research (New England Journal of Medicine online, July 23, 2008) suggests that some people are highly susceptible to muscle-related complications from high-dose statins. This genetic vulnerability may affect up to one-fourth of the population.
A: Statin-type cholesterol-lowering drugs such as Crestor (rosuvastatin), Lipitor (atorvastatin), Mevacor (lovastatin) and Zocor (simvastatin) are linked to muscle pain, weakness and nerve damage. Most physicians have assumed that muscle problems are an extremely rare side effect.
New research (New England Journal of Medicine online, July 23, 2008) suggests that some people are highly susceptible to muscle-related complications from high-dose statins. This genetic vulnerability may affect up to one-fourth of the population.
Sunday, August 10, 2008
Time to update your childs vaccinations
State public-health officials are reminding parents that several immunizations are required before children can attend school or child care. Requirements for new vaccines or boosters change year by year to phase in protection for all students.
This year, students entering sixth and seventh grade must get the tetanus, diphtheria and pertussis (Tdap) vaccine. This is a booster shot for most children and will help protect older ones against whooping cough (pertussis).
Also this year, children starting first, second and sixth grades must get chickenpox (varicella) vaccine or document that they've had the disease; kindergartners need two doses.
Exemptions are allowed for medical, religious or personal reasons, but children who are not fully immunized may be excluded from attending school, preschool or child care if an outbreak occurs, noted Michele Roberts, health promotion and communication manager for the state's immunization program.
This year, students entering sixth and seventh grade must get the tetanus, diphtheria and pertussis (Tdap) vaccine. This is a booster shot for most children and will help protect older ones against whooping cough (pertussis).
Also this year, children starting first, second and sixth grades must get chickenpox (varicella) vaccine or document that they've had the disease; kindergartners need two doses.
Exemptions are allowed for medical, religious or personal reasons, but children who are not fully immunized may be excluded from attending school, preschool or child care if an outbreak occurs, noted Michele Roberts, health promotion and communication manager for the state's immunization program.
Saturday, August 9, 2008
Average ER waiting time nears 1 hour, CDC says
The average time that hospital emergency rooms patients wait to see a doctor has grown from about 38 minutes to almost an hour over the past decade, according to new federal statistics released Wednesday.
The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the Centers for Disease Control and Prevention.
"There are more people arriving at the ERs. And there are fewer ERs," said Pitts, an associate professor of emergency medicine at Atlanta's Emory University.
Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 - a 32 percent increase.
Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.
Another reason for crowding is patients who are admitted to the hospital end up waiting in the ER because of the limited number of hospital beds, Pitts added.
A shortage of surgical specialists also contributes. So, too, does the difficulty many patients have in getting appointment to doctor's offices - which causes some to turn to emergency departments, experts said.
"It takes me a month to get an appointment for my own doctor, and I'm a physician, for God's sake," said Dr. Ricardo Martinez, an Atlanta emergency physician. He is executive vice president of Schumacher Group, an organization that manages about 140 hospital emergency departments.
The amount of time a patient waited before seeing a physician in an ER has been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.
Pitts added that 56 minutes may be the average, but it's not typical: The average was skewed to nearly an hour because of some very long waits.
"Half of people had waiting times of 31 minutes or less," Pitts noted.
Researchers also found that there has not been any recent increases in the number of patients arriving by ambulance, or in the number of cases considered to be true emergencies.
Black patients visited emergency departments at twice the rate as whites in 2006. Among age groups, the highest visitation rates were for infants and elderly people aged 75 and older.
About 40 percent of ER patients had private insurance, about 25 percent were covered by state programs for children and about 17 percent were covered by Medicare, the report found. About 17 percent were uninsured.
Some more findings: Summer and winter were the busiest season in ERs, and the early evening - around 7 p.m. - tended to be the busiest time of day. There were geographic differences as well, with hospitals in the South having the highest ER visitation rates.
Also, half of hospital admissions in 2006 came through emergency departments, up from 36 percent in 1996.
"The ER has become the front door to the hospital," said Pitts, a fellow at the CDC's National Center for Health Statistics.
Some doctors said the report supports a call for increased governmental funding for hospital emergency services.
"Millions more people each year are seeking emergency care, but emergency departments are continuing to close, often because so much care goes uncompensated," Dr. Linda Lawrence, president of the American College of Emergency Physicians, said in a statement.
"This report is very troubling, because it shows that care is being delayed for everyone, including people in pain and with heart attacks," her statement added.
The results are based on a national survey of 362 hospital emergency departments.
The increase is due to supply and demand, said Dr. Stephen Pitts, the lead author of the report by the Centers for Disease Control and Prevention.
"There are more people arriving at the ERs. And there are fewer ERs," said Pitts, an associate professor of emergency medicine at Atlanta's Emory University.
Overall, about 119 million visits were made to U.S. emergency rooms in 2006, up from 90 million in 1996 - a 32 percent increase.
Meanwhile, the number of hospital emergency departments dropped to fewer than 4,600, from nearly 4,900, according to American Hospital Association statistics.
Another reason for crowding is patients who are admitted to the hospital end up waiting in the ER because of the limited number of hospital beds, Pitts added.
A shortage of surgical specialists also contributes. So, too, does the difficulty many patients have in getting appointment to doctor's offices - which causes some to turn to emergency departments, experts said.
"It takes me a month to get an appointment for my own doctor, and I'm a physician, for God's sake," said Dr. Ricardo Martinez, an Atlanta emergency physician. He is executive vice president of Schumacher Group, an organization that manages about 140 hospital emergency departments.
The amount of time a patient waited before seeing a physician in an ER has been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.
Pitts added that 56 minutes may be the average, but it's not typical: The average was skewed to nearly an hour because of some very long waits.
"Half of people had waiting times of 31 minutes or less," Pitts noted.
Researchers also found that there has not been any recent increases in the number of patients arriving by ambulance, or in the number of cases considered to be true emergencies.
Black patients visited emergency departments at twice the rate as whites in 2006. Among age groups, the highest visitation rates were for infants and elderly people aged 75 and older.
About 40 percent of ER patients had private insurance, about 25 percent were covered by state programs for children and about 17 percent were covered by Medicare, the report found. About 17 percent were uninsured.
Some more findings: Summer and winter were the busiest season in ERs, and the early evening - around 7 p.m. - tended to be the busiest time of day. There were geographic differences as well, with hospitals in the South having the highest ER visitation rates.
Also, half of hospital admissions in 2006 came through emergency departments, up from 36 percent in 1996.
"The ER has become the front door to the hospital," said Pitts, a fellow at the CDC's National Center for Health Statistics.
Some doctors said the report supports a call for increased governmental funding for hospital emergency services.
"Millions more people each year are seeking emergency care, but emergency departments are continuing to close, often because so much care goes uncompensated," Dr. Linda Lawrence, president of the American College of Emergency Physicians, said in a statement.
"This report is very troubling, because it shows that care is being delayed for everyone, including people in pain and with heart attacks," her statement added.
The results are based on a national survey of 362 hospital emergency departments.
Friday, August 8, 2008
States mandate 'culturally competent' health care
When a doctor doesn't look an Asian-American patient in the eye, that might be seen as a sign of respect. But making eye contact is encouraged with black patients, according to the American Academy of Orthopaedic Surgeons, which has published a guidebook for culturally competent care.
As the country's ethnic profile diversifies, some states are trying to assure that health care providers are trained in "cultural competency."
New Mexico passed a law last year requiring that higher education institutions with health education programs provide such training, though the state still is grappling with how it will be implemented. New Jersey and California are among a handful of states with similar measures already in place.
"We don't expect that a provider is going to know everything about every nationality," said William Flores, chairman of New Mexico's task force charged with developing the curriculum.
"The critical thing here is developing sensitivity and the understanding that not every culture responds to medical providers in the same way, sees medicine in the same way."
Dr. Elizabeth Szalay, an associate professor of pediatric orthopedics and pediatrics at the University of New Mexico's Carrie Tingley Hospital, said that it's important for doctors to understand how patients may be different, but patients also need to be open about themselves, by asking questions and revealing their beliefs, concerns or fears.
Navajos often are reluctant to do so, without the coaxing of a social worker, said Linda Henderson, who interprets for Navajo patients. They view Western health care as foreign and won't question a doctor even if they don't understand what is being recommended, she said. It's a matter of respect.
"From our people's point of view, we're offending the doctors, because they're the experts as far as modern contemporary medicine," said Henderson, from Sanostee in the Navajo Nation.
Cynthia Lin, 55, of Taiwan, says she never has experienced a cultural barrier between herself and doctors, which she attributed to her open attitude.
She felt the need to tell a pediatrician once about something that's common among Asian babies - that they are born with a sort of bruised look near the buttocks.
"Some doctors may think, 'Oh my goodness, what happened to the baby's butt?'" said Lin, who lives in Albuquerque. "(But) the doctor understood that's just how Asians are. If the physician already knows about it, if they are aware that certain races have certain characteristics, then they don't have any doubts."
The New Mexico task force is holding meetings around the state to gather input on what should be included in the training and hopes to have the curriculum in place by 2010, Flores said.
New Jersey's law is similar to New Mexico's, requiring that the state's medical schools provide instruction to their students as a condition of receiving a degree. But the schools also must provide cultural competency training to licensed physicians who did not receive the training while they were in school - something Flores said the New Mexico Legislature might tackle down the road.
Although New Jersey's law was passed in 2005, the regulations weren't finalized until April.
California had a voluntary program in place since 2003 but later made it mandatory for the state's 400 continuing medical education providers.
Under the law, every CME course has to have an element of cultural and linguistic competency, which are accredited by the Institute for Medical Quality.
Alecia Robinson, project administrator for the Cultural and Linguistic Competency Program under IMQ, said how the requirements would be met has largely been left up to the providers.
"Each program is unique," she said.
Medical providers agree there's no one resource that can make a person culturally competent, but they say it's important to be familiar with a culture, drop any stereotypes or bias and treat patients in the appropriate way.
"It's a mind-set," Robinson said. "I've heard people speak of it as a level of humility about understanding different cultures. That's quite appropriate."
As the country's ethnic profile diversifies, some states are trying to assure that health care providers are trained in "cultural competency."
New Mexico passed a law last year requiring that higher education institutions with health education programs provide such training, though the state still is grappling with how it will be implemented. New Jersey and California are among a handful of states with similar measures already in place.
"We don't expect that a provider is going to know everything about every nationality," said William Flores, chairman of New Mexico's task force charged with developing the curriculum.
"The critical thing here is developing sensitivity and the understanding that not every culture responds to medical providers in the same way, sees medicine in the same way."
Dr. Elizabeth Szalay, an associate professor of pediatric orthopedics and pediatrics at the University of New Mexico's Carrie Tingley Hospital, said that it's important for doctors to understand how patients may be different, but patients also need to be open about themselves, by asking questions and revealing their beliefs, concerns or fears.
Navajos often are reluctant to do so, without the coaxing of a social worker, said Linda Henderson, who interprets for Navajo patients. They view Western health care as foreign and won't question a doctor even if they don't understand what is being recommended, she said. It's a matter of respect.
"From our people's point of view, we're offending the doctors, because they're the experts as far as modern contemporary medicine," said Henderson, from Sanostee in the Navajo Nation.
Cynthia Lin, 55, of Taiwan, says she never has experienced a cultural barrier between herself and doctors, which she attributed to her open attitude.
She felt the need to tell a pediatrician once about something that's common among Asian babies - that they are born with a sort of bruised look near the buttocks.
"Some doctors may think, 'Oh my goodness, what happened to the baby's butt?'" said Lin, who lives in Albuquerque. "(But) the doctor understood that's just how Asians are. If the physician already knows about it, if they are aware that certain races have certain characteristics, then they don't have any doubts."
The New Mexico task force is holding meetings around the state to gather input on what should be included in the training and hopes to have the curriculum in place by 2010, Flores said.
New Jersey's law is similar to New Mexico's, requiring that the state's medical schools provide instruction to their students as a condition of receiving a degree. But the schools also must provide cultural competency training to licensed physicians who did not receive the training while they were in school - something Flores said the New Mexico Legislature might tackle down the road.
Although New Jersey's law was passed in 2005, the regulations weren't finalized until April.
California had a voluntary program in place since 2003 but later made it mandatory for the state's 400 continuing medical education providers.
Under the law, every CME course has to have an element of cultural and linguistic competency, which are accredited by the Institute for Medical Quality.
Alecia Robinson, project administrator for the Cultural and Linguistic Competency Program under IMQ, said how the requirements would be met has largely been left up to the providers.
"Each program is unique," she said.
Medical providers agree there's no one resource that can make a person culturally competent, but they say it's important to be familiar with a culture, drop any stereotypes or bias and treat patients in the appropriate way.
"It's a mind-set," Robinson said. "I've heard people speak of it as a level of humility about understanding different cultures. That's quite appropriate."
Thursday, August 7, 2008
Pandemic Flu Not Terrorism Biggest Risk in UK
Pandemic flu, not terrorism, is the most serious risk to the U.K. public, says Britain's first ever national threat assessment, published on Friday.
The document, part of Prime Minister Gordon Brown's overhaul of homeland security strategy, considers the likely dangers posed by threats including terrorism, climate change, extreme weather and pandemic disease.
Britain's Cabinet Office - which drafted the document - said on Friday that a potential flu pandemic poses the most imminent danger over the next five years.
Previous government assessments have suggested an outbreak could cause as many as 750,000 deaths in Britain and acknowledged it could take several months to develop adequate vaccines against a particular strain of the virus.
Brown ordered a list of threats faced by Britain to be drafted shortly after he replaced Tony Blair in June 2007, arguing that previously classified assessments should be made public.
Though the new register does not rank threats in order of seriousness, it does indicate that flu is considered the most pressing concern, a spokeswoman for the Cabinet Office said on Friday.
"It looks at the whole range of risks and looks at them from a national perspective," said the spokeswoman, on condition of anonymity in line with policy. "It is the first time all of this has been brought together in this way."
Brown said in March that Britain was increasing its defenses against terrorism, but also preparing for potentially more serious risks from climate change and disease.
It followed a warning from Richard Mottram, who retired in November as Brown's chief adviser on intelligence and security, that the risks of a global flu pandemic, the impact of mass global migration and threats from organized crime were receiving too little attention.
Mottram claimed that the U.K.'s security strategy is too tightly focussed on terrorism.
But Britain's domestic spy agency MI5 says it is monitoring a constantly changing network of around 2,000 potential terrorists in the U.K., who are planning around 30 potential attacks at any given time.
Jonathan Evans, head of MI5, has acknowledged that the workload means officers are neglecting key counterespionage duties - despite an active spying threat from China and Russia against the U.K.
Under Brown's new security strategy, the agency will grow from around 3,000 staff to 4,000, and resources and technology at GCHQ, the government's secret eavesdropping center, will be upgraded.
A new advisory panel of security experts has also been created to report to Brown on threats faced by Britain.
The document, part of Prime Minister Gordon Brown's overhaul of homeland security strategy, considers the likely dangers posed by threats including terrorism, climate change, extreme weather and pandemic disease.
Britain's Cabinet Office - which drafted the document - said on Friday that a potential flu pandemic poses the most imminent danger over the next five years.
Previous government assessments have suggested an outbreak could cause as many as 750,000 deaths in Britain and acknowledged it could take several months to develop adequate vaccines against a particular strain of the virus.
Brown ordered a list of threats faced by Britain to be drafted shortly after he replaced Tony Blair in June 2007, arguing that previously classified assessments should be made public.
Though the new register does not rank threats in order of seriousness, it does indicate that flu is considered the most pressing concern, a spokeswoman for the Cabinet Office said on Friday.
"It looks at the whole range of risks and looks at them from a national perspective," said the spokeswoman, on condition of anonymity in line with policy. "It is the first time all of this has been brought together in this way."
Brown said in March that Britain was increasing its defenses against terrorism, but also preparing for potentially more serious risks from climate change and disease.
It followed a warning from Richard Mottram, who retired in November as Brown's chief adviser on intelligence and security, that the risks of a global flu pandemic, the impact of mass global migration and threats from organized crime were receiving too little attention.
Mottram claimed that the U.K.'s security strategy is too tightly focussed on terrorism.
But Britain's domestic spy agency MI5 says it is monitoring a constantly changing network of around 2,000 potential terrorists in the U.K., who are planning around 30 potential attacks at any given time.
Jonathan Evans, head of MI5, has acknowledged that the workload means officers are neglecting key counterespionage duties - despite an active spying threat from China and Russia against the U.K.
Under Brown's new security strategy, the agency will grow from around 3,000 staff to 4,000, and resources and technology at GCHQ, the government's secret eavesdropping center, will be upgraded.
A new advisory panel of security experts has also been created to report to Brown on threats faced by Britain.
Wednesday, August 6, 2008
Some cholesterol and heart drugs don't mix
Patients taking some common medications for high cholesterol and irregular heart beats can suffer severe muscle damage because of a problem in the way the drugs interact, the government warned on Friday.
The Food and Drug Administration said doctors should use extra care when prescribing Zocor, generic Zocor, or Vytorin to patients who are also taking amiodarone, a heart rhythm drug marketed as Cordarone or Pacerone. The danger is higher for patients taking more than 20 milligrams a day of the cholesterol drugs, the agency said.
The generic name for the cholesterol medications is simvastatin.
Muscle injury is a risk with any of the cholesterol drugs known as statins, including Lipitor, particularly for the elderly. Although the risk of such injuries is low overall, they can be serious because they can lead to kidney failure and even death.
The FDA urged doctors to consider switching patients who are taking the heart rhythm drug to other statins for controlling cholesterol. The heart medication is mainly used to treat irregular rhythms in the ventricles, the heart chambers that pump blood to the lungs and body.
A previous warning dating back to 2002 about the drug interaction apparently has not put an end to the problem. The FDA said since that time it has received 52 reports of serious muscle injury to patients taking the combination of medications, and almost all the patients had to be hospitalized.
The Food and Drug Administration said doctors should use extra care when prescribing Zocor, generic Zocor, or Vytorin to patients who are also taking amiodarone, a heart rhythm drug marketed as Cordarone or Pacerone. The danger is higher for patients taking more than 20 milligrams a day of the cholesterol drugs, the agency said.
The generic name for the cholesterol medications is simvastatin.
Muscle injury is a risk with any of the cholesterol drugs known as statins, including Lipitor, particularly for the elderly. Although the risk of such injuries is low overall, they can be serious because they can lead to kidney failure and even death.
The FDA urged doctors to consider switching patients who are taking the heart rhythm drug to other statins for controlling cholesterol. The heart medication is mainly used to treat irregular rhythms in the ventricles, the heart chambers that pump blood to the lungs and body.
A previous warning dating back to 2002 about the drug interaction apparently has not put an end to the problem. The FDA said since that time it has received 52 reports of serious muscle injury to patients taking the combination of medications, and almost all the patients had to be hospitalized.
Tuesday, August 5, 2008
Failures Give Children a Chance to Learn
In an era of so-called "helicopter parents," we've learned once again the downside of too much of a good thing. Swooping in and rescuing your child before he or she can make a mistake – in the hopes of preserving self-esteem – can bypass many learning opportunities.
Many adults have probably told themselves at some point that we "learn from our mistakes." Overcoming and learning from failure are vital life skills that your child needs your help to learn and develop during childhood.
Building your child's self-esteem is absolutely an important part of good parenting. Living in an environment of safety and love is central to building your child's healthy self-esteem. If your child knows your love is unconditional, he or she can attempt new things without fear of "losing" your love.
But it can be a tough balancing act. You want to encourage your child – help him or her try new things, reach for more and build on accomplishments – yet you may worry about what will happen when he or she inevitably fails at something and may feel the urge to prevent that failure. You want to acknowledge when your child is good at something, but you don't want him or her thinking they are so good that they don't need to try anymore.
What's important is instilling the message that, yes, it is great to be good at something, but ultimately it's about the effort put forth. Failure and setbacks are opportunities to learn and better ourselves.
In addition to praising the effort, it's important that you help your child learn to manage his or her self-criticism and temper when they do have problems. It is our role as parents to help teach children "child appropriate" coping skills. Let your child know that mistakes are a fairly routine part of life.
Often, mistakes happen through experimentation or when conditions are out of our control. Some mistakes happen when we don't have enough knowledge. And that is OK. That's how we learn for next time.
Some children react more to failure – they are much harder on themselves than others. If your child falls into this category, you'll need to spend extra energy helping your child manage his or her behavior in the face of adversity.
In addition to getting upset with him or herself, your child may be afraid of your reaction. It's important that you not be overly critical. Give your child space and the opportunity to think about what went wrong and why it happened. See if he or she can problem-solve the issue with some support from you.
React calmly and try to focus on what your child could do differently next time. Try to find an upside to the situation, and also try to find the humor in it; however, teasing or ridiculing is never acceptable. Your unconditional love will help your child be willing to try again.
You also need to be a great model through accepting your own failures. If you swear and sling the pan in the sink if you burn the dinner, you are not providing a good example of handling adversity!
It's great to involve your child in activities and projects that play to his or her interests and strengths. These successful experiences will help build and improve self-esteem. It's also important that your child doesn't go to great lengths to avoid failure. A child might avoid activities just because they are unfamiliar or uncomfortable and not things the child is sure he or she can do well.
If your child needs an example of someone who had success after years of failure, he probably needs to look no further than the bedroom bookshelf. Harry Potter series author J. K. Rowling gave Harvard's commencement address this year and said:
"Failure taught me things about myself that I could have learned no other way. Such knowledge is a true gift, for all that it is painfully won."
Many adults have probably told themselves at some point that we "learn from our mistakes." Overcoming and learning from failure are vital life skills that your child needs your help to learn and develop during childhood.
Building your child's self-esteem is absolutely an important part of good parenting. Living in an environment of safety and love is central to building your child's healthy self-esteem. If your child knows your love is unconditional, he or she can attempt new things without fear of "losing" your love.
But it can be a tough balancing act. You want to encourage your child – help him or her try new things, reach for more and build on accomplishments – yet you may worry about what will happen when he or she inevitably fails at something and may feel the urge to prevent that failure. You want to acknowledge when your child is good at something, but you don't want him or her thinking they are so good that they don't need to try anymore.
What's important is instilling the message that, yes, it is great to be good at something, but ultimately it's about the effort put forth. Failure and setbacks are opportunities to learn and better ourselves.
In addition to praising the effort, it's important that you help your child learn to manage his or her self-criticism and temper when they do have problems. It is our role as parents to help teach children "child appropriate" coping skills. Let your child know that mistakes are a fairly routine part of life.
Often, mistakes happen through experimentation or when conditions are out of our control. Some mistakes happen when we don't have enough knowledge. And that is OK. That's how we learn for next time.
Some children react more to failure – they are much harder on themselves than others. If your child falls into this category, you'll need to spend extra energy helping your child manage his or her behavior in the face of adversity.
In addition to getting upset with him or herself, your child may be afraid of your reaction. It's important that you not be overly critical. Give your child space and the opportunity to think about what went wrong and why it happened. See if he or she can problem-solve the issue with some support from you.
React calmly and try to focus on what your child could do differently next time. Try to find an upside to the situation, and also try to find the humor in it; however, teasing or ridiculing is never acceptable. Your unconditional love will help your child be willing to try again.
You also need to be a great model through accepting your own failures. If you swear and sling the pan in the sink if you burn the dinner, you are not providing a good example of handling adversity!
It's great to involve your child in activities and projects that play to his or her interests and strengths. These successful experiences will help build and improve self-esteem. It's also important that your child doesn't go to great lengths to avoid failure. A child might avoid activities just because they are unfamiliar or uncomfortable and not things the child is sure he or she can do well.
If your child needs an example of someone who had success after years of failure, he probably needs to look no further than the bedroom bookshelf. Harry Potter series author J. K. Rowling gave Harvard's commencement address this year and said:
"Failure taught me things about myself that I could have learned no other way. Such knowledge is a true gift, for all that it is painfully won."
Monday, August 4, 2008
Flu Shots May Not Protect Elderly
But researchers say seniors should get one anyway. Why?
The flu vaccine might not protect seniors as much as previously thought, according to a study of more than 3,500 patients over age 65 that found no link between flu vaccination and risk of pneumonia during three flu seasons.
One problem with previous studies looking at efficacy is that they failed to account for differences between healthier seniors and those who were 'frail,'" said lead researcher Michael Jackson, a postdoctoral fellow at the Group Health Center for Health Studies.
This study, published in The Lancet, used a rigorous case control method that included a control time period, after a flu vaccine became available but before each flu season actually started.
During those pre-flu season periods, people who had been vaccinated were much less likely to get pneumonia.
Why?
One possibility is the "healthy user" effect.
"Those who got the vaccine happened to be healthier--not because the flu vaccine was protecting them from pneumonia caused by the flu, since it wasn't present yet," Jackson said.
It's not the first study to point out that the use of flu vaccines in seniors might be a waste of time and money. A review by George Washington University researchers published in the Lancet Infectious Diseases found that flu shots may not save as many older patient's lives as generally claimed.
And a study led by Dean Eurich of the University of Alberta found that flu vaccinated people fared better than those without vaccination during the part of the year when influenza wasn't circulating. Once they adjusted for the "healthy user" effect, however, they found the benefit close to disappeared.
"So for several years now, we have had large studies which question the benefit of influenza vaccination. The notion that flu shots are so important thus seems more the result of repeated assertion than the weight of solid scientific evidence," said Peter Doshi, a graduate student at MIT, who was not involved in the Lancet study.
One of Doshi's studies, published in the May issue of the American Journal of Public Health, questioned the impact of influenza itself. Doshi suggests influenza is not as much of a problem as we have thought. Deaths from influenza have been consistently declining over the twentieth century, a trend that began far before the introduction of widespread vaccination, Doshi asserts.
Still, the researchers say the flu vaccine is safe so it seems worth getting, even if it might lower the risk of pneumonia only slightly.
"Despite our findings, and even though immune responses are known to decline with age, I still want my grandmother to keep getting the flu vaccine," said Jackson.
Doshi finds this troubling because it suggests there is an unspoken rule that "responsible scientists" must encourage vaccination, never question, discourage, or remain neutral, no matter what the evidence is.
"Such a taboo is irresponsible and definitely not serving the public's best interest," he said.
It also throws us back to the 1950s, the era of "the drug is safe, therefore let's use it," Doshi said. In 1962 the Food and Drug Administration required that drug manufacturers had to prove the effectiveness of their products before marketing them.
The flu vaccine might not protect seniors as much as previously thought, according to a study of more than 3,500 patients over age 65 that found no link between flu vaccination and risk of pneumonia during three flu seasons.
One problem with previous studies looking at efficacy is that they failed to account for differences between healthier seniors and those who were 'frail,'" said lead researcher Michael Jackson, a postdoctoral fellow at the Group Health Center for Health Studies.
This study, published in The Lancet, used a rigorous case control method that included a control time period, after a flu vaccine became available but before each flu season actually started.
During those pre-flu season periods, people who had been vaccinated were much less likely to get pneumonia.
Why?
One possibility is the "healthy user" effect.
"Those who got the vaccine happened to be healthier--not because the flu vaccine was protecting them from pneumonia caused by the flu, since it wasn't present yet," Jackson said.
It's not the first study to point out that the use of flu vaccines in seniors might be a waste of time and money. A review by George Washington University researchers published in the Lancet Infectious Diseases found that flu shots may not save as many older patient's lives as generally claimed.
And a study led by Dean Eurich of the University of Alberta found that flu vaccinated people fared better than those without vaccination during the part of the year when influenza wasn't circulating. Once they adjusted for the "healthy user" effect, however, they found the benefit close to disappeared.
"So for several years now, we have had large studies which question the benefit of influenza vaccination. The notion that flu shots are so important thus seems more the result of repeated assertion than the weight of solid scientific evidence," said Peter Doshi, a graduate student at MIT, who was not involved in the Lancet study.
One of Doshi's studies, published in the May issue of the American Journal of Public Health, questioned the impact of influenza itself. Doshi suggests influenza is not as much of a problem as we have thought. Deaths from influenza have been consistently declining over the twentieth century, a trend that began far before the introduction of widespread vaccination, Doshi asserts.
Still, the researchers say the flu vaccine is safe so it seems worth getting, even if it might lower the risk of pneumonia only slightly.
"Despite our findings, and even though immune responses are known to decline with age, I still want my grandmother to keep getting the flu vaccine," said Jackson.
Doshi finds this troubling because it suggests there is an unspoken rule that "responsible scientists" must encourage vaccination, never question, discourage, or remain neutral, no matter what the evidence is.
"Such a taboo is irresponsible and definitely not serving the public's best interest," he said.
It also throws us back to the 1950s, the era of "the drug is safe, therefore let's use it," Doshi said. In 1962 the Food and Drug Administration required that drug manufacturers had to prove the effectiveness of their products before marketing them.
Sunday, August 3, 2008
Exercise in a Pill?
Scientists have discovered what could be the ultimate workout for couch potatoes: exercise in a pill.
In experiments on mice that did no exercise, the chemical compound, known as AICAR, allowed them to run 44 percent farther on a treadmill than those that did not receive the drug.
The drug, according to the researchers, changed the physical composition of muscle, essentially transforming the tissue from sugar-burning fast-twitch fibers to fat-burning slow-twitch ones—the same change that occurs in distance runners and cyclists through training.
According to the study, published Thursday in the journal Cell, the researchers said the drug's fat-burning ability could also help reduce weight, ward off diabetes and prevent heart disease—the benefits of daily aerobic activity without the perspiration.
It is unknown if the drug has any benefit for athletes who actually work out—or any human for that matter, because the research has so far only involved mice.
Lead researcher Ronald Evans, a molecular physiologist at the Salk Institute for Biological Studies in La Jolla, Calif., said he already has been contacted by dozens of athletes and overweight people who have heard about his research from lectures he has given on the subject.
Evans said he has notified world anti-doping officials, who are scrambling to implement a test for it before the Beijing Olympics start next week.
The compound, which is naturally produced in tiny amounts in human muscle cells and has been studied for decades, is readily available through Web sites that cater to researchers. One site was offering it for $120 a gram.
In experiments on mice that did no exercise, the chemical compound, known as AICAR, allowed them to run 44 percent farther on a treadmill than those that did not receive the drug.
The drug, according to the researchers, changed the physical composition of muscle, essentially transforming the tissue from sugar-burning fast-twitch fibers to fat-burning slow-twitch ones—the same change that occurs in distance runners and cyclists through training.
According to the study, published Thursday in the journal Cell, the researchers said the drug's fat-burning ability could also help reduce weight, ward off diabetes and prevent heart disease—the benefits of daily aerobic activity without the perspiration.
It is unknown if the drug has any benefit for athletes who actually work out—or any human for that matter, because the research has so far only involved mice.
Lead researcher Ronald Evans, a molecular physiologist at the Salk Institute for Biological Studies in La Jolla, Calif., said he already has been contacted by dozens of athletes and overweight people who have heard about his research from lectures he has given on the subject.
Evans said he has notified world anti-doping officials, who are scrambling to implement a test for it before the Beijing Olympics start next week.
The compound, which is naturally produced in tiny amounts in human muscle cells and has been studied for decades, is readily available through Web sites that cater to researchers. One site was offering it for $120 a gram.
Saturday, August 2, 2008
Bee Stings and Anaphylaxis
Anaphylaxis has been characterized as a serious allergic reaction that is rapid in onset and may cause death. The reaction can range from mild to severe. It could be a bee sting, as in your friend's case, or a food substance that triggers this reaction.
The body's immune system occasionally identifies a substance -- for example, insect venom -- as a foreign invader, almost like bacteria, and sends antibodies to attack the offending substance. This action results in a release of chemicals within the body that can cause an allergic reaction, such as hives.
However, sometimes an individual develops a sensitivity to the allergen and, when exposed to it, the immune system has an over-the-top response. The chemicals are released in a flood, the blood pressure may drop and the bronchial tubes narrow, causing difficulty breathing or even unconsciousness and death. An anaphylactic response can occur within seconds or minutes of exposure to the allergen.
Why some people have this reaction is still a matter of debate and research. Infrequently the condition appears to be inherited or genetic, but for the majority of cases, we don't have an answer.
We do know that certain factors such as eczema and childhood asthma appear to put people at higher risk for an anaphylactic reaction. But often it's completely unpredictable.
People who've had a mild reaction to a food substance or insect sting should be wary. A mild reaction in the first episode, for example a couple of hives, could be associated with a severe or life-threatening reaction the next time.
You also should be aware that the symptoms may recur soon after treatment. Typically, such symptoms (a biphasic reaction) would return within eight hours of treatment, but in rare instances, they may recur 24 hours or even a day or two later.
Prevention is key. Avoid exposure to known allergens. People who are at risk should carry a syringe of adrenaline (epinephrine). These auto-injectors (EpiPen, Twinject) can be self-administered or used by a loved one on your behalf in the event of an anaphylactic reaction. Some research on desensitization to allergens is under way, but so far desensitization has not been entirely successful.
A S.A.F.E. campaign was developed by experts to promote steps you should take when confronted with such a situation:
Seek support -- If you've had an anaphylactic reaction, educate those around you as to its signs and symptoms and when and how to use medication such as the auto-injector. It also means that during an event, contact 911 early. Even after using an auto-injector, you still need to go to an emergency department to be evaluated for care, as the effects of the epinephrine are only temporary.
Assess for allergen -- Right after the event is probably the time when you and your family are best able to remember what you were exposed to. Most of the time it is obvious, for example, an insect sting or a food source such as seafood, a peanut or tree nut, such as a walnut or pecan.
Follow-up -- Anyone who has experienced a systemic allergic reaction should seek timely follow-up care with a primary care physician and referral to an allergist for further treatment and testing.
Epinephrine -- This is really the cornerstone of treatment for severe reactions with hypotension (low blood pressure) or difficulty breathing. The epinephrine should be given right away at home, in the field or in the emergency room. Those who have had an anaphylactic episode should carry an auto-injector of epinephrine.
Some kinds of food reactions are not dangerous, for example mild scratching in the roof of the mouth or a mildly upset stomach. On the other hand, we prefer to err on the side of caution. People who have experienced an allergic reaction to a food substance or an insect sting should talk to their primary care provider about whether they should carry epinephrine.
Healthy Trust Immediate Medical Care serves 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.
The body's immune system occasionally identifies a substance -- for example, insect venom -- as a foreign invader, almost like bacteria, and sends antibodies to attack the offending substance. This action results in a release of chemicals within the body that can cause an allergic reaction, such as hives.
However, sometimes an individual develops a sensitivity to the allergen and, when exposed to it, the immune system has an over-the-top response. The chemicals are released in a flood, the blood pressure may drop and the bronchial tubes narrow, causing difficulty breathing or even unconsciousness and death. An anaphylactic response can occur within seconds or minutes of exposure to the allergen.
Why some people have this reaction is still a matter of debate and research. Infrequently the condition appears to be inherited or genetic, but for the majority of cases, we don't have an answer.
We do know that certain factors such as eczema and childhood asthma appear to put people at higher risk for an anaphylactic reaction. But often it's completely unpredictable.
People who've had a mild reaction to a food substance or insect sting should be wary. A mild reaction in the first episode, for example a couple of hives, could be associated with a severe or life-threatening reaction the next time.
You also should be aware that the symptoms may recur soon after treatment. Typically, such symptoms (a biphasic reaction) would return within eight hours of treatment, but in rare instances, they may recur 24 hours or even a day or two later.
Prevention is key. Avoid exposure to known allergens. People who are at risk should carry a syringe of adrenaline (epinephrine). These auto-injectors (EpiPen, Twinject) can be self-administered or used by a loved one on your behalf in the event of an anaphylactic reaction. Some research on desensitization to allergens is under way, but so far desensitization has not been entirely successful.
A S.A.F.E. campaign was developed by experts to promote steps you should take when confronted with such a situation:
Seek support -- If you've had an anaphylactic reaction, educate those around you as to its signs and symptoms and when and how to use medication such as the auto-injector. It also means that during an event, contact 911 early. Even after using an auto-injector, you still need to go to an emergency department to be evaluated for care, as the effects of the epinephrine are only temporary.
Assess for allergen -- Right after the event is probably the time when you and your family are best able to remember what you were exposed to. Most of the time it is obvious, for example, an insect sting or a food source such as seafood, a peanut or tree nut, such as a walnut or pecan.
Follow-up -- Anyone who has experienced a systemic allergic reaction should seek timely follow-up care with a primary care physician and referral to an allergist for further treatment and testing.
Epinephrine -- This is really the cornerstone of treatment for severe reactions with hypotension (low blood pressure) or difficulty breathing. The epinephrine should be given right away at home, in the field or in the emergency room. Those who have had an anaphylactic episode should carry an auto-injector of epinephrine.
Some kinds of food reactions are not dangerous, for example mild scratching in the roof of the mouth or a mildly upset stomach. On the other hand, we prefer to err on the side of caution. People who have experienced an allergic reaction to a food substance or an insect sting should talk to their primary care provider about whether they should carry epinephrine.
Healthy Trust Immediate Medical Care serves 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.
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