Soldiers with mental illness more often get PTSD

Soldiers with mental illness more often get PTSD


NEW YORK (Reuters Health) - Preexisting mental health problems could be setting soldiers up for posttraumatic stress disorder, or PTSD, when they return from the battlefield, U.S. Navy researchers said Monday.

They found those with depression, panic disorder or another psychiatric illness were more than twice as likely to develop the condition as their mentally stable peers.

"More vulnerable members of the deployed population might be identified and benefit from interventions targeted to prevent or to ensure early identification and treatment of postdeployment PTSD," Dr. Donald Sandweiss of the Naval Health Research Center in San Diego, California, and colleagues write.

Earlier studies have come to different conclusions, but their methods were less reliable than those used in the current one, the researchers add.

Between seven to eight percent of the general population eventually develops PTSD, according to the National Center for PTSD at the U.S. Department of Veterans Affairs.

The psychological toll -- including flashbacks, "numbing" toward other people, and drug problems -- can be extremely hard to deal with and may destroy relationships or cause trouble on the job.

While PTSD can be treated effectively with talk therapy, the military has also begun focusing on whether the problem might be prevented in the first place -- for instance by identifying those at high risk and preparing them psychologically for conflict.

In the new study, published in the Archives of General Psychiatry, more than 22,000 soldiers completed a health questionnaire before they were deployed to Iraq or Afghanistan, and again after they returned.

Just over three percent had some mental illness, including PTSD, at the outset.

Upon returning, however, eight percent had symptoms of PTSD. Those who had mental illness other than PTSD before deployment had more than twice the odds of developing the condition after they got home.

Physical injuries during deployment were also tied to a higher risk, although much less so than preexisting mental health problems.

SOURCE: http://bit.ly/m15IWv Archives of General Psychiatry

Patient information: Poor weight gain in infants and children

Patient information: Poor weight gain in infants and children
Author
Rebecca T Kirkland, MD, MPH Section Editors
Kathleen J Motil, MD, PhD
Jan E Drutz, MD
Marilyn Augustyn, MD Deputy Editor
Mary M Torchia, MD


POOR WEIGHT GAIN OVERVIEW

During infancy and childhood, children gain weight and grow more rapidly than at any other time in life. However, some children do not gain weight at a normal rate, either because of expected variations related to genes, being born prematurely, or because of undernutrition, which may occur for a variety of reasons. Undernutrition is sometimes called a growth deficit or failure to thrive.

It is important to recognize and treat children who are not gaining weight normally because it may be a sign of undernutrition or an underlying medical problem that requires treatment. Undernutrition can have complications, such as a weakened immune system, shorter than normal height, or difficulties with learning. These complications are more common in children who are undernourished for a long period of time.

HOW IS POOR WEIGHT GAIN DEFINED?

Poor weight gain is defined as gaining weight at a slower rate than other children who are the same age and sex. "Normal" ranges for weight and height are based upon the weight and height of thousands of children. In the United States, standard growth charts are published by the Centers for Disease Control and Prevention; these charts are available for boys and girls and are appropriate for all races and nationalities.

For children 2 years and older, charts are available here for boys (graph 1 and graph 2) and here for girls (graph 3 and graph 4). For children less than 2 years old, charts are available here for boys (graph 5 and graph 6) and here for girls (graph 7 and graph 8).

Weight gain normally follows a predictable course from infancy through adolescence. However, some children do not gain weight normally from birth, while other children gain weight normally for a while, then slow or stop gaining weight. Weight gain usually slows before the child slows or stops growing in length.

A child is said to have poor weight gain if he or she does not grow at the expected rate for their age and sex.

POOR WEIGHT GAIN CAUSES

Poor weight gain is not a disease, but rather a symptom, which has many possible causes. The causes of poor weight gain include the following:

Not consuming an adequate amount of calories or not consuming the right combination of protein, fat, and carbohydrates
Not absorbing an adequate amount of nutrients
Requiring a higher than normal amount of calories


Poor weight gain can occur as a result of a medical problem, a developmental or behavioral problem, lack of adequate food, a social problem at home, or most frequently, a combination of these problems. Common causes of poor weight gain for each age group are described below:

Prenatal — Small for age at birth (called intrauterine growth restriction); prematurity; prenatal infection, birth defects; exposure to medications/toxins that limit growth during pregnancy (eg, anticonvulsants, alcohol).
Neonatal (<1 month) — Poor quality of suck (whether breast- or bottle-fed), incorrect formula preparation; breastfeeding problems; inadequate number of feedings; poor feeding interactions (eg, infant gags or vomits during feedings and parent assumes child is full); neglect; birth defects that affect the child's ability to eat or digest normally
Three to six months — Underfeeding (sometimes associated with poverty or not understanding dietary needs of infants); improper formula preparation; milk protein intolerance; problems with child's mouth/throat; medical problems that affect absorption of nutrients (celiac disease; cystic fibrosis); medical problems that increase the number of calories needed (congenital heart disease), gastroesophageal reflux.
Seven to 12 months — Feeding problems (eg, struggles between the child and parent about what will be eaten; problems with the child's mouth that make it hard to adapt to textured foods, not introducing solids by six months of age; refusal to eat new foods when first offered, and then not offering the food again); intestinal parasites.
Over 12 months — Easily distracted at meal time; illness; new stress at home (divorce, job loss, new sibling, death in the family, etc.); social issues (underfeeding related to fear of overfeeding, limiting food choices, poverty).

POOR WEIGHT GAIN DIAGNOSIS

If an infant or child slows or stops gaining weight, it is important to try to determine and treat the underlying cause. The first step is a complete medical history and physical examination. Most children will not require blood testing or imaging tests, although testing may be recommended in certain situations.

The parent(s) should mention if the child has any of the following:

Vomiting, diarrhea, or rumination (swallowing, regurgitating, then re-swallowing food)
Avoids foods with particular textures (eg, hard or crunchy), which may be a sign of a problem with chewing/swallowing
Avoids types or groups of food (eg, milk, wheat), which can be a sign of a food allergy or intolerance
Drinks large amounts of low-calorie liquids or fruit juices. Drinking these beverages may prevent the child from eating solid foods, which contain more calories.
Follows a restricted diet (vegetarian, wheat or lactose free, etc.)


Parents should also mention if they have eliminated foods from the child's diet due to concern about the effects of these foods (eg, abdominal pain, diarrhea, "hyperactivity").

The provider may also ask about the child's household, including who lives in the child's house, if there have been recent changes or stresses (eg, divorce, illness, death, new sibling), or if anyone in the house has a medical or psychiatric illness. The provider may also ask about the food supply (eg, if there have been days when anyone in the family went hungry because there was not enough money for food). Although these questions can be difficult to answer, it is important to be honest.

In some cases, the provider will ask the parent(s) to keep a record of everything the child eats and drinks for a few days (figure 1). This can help to determine if the child is eating an adequate number and type of calories.

POOR WEIGHT GAIN TREATMENT

The goal of treatment is to provide the child with adequate nutrition so that he or she can "catch up" to a normal weight. There is a range of normal weights for a particular age. Catch-up growth may require changes to the child's diet, feeding schedule, or feeding environment. The parent and healthcare provider should work together to develop a plan that meets the needs of both the child and the family.

The type of treatment needed depends upon the underlying cause of poor weight gain, any underlying medical problems, and the severity of the situation.

Most children who are mildly to moderately malnourished can be managed at home with help from the child's healthcare provider, and in some cases, other specialty providers (eg, dietitian, occupational or speech therapist, social worker, nurse, developmental specialist, child-life worker, psychiatrist).
Children who are severely malnourished are usually hospitalized initially. While in the hospital, the child's diet and weight can be monitored closely.

Nutritional therapy — Nutritional therapy is the primary treatment for children with poor weight gain. The goal of nutritional therapy is to enable "catch up" weight gain, which is usually two to three times the normal rate of weight gain for the child's age. The best way to increase calorie depends upon the child's age and nutritional status; individual recommendations should be determined by the child's healthcare provider or dietitian. A multivitamin supplement may be recommended in some cases.

For infants — The number of calories in breast milk can be increased by pumping the breast milk and adding a predetermined amount of formula powder or liquid concentrate. This combination is called fortified human milk. (See "Patient information: Breast pumps".) This treatment should be undertaken with the supervision of a healthcare provider or dietitian.

The number of calories in infant formula can be increased by adding less water to powder or liquid concentrate, or by adding a calorie supplement, such as polycose or corn oil. As above, this treatment should be undertaken with the supervision of a healthcare provider or dietitian.

Infants between zero and four months require frequent feedings, typically eight to 12 per day; older infants typically require four to six feedings per day.

In older infants, calorie intake can be increased by adding rice cereal or formula powder to pureed foods.

For older children — In older children, calorie intake can be increased by adding cheese, butter, or sour cream to vegetables, or by using calorie enriched milk drinks instead of whole milk. Other ideas are provided in the table (table 1).

During catch-up growth, the amount of calories and protein that a child eats is more important than the variety of foods eaten. For example, if a child is willing to eat chicken nuggets and pizza, but refuses all vegetables, this is acceptable. At meal and snack time, solid foods should be offered before liquids. Fruit juice should be limited to four to eight ounces of unsweetened 100 percent juice per day.

The older child should eat often (every two to three hours, but not constantly). The child should have three meals and three snacks on a consistent schedule. Snacks should be timed so that the child's appetite for meals will not be spoiled (eg, snack time should not occur within one hour of meal time; snacks should not be offered immediately after an unfinished meal). Examples of healthy snacks include crackers, peanut butter, cheese, hard boiled eggs, pudding, yogurt, fresh fruit or vegetables, or pretzels. A multivitamin and mineral supplement may be recommended in some cases.

Eating environment — Changes to the area where the child eats may help the child to eat more. All members of the child's household should be aware of the importance of these changes.

The child should be positioned so that the head is up and the child is comfortable. The child should be allowed to feed him/herself (eg, by holding a bottle or eating finger foods), but may need to be fed soft foods with a spoon. A certain amount of messiness is to be expected as the child learns to feed him/herself. Allow the child to finish eating before cleaning up.
Meal time distractions, such as television, phone calls, and loud music, should be minimized.
Make meal time routines consistent, no matter who feeds the child.
Meal time should be relaxed and social; eating with other family members and pleasant conversation (not related to how much the child eats) are encouraged. Eating with others allows the child to observe how others make food choices, hopefully encouraging healthy eating habits.
Do not be discouraged if the child refuses a new food. New foods may need to be offered multiple times (even up to 10) before they are accepted.
Meal time should be free of battles over eating; caretakers should encourage, but not force, the child to eat; food should not be withheld as punishment. In addition, food should not be offered as a reward.
The child should be praised when he or she eats well, but not punished when he or she does not.


Additional tips are provided in the table (table 2).

Medical treatment — Children who have an underlying medical problem that is limiting weight gain are usually managed by their primary healthcare provider (eg, pediatrician, family practitioner). On occasion, a specialist may need to be consulted (eg, an allergist/immunologist for a child with food allergies, a gastroenterologist for a child with gastroesophageal reflux). These specialists can provide guidance regarding the need to eliminate certain foods. Foods and groups of food (eg, milk products) should not be eliminated without the advice of a knowledgeable healthcare provider because this can further increase a child's risk of undernutrition.

Children who are undernourished are at risk for complications, including an increased risk of developing common infections. Normal infection prevention techniques, such as handwashing and avoiding exposure to sick friends or family, are encouraged. However, it is not usually necessary to take additional precautions (eg, by preventing the child from attending day care or school).

Childhood vaccinations should continue to be given on schedule; immunizations that have been missed should be updated. (See "Patient information: Vaccines for infants and children age 0 to 6 years" and "Patient information: Vaccines for children age 7 to 18 years".)

Developmental and behavioral treatment — Developmental and behavioral problems can increase a child's risk of being underweight. For example, if a child has difficulty chewing or swallowing food, he or she may not be able to consume an adequate number of calories.

In the United States, early intervention programs can provide developmental stimulation and physical and occupational therapy when needed. Some children also benefit from seeing a developmental behavioral pediatrician or behavioral psychologist for further assistance. These clinicians have specialized training in the medical, psychologic, and social aspects of childhood developmental and behavioral problems.

Psychosocial issues — In some situations, the child's poor weight gain is related to issues at home, such as not having an adequate amount of food in the house, parental concerns about feeding the child certain types of food (eg, foods with fat), or medical or psychiatric problems in the parents (eg, alcohol/drug abuse).

In these situations, treatment includes measures to improve conditions at home, ensure that there is enough food for all family members, and educate parents about the importance of adequate nutrition. This may involve:

Home visits by a nurse, social worker, or other clinician to provide education, support, and guidance to parents
Referral to programs that provide supplemental food, eg, Commodity Supplemental Food Program (www.fns.usda.gov/fdd/programs/csfp/), Supplemental Nutrition for Women, Infants, and Children (WIC, www.fns.usda.gov/wic), and food stamps (www.ssa.gov/pubs/10101.html).
Referral to programs for parents, including assistance locating child care, housing, job training, or alcohol/drug abuse treatment. A social worker can usually help to connect a family with these programs.

POOR WEIGHT GAIN FOLLOW UP

Children who are underweight are usually seen by their healthcare provider on a regular basis after treatment begins; the frequency of visits (weekly to monthly) depends upon the individual situation. During these visits, the child will be weighed and measured and the provider will talk to the parent(s) (and child, if applicable) about any new or ongoing questions or concerns. These frequent visits are usually continued until the child's weight is near normal and increasing regularly. If the child is able to take in an adequate amount of calories, catch up weight gain is usually complete within three to six months.

Many parents wonder how poor weight gain will affect the child's height and weight as an adult. A child's size as an adult depends upon several factors, including genetics, the age at which the child was underweight (eg, as young infant versus toddler), the severity of the malnutrition, the presence of underlying medical problems, and how successfully the child's weight and medical problems were managed.

WHERE TO GET MORE INFORMATION

Your child's healthcare provider is the best source of information for questions and concerns related to your child's medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient Level Information:

Patient information: Breast pumps
Patient information: Vaccines for infants and children age 0 to 6 years
Patient information: Vaccines for children age 7 to 18 years

Professional Level Information:

Etiology and evaluation of failure to thrive (undernutrition) in children younger than two years
Management of failure to thrive (undernutrition) in children younger than two years
Management of isolated ventricular septal defects in infants and children
Poor weight gain in children older than two years of age

The following organizations also provide reliable health information.

National Library of Medicine


(www.nlm.nih.gov/medlineplus/ency/article/000991.htm, available in Spanish)

The Nemours Foundation

(http://kidshealth.org/parent/food/weight/failure_thrive.html, available in Spanish)

[1-4]
Last literature review version 19.1: January 2011
This topic last updated: June 26, 2008
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2011 UpToDate, Inc.
References
Committee on Nutrition American Academy of Pediatrics. Failure to thrive (pediatric undernutrition). In: Pediatric Nutrition Handbook, 5th ed, Kleinman, RE (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2004. p.443.
Zenel JA Jr. Failure to thrive: a general pediatrician's perspective. Pediatr Rev 1997; 18:371.
Gahagan S. Failure to thrive: a consequence of undernutrition. Pediatr Rev 2006; 27:e1.
Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. J Am Diet Assoc 2004

You Can Live Your Life Well Why Mental Health Matters

You Can Live Your Life Well
Why Mental Health Matters

Some people think that only people with mental illnesses have to pay attention to their mental health.

But the truth is that your emotions, thoughts and attitudes affect your energy, productivity and overall health. Good mental health strengthens your ability to cope with everyday hassles and more serious crises and challenges. Good mental health is essential to creating the life you want.

Just as you brush your teeth or get a flu shot, you can take steps to promote your mental health. A great way to start is by learning to deal with stress.
How Stress Hurts

Stress can eat away at your well-being like acid eating away at your stomach. Actually, stress can contribute to stomach pains and lots of other problems, like:
headaches
insomnia
overeating
back pain
high blood pressure
irritability
vulnerability to infection

Stress also can lead to serious mental health problems, like depression and anxiety disorders. If you think you have such a problem, you can get help.

Of course you can't magically zap all sources of stress. But you can learn to deal with them in a way that promotes the well-being you want--and deserve.

Learn more about how stress really hurts.
The Evidence

The concrete steps we're suggesting are not based on guesses, fads or advice from grandma (though she probably got a lot right). They represent hundreds of research studies with thousands of participants, often conducted over decades and backed by major universities or government agencies.

This research shows that how good you feel is to a fairly large extent up to you. No matter how stressful your situation, you can take steps to promote your well-being.

We're not talking about huge changes to your lifestyle, either. We're talking about reasonable steps that if used consistently can increase your comfort and boost your ability to build a rewarding life.
About the Live Your Life Well Campaign

Mental Health America is the country's leading non-profit dedicated to promoting mental health. We have worked with communities, families, schools and individuals across the nation to ensure that all people have a chance to thrive. Founded 100 years ago to improve conditions for people with mental illnesses, we have worked tirelessly since then to promote understanding of anxiety disorders, depression and other mental health issues. Our more than 300 affiliate offices help veterans returning from war, victims of natural disasters, children at risk of substance abuse and millions of other people across the country.

Now we are launching the Live Your Life Well campaign to provide tools to people like you who are stressed by the many demands of modern life.

We want you to know that you can thrive even in the face of stress. We want you to know that you can build more of the life you want.

We also want you to know that your mental health is one of your greatest assets. It helps you focus at work, overcome obstacles, get along with the people around you and even fight off illness. And there are simple, effective tools you can use to support this vital asset.

Vitamin E helps diminish a type of fatty liver disease in children NIH-funded researchers gain ground in treatment

Vitamin E helps diminish a type of fatty liver disease in children
NIH-funded researchers gain ground in treatment 


A specific form of vitamin E improved the most severe form of fatty liver disease in some children, according to a study funded by the National Institutes of Health. Results appear in the April 27 issue of the Journal of the American Medical Association. A previous study found vitamin E effective in some adults with the disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease among U.S. children. NAFLD ranges in severity from steatosis (fat in the liver without injury) to nonalcoholic steatohepatitis or NASH (fat, inflammation, and liver damage). Fatty liver increases a child’s risk of developing heart disease and liver cirrhosis. The only way to distinguish NASH from other forms of fatty liver disease is with a liver biopsy. Weight loss may reverse the disease in some children, but other than dietary advice, there are no specific treatments. Excess fat in the liver is believed to cause injury by increasing levels of oxidants, compounds that damage cells.

Most children with fatty liver disease are overweight and resistant to insulin, a critical hormone that regulates energy. Boys are more likely affected than girls, as are Hispanic children compared to African-Americans and whites.

Using liver biopsies, researchers found that after 96 weeks of treatment, 58 percent of the children on vitamin E no longer had NASH, compared to 41 percent of the children on metformin (a diabetes drug), and 28 percent on placebo. Vitamin E was better than placebo because it significantly reduced enlargement and death of liver cells.

"These results suggest that vitamin E improves or resolves NASH in at least half of children, which we previously showed to be true in adults," said Stephen P. James, M.D., director of the digestive diseases and nutrition division at NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which funded the study. While the results are encouraging, patients using vitamin E for NASH should be under a doctor’s care. "We hope to build on these results by looking for other therapies and reliable, non-invasive ways to monitor the disease and response to therapy."

The Treatment of Nonalcoholic Fatty Liver Disease in Children (TONIC) trial studied whether vitamin E (an antioxidant) or metformin could improve fatty liver disease. The endpoint to measure success was either a sustained reduction in the liver enzyme alanine aminotransferase (ALT) or improvements in the liver as shown by biopsies. A total of 173 children, mostly whites and Hispanics ages 8 to 17, were recruited into three treatment groups. The children received either 500 milligrams of metformin or 400 international units of a natural form of vitamin E or placebo twice a day for two years.

Neither vitamin E nor metformin were significantly better than placebo in reducing ALT levels. Twenty-six percent of patients on vitamin E, 16 percent on metformin, and 17 percent of those on placebo had reduced liver enzyme levels. Interestingly, ALT levels improved more rapidly among patients on vitamin E (within six months) compared to those on placebo. The ALT levels among the children on placebo improved over the two years.

"We believe all children in the trial benefited from the frequent diet and exercise advice provided throughout the study," said Joel E. Lavine, M.D., Ph.D., a TONIC principal investigator and professor of pediatrics at Columbia University, New York. "Now we have information on the natural history of a placebo group over time, which will help us design future trials."

Using biopsies in children with liver disease is unique. "TONIC is ground-breaking on two fronts. It is the first study to use liver biopsy to evaluate potential treatments for any liver disease in children," said Patricia Robuck, Ph.D., M.P.H., the project scientist at NIDDK. "It is also the first multi-center, randomized, controlled trial to use a liver biopsy to evaluate a therapy for fatty liver in children, considered the most rigorous design for studies of liver disease."

TONIC was conducted by NASH Clinical Research Network investigators at:
Case Western Reserve University and the Cleveland Clinic, Cleveland
Children's National Medical Center, Washington, D.C.
Indiana University, Indianapolis
Johns Hopkins University, Baltimore (data coordinating center)
Saint Louis University and Washington University, St. Louis
Texas Children's Hospital, Houston
University of California, San Diego
University of San Francisco
Virginia Commonwealth University, Richmond
Virginia Mason Medical Center, teamed with the University of Washington, Seattle

For egg-allergic kids, one-dose flu shot may be OK

For egg-allergic kids, one-dose flu shot may be OK



By Amy Norton

NEW YORK (Reuters Health) - Children with egg allergies may be able to safely get their flu shot in one dose, just like other kids, a new study suggests.

Because the flu vaccine is grown in chicken eggs, there have traditionally been concerns about the safety of flu shots for people with egg allergies -- most of whom are young children.

To be safe, children with egg allergies often get their flu shot divided into smaller doses. They might, for instance, get 10 percent of the dose, then if they have no allergic reaction get the remainder of the dose 30 minutes later.
Children with a history of severe allergic reaction to egg could get up to five small doses.

However, today's flu vaccines actually contain "vanishingly small" amounts of egg protein, said Dr. Susan Laubach, the senior researcher on the new study and a physician at Walter Reed Army Medical Center in Washington, D.C.

And studies have been suggesting that flu vaccination is safe for most children with egg allergies. A study last year in the journal Pediatrics found that of 171 egg-allergic children who received a two-dose flu shot, upwards of 95 percent had no significant reaction. A few had mild symptoms like hives and itchy skin.

The new study, published in the Journal of Allergy & Clinical Immunology, looked at the safety of single-dose vaccination.

Laubach and her colleagues reviewed the records of 152 egg-allergic patients -- mostly young children -- who had gotten a seasonal flu shot and/or the vaccine against "swine flu" during the 2009-2010 flu season.

All of the patients underwent skin-prick testing to see if they were likely to have an immune reaction to the flu vaccine. Only one child had a positive result on the skin test, while six had unclear findings. So, most of the study group was given a single-dose flu shot.

Overall, Laubach's team found, none of the patients had a serious reaction to the vaccine, whether they got one dose or divided doses. That included the 22 percent of patients with a history of severe reactions to egg.

"The results of this study, combined with others, suggest that most kids with egg allergy can probably receive the flu vaccine safely," Laubach told Reuters Health.

These latest findings also suggest that many kids can be vaccinated, literally, in one shot -- which would offer the advantage of having to jab young children only once.

However, more research is needed to confirm that, according to Laubach. She said a clinical trial is now underway comparing two- and single-dose vaccination in egg-allergic kids.

Such clinical trials, Laubach noted, "are our 'gold standard' for proof."

For now, she recommended that parents of children with egg allergies talk with their doctor about flu vaccination.

In general, experts recommend that all children age 6 months or older get an annual flu shot.

Although the flu causes no more than a week or so of misery in most kids, children younger than 5 are at increased risk of flu complications like pneumonia, bronchitis and sinus infections.

There are probably many children with egg allergies who have never gotten the flu shot, Laubach noted. "I hope that will change in the future," she said.

It's estimated that about 1.5 percent of children are allergic to eggs, according to the American College of Allergy, Asthma and Immunology.

SOURCE: http://bit.ly/fWs1OO Journal of Allergy & Clinical Immunology, online April 4, 2011.

Report Ranks Top Sources of Illness Related to Foods Salmonella is leading contaminant, researchers say

Report Ranks Top Sources of Illness Related to Foods
Salmonella is leading contaminant, researchers say

By Robert Preidt

THURSDAY, April 28 (HealthDay News) -- Poultry contaminated with Campylobacter bacteria is the food-pathogen combination that causes the most foodborne illness in the United States, sickening more than 600,000 people a year at a cost of $1.3 billion, according to a new report.

Issued by the University of Florida Emerging Pathogens Institute, the report identifies the 10 riskiest combinations of foods and disease-causing microorganisms in the United States.

"The number of hazards and scale of the food system make for a critical challenge for consumers and government alike," Michael Batz, head of food safety programs at the institute and lead author of the report, said in a university news release.

"Government agencies must work together to effectively target their efforts," Batz said. "If we don't identify which pairs of foods and microbes present the greatest burden, we'll waste time and resources and put even more people at risk."

The top five illness-causing pathogens -- Campylobacter, Salmonella, Listeria monocytogenes, Toxoplasma gondii and norovirus -- cause $12.7 billion in economic losses each year, with the top 10 pathogen-food combinations accounting for more than $8 billion a year, according to the report.

The economic cost takes into account lost productivity, medical care and serious complications or chronic disabilities associated with the illness.

The report names Salmonella as the leading disease-causing microorganism (costing more than $3 billion a year), and Salmonella-contaminated produce, poultry, eggs and multi-ingredient foods all rank in the top 10 food-pathogen combinations.

Other top-ranked combinations include Listeria in deli meats and soft cheeses, Toxoplasma in pork and beef, E. coli in beef and produce, and norovirus in multi-ingredient food products.

SOURCE: University of Florida, news release, April 28, 2011

Armadillos Give Leprosy to Humans in Southern U.S.: Study Experts confirm long-suspected link but say risk is minuscule

Armadillos Give Leprosy to Humans in Southern U.S.: Study
Experts confirm long-suspected link but say risk is minuscule


WEDNESDAY, April 27 (HealthDay News) -- The prehistoric-looking armadillo, already the state animal of Texas, now has a new claim to fame: leprosy.

A new study finds that armadillos carry the bacterium that causes leprosy, and have somehow passed the disease to several dozen humans in the southern United States.

"We've confirmed a long-suspected link between leprosy in humans and armadillos," said the study's lead author, Richard Truman, from the Bureau of Primary Health Care at the Health Resources and Services Administration's National Hansen's Disease Program at Louisiana State University in Baton Rouge.

Truman said it's important to realize that the risk of contracting leprosy (also known as Hansen's disease) from armadillos "is still infinitesimally small."

"The last thing we want is to induce panic in the population and incite a slaughter of armadillos. The best way to combat further infection is through education and prudence," the study's senior author, Stewart Cole, from the Global Health Institute in Lausanne, Switzerland, said in a news release.

James Krahenbuhl, director of the National Hansen's Disease Program, agreed. "This study doesn't change the risk of acquiring Hansen's disease from armadillos. It doesn't increase the risk. In fact, we're hoping publicity should decrease the risk by encouraging the public to decrease their contact with armadillos," he said.

Leprosy, caused by Mycobacterium leprae, is characterized by disfiguring skin lesions and peripheral nerve damage. The disease has been around since Biblical times, and was likely brought to North America by European settlers. People with leprosy were once shunned, and often forced to live in "leper colonies." Fortunately, the disease is treatable today, though it requires a long course of antibiotics.

Krahenbuhl said the treatment consists of a "cocktail" of three antibiotics ideally taken for two years. "The key is to diagnose early to prevent deformity and disability. Once these occur, they're irreversible. And, this is problematic because most physicians aren't even aware that the disease still exists," he said.

Although rare in the United States, leprosy still affects many people in tropical and semitropical areas. Almost 250,000 cases were reported worldwide in 2008. In the United States, the authors estimate that about 150 people develop Hansen's disease each year. And, most of these have traveled to parts of the world where leprosy is more common.

But the researchers noticed that about one-third of new cases developed in people who hadn't left the country, and most of these people lived in Louisiana or Texas.

Since the 1970s, armadillos have been suspected of being potential carriers of the disease. Their low body temperature makes them ideal incubators for the bacteria, according to the authors.

Using DNA analysis, the researchers were able to identify a unique strain of M. leprae that was present in 28 of 33 armadillos tested and 25 of 39 U.S. residents who lived in areas where exposure to armadillos would be possible.

Results of the study are published in the April 28 issue of the New England Journal of Medicine.

"The researchers used the same type of DNA analysis that's used in foodborne illness outbreaks. It's how we know that a certain strain of salmonella is responsible for a particular outbreak," explained Dr. Kenneth Bromberg, director of the Vaccine Research Center at the Brooklyn Hospital Center in New York City.

"This is a warning for people in the south and southwest who might have environmental exposure to stay away from armadillos," said Bromberg.

The study authors recommend that frequent direct contact with armadillos should be discouraged, as should consumption of armadillo meat.

SOURCES: Richard Truman, Ph.D., Bureau of Primary Health Care, Health Resources and Services Administration, National Hansen's Disease Program, Louisiana State University, Baton Rouge, La.; James Krahenbuhl, Ph.D., director, National Hansen's Disease Program, Louisiana State University, Baton Rouge, La.; Kenneth Bromberg, M.D., director, Vaccine Research Center, Brooklyn Hospital Center, New York City; April 28, 2011, New England Journal of Medicine

Animal Diseases and Your Health Also called: Zoonoses

Animal Diseases and Your Health

Also called: Zoonoses 


Animal diseases that people can catch are called zoonoses. About 75 percent of the new diseases affecting humans in the past decade can be traced to animals or animal products. You can get a disease directly from an animal, or indirectly, through the environment.

Farm animals can carry diseases. If you touch them or things they have touched, like fencing or buckets, wash your hands thoroughly. Adults should make sure children who visit farms or petting zoos wash up as well.

Pets can also make you sick. Reptiles pose a particular risk. Turtles, snakes and iguanas can transmit Salmonella bacteria to their owners. You can get rabies from an infected dog or toxoplasmosis from handling kitty litter of an infected cat. The chance that your dog or cat will make you sick is small. You can reduce the risk by practicing good personal hygiene, keeping pet areas clean and keeping your pets' shots up-to-date.

Anxiety Disorders in Children and Adolescents (Fact Sheet)

Anxiety Disorders in Children and Adolescents (Fact Sheet)

A fact sheet that describes the development in our understanding of how anxiety disorders affect children and adolescents and the direction of future research.

Anxiety can be a normal reaction to stress. It can help us deal with a tense situation, study harder for an exam, keep focused on an important speech. In general, it can help us cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling condition. Examples of anxiety disorders are obsessive compulsive disorder, post-traumatic stress disorder, social phobia, specific phobia, and generalized anxiety disorder. Symptoms of many of these disorders begin in childhood or adolescence.
Yesterday
The brain areas and circuitries underlying symptoms of anxiety disorders were unknown.
No targeted psychotherapies for anxiety disorders existed.
Clinicians did not have strong information to help them make treatment decisions between a specific psychotherapy, medication alone, or a combination of medication and psychotherapy.
Today
A large, national survey of adolescent mental health reported that about 8 percent of teens ages 13-18 have an anxiety disorder, with symptoms commonly emerging around age 6. However, of these teens, only 18 percent received mental health care.
Imaging studies show that children with anxiety disorders have atypical activity in specific brain areas, compared with other people. For example:
In one, very small study, anxious adolescents exposed to an anxiety-provoking situation showed heightened activity in brain structures associated with fear processing and emotion regulation, when compared with normal controls.
Another small study found that youth with generalized anxiety disorder had unchecked activity in the brain’s fear center, when looking at angry faces so quickly that they are hardly aware of seeing them.
Brain scans of teens sizing each other up reveal an emotion circuit activating more in girls as they grow older, but not in boys. This finding highlights how emotion circuitry diverges in the male and female brain during a developmental stage in which girls are at increased risk for developing mood and anxiety disorders.
The Child/Adolescent Anxiety Multimodal Study (CAMS), in addition to other studies on treating childhood anxiety disorders, found that high-quality cognitive behavioral therapy (CBT), given with or without medication, can effectively treat anxiety disorders in children. One small study even found that a behavioral therapy designed to treat social phobia in children was more effective than an antidepressant medication.
Tomorrow
Novel approaches to treatment and prevention that are currently being studied in adults with anxiety disorders may someday lead to advances in treatment for children. Examples of such approaches include:
Identifying predictive markers, such as hormone levels and genes, for determining people at risk for developing PTSD after a traumatic event.
Developing Internet-based cognitive and behavioral therapies to make interventions more widely available.
Imaging, molecular biology, and genetics research are pointing the way to brain mechanisms involved in anxiety disorders. Features of these mechanisms are potential biomarkers that could identify people at risk—a key to early intervention—or help clinicians to determine which treatments are likely to work for different patients.
Research to identify brain mechanisms involved in anxiety disorders also holds the potential to reveal targets for better medications with fewer side effects.

Don't Blame Memory for Trouble Switching Tasks Study points instead to slowdown in brain's processing speed that comes with aging

Don't Blame Memory for Trouble Switching Tasks
Study points instead to slowdown in brain's processing speed that comes with aging

By Robert Preidt

TUESDAY, April 26 (HealthDay News) -- Slowing of the brain's processing speed as people age is the prime cause of typical communication problems in older adults, new research indicates.

In the study, University of Kansas researchers compared the ability of young and older adults to do two things at once: keep a cursor on a moving target on a computer screen while responding to questions. Overall, younger adults did better at this dual-tasking.

"We didn't find much evidence that working memory or long-term memory play a role in dual-tasking, but we think that processing speed does," psychology professor Susan Kemper, a senior scientist at the Gerontology Center at the university's Life Span Institute, said in a university news release.

"What I think is going on is that you have to rapidly switch your attention from tracking to talking, going back and forth pretty rapidly, and that's where the processing speed really comes in," Kemper said. "Older adults seem to be slower at switching between tasks so their functional ceiling is lower."

The study findings were published recently in both the Journal of Gerontology: Psychological Sciences and Psychology and Aging.

Language and communication problems, especially those that occur during dual-tasking, may be early indicators of the onset of Alzheimer's disease or other types of dementia, Kemper said.

"We know that there are brain markers even for people in their 40s who may be on the verge of developing dementia," Kemper said. "But those are revealed by very expensive tests that are not widely available. So perhaps language and communication might provide early warning signs that might be picked up and also serve as an access point for trying to develop interventions."

SOURCE: University of Kansas Life Span Institute, news release, April 22, 2011

Flu Vaccine Appears Safe After Kidney Transplant Vaccinated patients were less likely to lose new organ or to die, study says

Flu Vaccine Appears Safe After Kidney Transplant
Vaccinated patients were less likely to lose new organ or to die, study says

By Robert Preidt

THURSDAY, April 28 (HealthDay News) -- Flu vaccination is safe for kidney transplant patients and lowers their risk of organ loss and death, a new study says.


Kidney transplant patients face a high risk of death if they get infected with flu, but some previous studies have suggested that flu vaccines could trigger an immune response that might lead to rejection of the new organ, the study authors noted.

In addition, some research has suggested that immune system-suppressing drugs that transplant patients must take may reduce the effectiveness of flu vaccines.

In this new study, researchers analyzed Medicare data about flu vaccination and flu cases in 51,730 adults who received a kidney transplant between January 2000 and July 2006 and were followed until October 2006.

Of those patients, 9,678 -- or 18.7 percent -- received a flu vaccination in the first year after their transplant. These patients were 23 percent less likely to suffer organ loss and 18 percent less likely to die during the study period than patients who didn't receive a flu vaccination, the researchers found.

The 310 study patients (0.6 percent) who got the flu were no more likely to lose their transplanted kidney than those who did not get the flu.

The study is published online April 28 in the Clinical Journal of the American Society of Nephrology.

The findings show that flu vaccination shouldn't be withheld from kidney transplant patients because of fears that the new organ could be harmed, said Dr. Frank Hurst of the Walter Reed Army Medical Center and F. Edward Hebert School of Medicine, and colleagues in a journal news release.

However, they added, there's no proof that flu vaccination actually prevents flu in kidney transplant recipients.

SOURCE: Clinical Journal of the American Society of Nephrology, news release, April 28, 2011

Breast-feeding May Influence Long-Term Health: Study Formula vs. breast-fed babies show metabolic differences in first three years of life

Breast-feeding May Influence Long-Term Health: Study
Formula vs. breast-fed babies show metabolic differences in first three years of life

By Robert Preidt

MONDAY, MAY 2 (HealthDay News) -- Infants who aren't breast-fed may experience long-term health consequences, a new study suggests.

French researchers compared growth, body composition (fat mass vs. lean body mass) and blood pressure in three groups of newborns. One group was breast-fed for the first four months of life, while infants in the two other groups received one of two types of formula: a lower-protein formula with 1.8 grams (g) of protein per 100 kilocalories (kcal) or a higher-protein formula with 2.7 g/100 kcal.

The protein content of both formulas fell within the recommended range of formula protein levels, researchers noted.

After four months, the infants in the formula-fed groups continued to receive the same formula while the breast-fed infants were switched to the low-protein formula, if needed.

Researchers then followed the 234 children for three years.

By age 3, diastolic and average blood pressure for babies fed the higher-protein formulas was higher than for breast-fed kids, though the blood pressure was still within the normal range.

Children who were breast-fed also showed a different pattern of growth and metabolic profile than formula-fed infants. The breast-fed infants had lower blood insulin levels when they were 15 days and 4 months old, but not when they were 9 months old.

The breast-fed infants also had different growth patterns during their first year of life, but by age 3, there were no differences in length, weight or body composition (fat. vs. lean mass).

Though what these differences mean over a lifespan is unclear, researchers said it may be evidence of a "metabolic programming effect," or the concept that nutritional experiences at critical points early in life can influence a person's future metabolism and health.

"It appears that formula feeding induces differences in some hormonal profiles as well as in patterns of growth compared with breast-feeding," study co-author Dr. Guy Putet said in an American Academy of Pediatrics news release. "The long-term consequences of such changes are not well-understood in humans and may play a role in later health. Well-designed studies with long-term follow-up are needed."

The study was to be presented Monday at the annual meeting of the Pediatric Academic Societies in Denver. The data and conclusions should be viewed as preliminary until confirmed in large long-term studies.

SOURCE: American Academy of Pediatrics, news release, May 2, 2011

Catheterization recommended for treating pediatric heart conditions

Catheterization recommended for treating pediatric heart conditions

Statement Highlight:

Because of new developments in procedures, technology and expertise, considerations for using catheterization to treat children born with heart defects in addition to its role in diagnosis are reviewed.

DALLAS, May 2, 2011 — Doctors should consider using catheterization as a treatment tool in addition to its established role in diagnosing children with heart defects, according to a new American Heart Association scientific statement.

A catheter is a thin flexible tube inserted into a blood vessel and used in procedures such as angiography, in which physicians use the catheter to inject dye into the arteries near the heart to illuminate the vessels via X-ray technology. It can also open a valve, enlarge a narrow blood vessel, close a hole in the heart or close off a blood vessel.

The statement, published in Circulation: Journal of the American Heart Association, is a major overhaul of the association’s last statement released in 1998.

“What we can offer patients now, versus just 10 or 15 years ago, is remarkably different,” said Timothy F. Feltes, M.D., lead author of the statement and chief of pediatric cardiology and professor of pediatrics at The Ohio State University. “There have been tremendous advances in the procedures, devices, experience and the expertise of the physicians who perform the procedures. As physicians caring for patients with congenital heart disease, we have to look at heart catheterizations a little differently than we have in the past.”

The statement provides an extensive inventory of diagnostic and interventional techniques that are now considered as options for pediatric patients, noting that catherization procedures carry a degree of risk for patients.

Some of the 22 new therapeutic options for congenital heart disease include catheter-based techniques to: improve blood flow through the heart; repair inborn heart defects such as holes in the heart, repair or replace faulty valves; remove arterial blockages and many other conditions, such as malformed heart chambers.

In addition, the statement covers several hybrid procedures that use traditional surgical techniques in combination with catherization for treating conditions such as hypoplastic left heart syndrome (severe under development of the left side of the heart), stent implantation (to widen arteries and keep them open) and others.

The take-home message of this statement, Feltes said, is that “there are numerous conditions that are best served by interventional catheterization procedures.”

The statement is key to cardiologists who treat pediatric defects, because there are few other sources of such information. “By virtue of the relatively small number of children and adolescents with congenital heart disease, it is difficult to design clinical trials. Ideally, you need thousands of patients to compare one treatment versus another. Only one child in 100 is born with heart disease, so it is very unlikely that one center will have more than one patient to do a side-by-side comparison,” Feltes said.

The Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics endorsed the statement.

Study Reveals Association Between Childhood Vaccination and Care by CAM Providers

Study Reveals Association Between Childhood Vaccination and Care by CAM Providers


Children in Washington State who receive care from complementary and alternative medicine (CAM) providers are less likely to receive recommended pediatric immunizations and are more likely to be diagnosed with a vaccine-preventable disease. This is according to a study funded by NCCAM and published in the Maternal and Child Health Journal. Previous research has shown an association between parents who use and support CAM therapies and opposition to childhood vaccinations.

Researchers from the University of Washington and the University of Missouri-Kansas City analyzed insurance claims and enrollment data in Washington State from 2000 to 2003. The researchers analyzed two subsets of the data. In the first, they correlated provider-based CAM use with vaccinations in 11,144 children ages 1 to 2 years. CAM services were provided by chiropractors, naturopaths, acupuncturists, or massage therapists.

A total of 10,719 children received conventional care only, 376 received conventional and CAM care, and 49 received only CAM care. Among all of the children, 75 percent received diphtheria/tetanus or Haemophilus influenza type B vaccinations, 67 percent received measles/mumps/rubella vaccinations, and 51 percent received chickenpox vaccinations. Children who saw conventional and CAM providers had significantly lower vaccination rates for all four vaccines than children who saw only conventional health care providers. Children who saw only CAM providers had even lower vaccination rates. Those who received naturopathic care had consistently reduced rates of all four vaccinations, while those who received chiropractic care had reduced rates of all except diphtheria/tetanus.

The second aspect of the study focused on the relationship between CAM use and the diagnosis of a vaccine-preventable disease. The researchers examined family insurance records of 213,884 children ages 1 to 17 years. More than 7 percent of the children received care from a CAM provider, most commonly a chiropractor, and approximately 30 percent had family members who used CAM providers. Children who saw a CAM provider were more likely to be diagnosed with a vaccine-preventable disease than than those who saw only a conventional provider; the percentage of those diagnosed was low (about 1 percent)—and most diagnoses (85 percent) involved chickenpox. Use of naturopathy was associated with significantly more vaccine-preventable disease diagnoses than were other CAM therapies.

The researchers noted that although the findings suggest that parents who use CAM providers for their children are less likely to meet recommended pediatric vaccination schedules, the data do not clarify whether the reduced vaccination rates among children who see CAM providers reflect an increased likelihood that vaccine-hesitant parents seek out CAM practitioners, or a direct result of influence of CAM providers on parents’ attitudes and choices. However, the researchers suggest that outreach and promotion of immunization awareness and education as well as intervention strategies with parents and CAM providers may be needed to increase their support for and adherence to recommendations regarding childhood immunizations.
Reference
Downey L, Tyree PT, Huebner CE, et al. Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers. Maternal and Child Health Journal. 2010;14(8):922–930.

U.S. Asthma Rates Continue to Rise CDC and partners reinforce World Asthma Day's message take control of your asthma

U.S. Asthma Rates Continue to Rise
CDC and partners reinforce World Asthma Day's message take control of your asthma

People diagnosed with asthma in the United States grew by 4.3 million between 2001 and 2009, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention. In 2009, nearly 1 in 12 Americans were diagnosed with asthma. In addition to increased diagnoses, asthma costs grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6 percent increase. The explanation for the growth in asthma rates is unknown.

Asthma is a lifelong disease that causes wheezing, breathlessness, chest tightness, and coughing, though people with asthma can control symptoms and prevent asthma attacks by avoiding things that can set off an asthma attacks, and correctly using prescribed medicine, like inhaled corticosteroids. The report highlights the benefits of essential asthma education and services that reduce the impact of these triggers, but most often these benefits are not covered by health insurers.

"Despite the fact that outdoor air quality has improved, we've reduced two common asthma triggers—secondhand smoke and smoking in general—asthma is increasing," said Paul Garbe, D.V.M., M.P.H, chief of CDC's Air Pollution and Respiratory Health Branch. "While we don't know the cause of the increase, our top priority is getting people to manage their symptoms better."

Asthma triggers are usually environmental and can be found at school, work, home, outdoors, and elsewhere and can include tobacco smoke, mold, outdoor air pollution, and infections linked to influenza, cold-like symptoms, and other viruses.

Asthma diagnoses increased among all demographic groups between 2001 and 2009, though a higher percentage of children reported having asthma than adults (9.6 percent compared to 7.7 percent in 2009), Diagnoses were especially high among boys (11.3 percent). The greatest rise in asthma rates was among black children (almost a 50 percent increase) from 2001 through 2009. Seventeen percent of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.

Annual asthma costs in the United States were $3,300 per person with asthma from 2002 to 2007 in medical expenses. About 2 in 5 uninsured and 1 in 9 insured people with asthma could not afford their prescription medication.

"Asthma is a serious, lifelong disease that unfortunately kills thousands of people each year and adds billions to our nation's health care costs," said CDC Director Thomas R. Frieden, M.D., M.P.H. "We have to do a better job educating people about managing their symptoms and how to correctly use medicines to control asthma so they can live longer more productive lives while saving health care costs."

This report coincides with World Asthma Day, an annual event sponsored by the Global Initiative for Asthma. This year's theme is "You Can Control Your Asthma." Reducing asthma attacks and the human and economic costs of asthma are key priorities for the U.S. Department of Health and Human Services and the focus of a collaborative effort involving many parts of HHS. In support of this effort CDC recommends:
Improving indoor air quality for people with asthma through measures such as smoke-free air laws and policies, healthy schools and workplaces.
Teach patients how to avoid asthma triggers such as tobacco smoke, mold, pet dander, and outdoor air pollution.
Encouraging clinicians to prescribe inhaled corticosteroids for all patients with persistent asthma and to use a written asthma action plan to teach patients how manage their symptoms.
Promoting measures that prevent asthma attacks such as increasing access to corticosteroids and other prescribed medicines.
Encourage home environmental assessments and educational sessions conducted by clinicians, health educators, and other health professionals both within and outside of the clinical setting.
About Vital Signs

CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, access to health care, HIV/AIDS, motor vehicle passenger safety, health care-associated infections, cardiovascular health, teen pregnancy, asthma, and food safety.

Heart Bypass Surgery Rates Drop Dramatically, Study Finds But researchers say it's still the best option for certain patients

Heart Bypass Surgery Rates Drop Dramatically, Study Finds
But researchers say it's still the best option for certain patients


TUESDAY, May 3 (Healthlinne News) -- The number of heart patients getting bypass surgery fell by nearly 40 percent between 2001 and 2008, new U.S. research finds.

The drop likely reflects several factors, including a decline in smoking rates, which has led to less coronary artery disease, said senior study author Dr. Peter Groeneveld, an assistant professor of medicine at the University of Pennsylvania School of Medicine.

Also, better and more aggressive treatment of coronary artery disease risk factors, such as high blood pressure, high cholesterol and diabetes, means fewer patients progress to needing surgery.

Another factor is that many patients with blocked arteries instead undergo percutaneous coronary intervention (PCI), also called balloon angioplasty, in which a doctor threads a catheter into the artery and inflates a balloon at the tip. Usually, a wire mesh structure called a stent is left behind to prevent the artery from narrowing again.

Though PCI is an excellent option for many patients, researchers stressed that bypass surgery -- officially called coronary artery bypass graft, or CABG -- may be the best option for some patients with certain severe blockages, including those with triple blockages or left main coronary artery stenosis, Groeneveld said.

"Patients need to be aware that CABG can be a good treatment option, and it's gotten better," Groeneveld said. "There have been several innovations that have made the recovery time much less than it used to be." In CABG, a new artery or vein is grafted, or connected, to the blocked artery to restore blood flow.

The study is published in the May 4 issue of the Journal of the American Medical Association.

Groeneveld and his colleagues analyzed data on a national sample of patients who underwent procedures to clear blockages at U.S. hospitals between 2001 and 2008. Most of the procedures were scheduled, though some were for emergency situations such as heart attacks.

During that period, there was a 15 percent overall decrease in procedures to clear coronary blockages, the investigators found.

Most of that reduction was because of a decline in annual CABG surgeries, which dropped by 38 percent. PCI, in contrast, held mostly steady with a 4 percent dip.

When the figures were projected to the entire U.S. population, there were an estimated 130,000 fewer CABG surgeries in 2008 compared with 2001, according to the study.

Dr. Debabrata Mukherjee, chief of cardiology at Texas Tech University Health Sciences Center, said even though PCI popularity has risen (the number of hospitals offering PCI increased by 26 percent during the study period, compared to about 12 percent for CABG), technological advances have made fewer PCI surgeries necessary.

In 2003, the U.S. Food and Drug Administration approved drug-eluting stents, which come with an immunosuppressant coating that helps prevent scarring and inflammation around the stent. The improved stents, which were in widespread use by 2005, reduced the need for redoing procedures because of scarring, Mukherjee said.

Prior to the innovation, about one-third of PCI patients needed a re-do within six months, he said. "Now, 5 percent, maybe 10 percent at most, need to come back," he said. "There has been a marked decrease in repeat procedures. So even as cardiologists are taking on more complex, multi-vessel cases, the overall volume of PCI hasn't gone up."

Groeneveld raised another possibility for the decline in CABG: Interventional cardiologists can do PCI, while only cardiac surgeons do bypass surgery.

Since most people see a cardiologist who would refer them to a cardiac surgeon if necessary, it's possible some patients who might be better off getting bypass surgery are being offered PCI instead, Groeneveld said.

"My hunch is cardiologists are referring fewer [patients] onto surgeons and treating more with interventional cardiology," he said. "The worry is there are patients who really who should be getting CABG that aren't getting it."

While bypass procedures used to involve cutting through the chest, technological advances now allow surgeons to do the procedure much less invasively. Innovations include doing the surgery through a small incision and using fiber-optic cameras, or even robotic surgery.

Despite the improvements, it's possible old perceptions die hard. Given the choice between doing PCI on the spot or waiting to see a surgeon and getting bypass surgery that comes with a longer recovery time, many patients may opt for the PCI, Groeneveld said.

"Patients are sometimes put in positions to make decisions while lying on a cath lab table with a cardiologist leaning over them," Groeneveld said, referring to the catheterization lab, where cardiologists perform PCIs.

"Patients should be made aware that there are alternatives to PCI, and those conversations about whether PCI is the right thing should be happening before the patient goes into the cath lab," he added.

SOURCES: Peter W. Groeneveld, M.D., assistant professor, medicine, University of Pennsylvania School of Medicine, Philadelphia; Debabrata Mukherjee, M.D., chief, cardiology, Texas Tech University Health Sciences Center, El Paso; May 4, 2011, Journal of the American Medical Association

Many Consumers Don't Know What's in Over-the-Counter Painkillers: Study Lack of knowledge about active ingredients may up the risk of overdose, researchers say

Many Consumers Don't Know What's in Over-the-Counter Painkillers: Study
Lack of knowledge about active ingredients may up the risk of overdose, researchers say

By Robert Preidt

TUESDAY, May 3 (HealthDay News) -- Few Americans bother to read the labels on over-the-counter pain relievers, nor do they pay much attention to the drugs' ingredients, a new study says.

This lack of awareness could be a main reason why acetaminophen overdose is a leading cause of acute liver failure in the United States, according to the researchers at Northwestern University in Chicago.

Acetaminophen, the active ingredient in Tylenol, is in more than 600 over-the-counter (OTC) and prescription medicines.

Researchers interviewed 45 people in six focus groups and found that only 31 percent knew that Tylenol contained acetaminophen, 19 percent realized Advil contained ibuprofen and about the same number knew that Aleve contained naproxen sodium.

About 75 percent knew Bayer contained aspirin and 47 percent knew Motrin contained ibuprofen.

Fewer than half -- 41 percent -- said they read the ingredients on drug labels.

The study appears in the May 3 issue of the American Journal of Preventive Medicine.

The fact that many people don't know acetaminophen is present in OTC products is "incredibly alarming," said senior author Michael Wolf, an associate professor of medicine at Northwestern University Feinberg School of Medicine.

"People may unintentionally misuse these medicines to a point where they cause severe liver damage," Wolf said in a university news release. "It's easy to exceed the safe limit if people don't realize how much acetaminophen they are taking. Unlike prescription products, there is no gatekeeper, no one monitoring how you take it."

He and his colleagues recommend that a universal icon for acetaminophen should appear on the labels of all medicines that contain it.

The study was funded by McNeil Consumer Healthcare, which makes Tylenol. Wolf has worked as a paid consultant to McNeil.

SOURCE: Northwestern University, news release

MRIs Can Tell Endometrial, Cervical Cancer Apart: Study In about 3 percent of cases, biopsies fail to do so, researchers say

MRIs Can Tell Endometrial, Cervical Cancer Apart: Study
In about 3 percent of cases, biopsies fail to do so, researchers say

By Robert Preidt

TUESDAY, May 3 (HealthDay News) -- Magnetic resonance imaging (MRI) can distinguish between endometrial and cervical cancer in most cases where a biopsy fails to do so, a new study says.

It found that radiologists using MRI were able to correctly identify the type of cancer in 38 of 48 patients, or 79 percent, who had inconclusive biopsy results.

More than 43,000 women were newly diagnosed with endometrial cancer, which starts in the lining of the uterus, in the United States last year, according to the U.S. National Cancer Institute.

There were about 12,200 newly diagnosed cases of cervical cancer, which starts in the cervix, or the lower part of the uterus that opens into the vagina, according to the NCI.

"In about 3 percent of the cases, there is difficulty determining the primary cancer site," said study author Dr. Heather He, of the M.D. Anderson Cancer Center in Houston, in an American Roentgen Ray Society news release. "Knowing the primary cancer site means that we can give the patients the most appropriate therapy and save some patients from unnecessary surgery."

The MRI images used in the study were examined by two radiologists, one with five years' experience and the other with 18 years' experience. Their diagnoses matched most of the time, which shows that extensive experience isn't crucial, according to He.

The study was presented Tuesday at the society's annual meeting in Chicago.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCE: American Roentgen Ray Society, news release, May 3, 2011

Expert Suggests Skipping Pelvis When Scanning for Clots Technique would cut radiation exposure but not harm diagnosis, study suggests

Expert Suggests Skipping Pelvis When Scanning for Clots
Technique would cut radiation exposure but not harm diagnosis, study suggests

By Robert Preidt

TUESDAY, May 3 (HealthDay News) -- A new study suggests that eliminating the pelvis from areas of the lower body that are scanned when looking for blood clots would not lessen the effectiveness of the test but would significantly reduce the exposure to radiation.

The imaging test, called CT venography, checks for a venous thromboembolism, or a blood clot in the veins. Such clots usually form in the legs. It's critical to locate and treat any clots before they can migrate to the lungs, where they can be life-threatening.

But it does not truly aid the diagnosis to include the pelvis in the scanning, according to the researchers, who were to present their findings Tuesday in Chicago at the annual meeting of the American Roentgen Ray Society.

The study involved an analysis of data on 1,527 people who were examined for venous thromboembolism at the Nassau University Medical Center in East Meadow, N.Y., during a three-year period. In those exams, just five people -- 0.3 percent -- were found to have isolated pelvic VTE, according to the study.

Dr. Charbel Ishak, the study's lead author, said that the finding should help radiologists implement new protocols for pelvic examinations that would reduce patients' exposure to radiation.

"Radiologists and technologists can eliminate pelvic imaging while acquiring only images of the lower extremities with CT venography, starting from groin to below the knee," he said in a news release from the society. "We believe that by stopping the imaging of the pelvis, we can decrease patient radiation dose without significantly affecting the diagnosis of VTE."

Experts note that research presented at a meeting should be considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals.

SOURCE: American Roentgen Ray Society, news release, May 3, 2011

Analysis of National Survey Shows CAM Use in People With Pain or Neurological Conditions

Analysis of National Survey Shows CAM Use in People With Pain or Neurological Conditions

According to an analysis of the 2007 National Health Interview Survey, approximately 44 percent of American adults with pain or neurological conditions, compared to about 33 percent of people without those conditions, used complementary and alternative medicine (CAM) during the previous year. The analysis, published in the Journal of Neurology, also revealed that 51 percent of adults with these conditions did not talk to their health care provider about their CAM use.

Researchers examined common pain or neurological conditions: headaches, including migraines; memory loss; stroke; low-back pain spreading to the leg; seizures; and dementia. The most common CAM therapies used by people with these conditions were mind-body therapies (25 percent), such as deep breathing exercises, meditation, and yoga; biologically based therapies (21 percent), such as herbal therapies; manipulative and body-based therapies (19 percent), such as massage and chiropractic care; and alternative medical systems (4 percent).

Nearly 33 percent of respondents with pain or neurological conditions, compared to approximately 21 percent of respondents without those conditions, reported using CAM because of their health care provider’s recommendation. In addition, respondents with pain or neurological conditions indicated that they used CAM because conventional treatment did not work (20 percent vs. 10 percent) and was too expensive (9 percent vs. 4 percent).

These data offer more insight into the use of CAM by people with pain or neurological conditions. The researchers noted that this analysis demonstrates the need for more robust studies on the efficacy of CAM therapies for people with these conditions.
Reference
Wells RE, Phillips RS, Schachter SC, et al. Complementary and alternative medicine use among U.S. adults with common neurological conditions. Journal of Neurology. 2010;257:1822–1831.

FDA approves new treatment for Type 2 diabetes

FDA approves new treatment for Type 2 diabetes

The U.S. Food and Drug Administration today approved Tradjenta (linagliptin) tablets, used with diet and exercise, to improve blood glucose control in adults with Type 2 diabetes.

People with Type 2 diabetes do not produce or respond normally to insulin, a hormone that regulates the amount of glucose in the blood. Over time, high blood glucose levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage.

"This approval provides another treatment option for the millions of Americans with Type 2 diabetes," said Mary Parks, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research. “It is effective when used alone or when added to existing treatment regimens.”

Type 2 diabetes is the most common form of the disease, affecting between 90 percent and 95 percent of the 24 million people in the United States with diabetes. Tradjenta increases the level of hormones that stimulate the release of insulin after a meal by blocking the enzyme dipeptidyl peptidase-4 or DPP-4, which leads to better blood glucose control.

Tradjenta was demonstrated to be safe and effective in eight double-blind, placebo-controlled clinical studies involving about 3,800 patients with Type 2 diabetes. The studies showed improvement in blood glucose control compared with placebo.

Tradjenta has been studied as a stand-alone therapy and in combination with other Type 2 diabetes therapies including metformin, glimepiride, and pioglitazone. Tradjenta has not been studied in combination with insulin, and should not be used to treat people with Type 1 diabetes or in those who have increased ketones in their blood or urine (diabetic ketoacidosis).

Tradjenta will be dispensed with an FDA-approved Patient Package Insert that explains the drug’s uses and risks. The most common side effects of Tradjenta are upper respiratory infection, stuffy or runny nose, sore throat, muscle pain, and headache.

Tradjenta is marketed by Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Conn., and Indianapolis-based Eli Lilly Co.

When Combined with Chemotherapy, Bevacizumab Is Associated with Increased Risk of Death

When Combined with Chemotherapy, Bevacizumab Is Associated with Increased Risk of Death

Adapted from the NCI Cancer Bulletin.

Cancer patients who receive the targeted therapy bevacizumab (Avastin) in combination with chemotherapy are at increased risk of serious side effects that may lead to death, according to a meta-analysis of 16 clinical trials that was conducted by researchers at Stony Brook University School of Medicine in New York. The results were published February 2, 2011, in JAMA.

The risk of fatal adverse events varied by the type of chemotherapy agents used with bevacizumab, lead author Vishal Ranpura, M.D., and his colleagues reported. There were also suggestions that the risk might vary by tumor type and bevacizumab dose, but the study did not have the statistical power to provide a definitive answer in either case.

More than 10,200 patients were enrolled in the randomized trials included in the analysis. Overall, fatal events were relatively rare, occurring in 2.5 percent of trial participants who received bevacizumab, compared with 1.7 percent of patients who did not—an approximately 50 percent increase in risk. However, the increased risk was more than threefold higher in patients who received bevacizumab in combination with platinum or taxane chemotherapy agents, such as carboplatin and paclitaxel, respectively.

The most common fatal event, accounting for nearly one-quarter of the total, was hemorrhage. Neutropenia, a decrease in a specific type of white blood cell that can put patients at increased risk of infections, was next, followed by perforations of the gastrointestinal tract, blockages of the pulmonary arteries, and cerebrovascular events such as stroke.

The benefits of bevacizumab can outweigh the risks of its use in a proportion of patients, explained Shenhong Wu, M.D., Ph.D., the study’s senior author, but the finding should prompt closer scrutiny of how bevacizumab is used. Oncologists, he said, “should have a healthy respect for the toxicity of this drug and the possibility that it can cause fatal events.”

The finding of an increased risk of serious events in patients treated with bevacizumab “is generally consistent with what’s known about the drug,” said Helen Chen, M.D., of NCI’s Division of Cancer Treatment and Diagnosis. “What is clear [about bevacizumab] at this point is that the patients’ susceptibility to serious adverse side effects from bevacizumab can have a lot to do with the tumor setting and comorbidity.” Certain tumor types can predispose patients to an increased risk of certain events, she continued, such as bleeding in patients with advanced lung cancer.

Cary Presant, M.D., of the Wilshire Oncology Medical Group, who is also a clinical professor of medicine at the USC Keck School of Medicine, believes that the study’s finding will likely affect clinical practice. “I do believe…that [bevacizumab] usage will go down,” he said. “This obligates every physician who wants to use [bevacizumab] to have a conversation with their patients about fatal events, and it will lead to less use of this drug in cases where the beneficial effects are more marginal.”

The strongest evidence of benefit with bevacizumab still seems to be in treating patients with metastatic colorectal cancer, Dr. Presant continued. “But some patients with lung [or] breast cancer might be inclined to choose not to receive it because the benefits are not as great.”

An antiangiogenic agent that binds to vascular endothelial growth factor (VEGF), bevacizumab was the first FDA-approved drug designed to target the blood supply that feeds tumors. In addition to being approved for the treatment of colorectal cancer, the monoclonal antibody is approved to treat lung cancer, kidney cancer, and glioblastoma. (See the table below on specific indications.)

Bevacizumab is also approved to treat metastatic, HER2-negative breast cancer. In December 2010, however, the FDA announced it was beginning the process of withdrawing that approval for breast cancer based on results from several post-market clinical trials that failed to show an improvement in overall survival and which, the agency stated, did not “provide a sufficient benefit in slowing disease progression to outweigh the significant risk to patients.” Genentech, which manufactures bevacizumab, has asked for a public hearing on the FDA’s withdrawal decision.

In an accompanying JAMA editorial, Daniel Hayes, M.D., of the University of Michigan Comprehensive Cancer Center noted that treatment with bevacizumab can run as high as $100,000 a year, yet there is still substantial uncertainty around appropriate use of the drug in cancer care.

“Why, despite the impressively solid preclinical data and the promising early clinical results, has bevacizumab not been more successful in improving overall survival?” he wrote. Improvements in median overall survival were seen in only three of the pivotal trials on which the FDA based its approvals. In two of the trials, survival increased by less than 3 months.

“Careful review of response rates to bevacizumab suggest that bevacizumab works well, but only in selected patients,” Dr. Hayes wrote further. Despite being broadly tested in numerous clinical trials, he continued, “few insights are available about specific subgroups of patients who may benefit.”

In a statement responding to the JAMA study, Genentech noted that “the majority of our clinical studies include collection of blood, tumor tissue, and DNA for biomarker analysis as part of a comprehensive biomarker program.” To date, although some studies have reported a correlation between certain markers and outcomes of bevacizumab-based therapy, no markers have undergone the rigorous validation studies needed for use in the clinic, Dr. Chen stressed.

Genentech has proposed a phase III clinical trial of bevacizumab in HER2-negative breast cancer that would have a biomarker component. Based on a retrospective analysis of a previous trial, the company explained in a document filed with the FDA, the new trial would assess whether plasma levels of the protein VEGF-A are indicative “of a more substantial benefit” with bevacizumab.

Report names U.S. cities with foulest, cleanest air

Report names U.S. cities with foulest, cleanest air


NEW YORK (Reuters) - The nation's 25 most smoggy cities improved air quality over the last year, but half the nation's residents still live with unhealthy levels of air pollution, according to an American Lung Association report released on Wednesday.

Weighing the pluses and minuses in U.S. air quality over the past year, the "State of the Air 2011" report concluded that the U.S. Clean Air Act, the federal law aimed at limiting pollution in the nation's skies, is working.

"The progress the nation has made cleaning up coal-fired power plants, diesel emissions and other pollution sources has drastically cut dangerous pollution from the air we breathe," Lung Association President Charles Connor said in a statement.

The most dramatic improvement has been controlling ozone, commonly known as smog. The report found all 25 cities most polluted by ozone had cleaner air than they did last year,

Still, the report found that 154.5 million people, just over half the nation's population, live in areas where the air is filled with dangerous levels of ozone and particle pollution, also known as soot.

Cities with the foulest air were broken down into three categories and the worst three in each were Los Angeles, Bakersfield and Visalia, all in California, as most ozone polluted; Bakersfield and Fresno, both in California, and Pittsburgh, Pennsylvania, as most polluted by short-term particle pollution; and Bakersfield, Los Angeles and Phoenix as most polluted by year-round particle pollution.

Cities with nation's best overall air quality were Honolulu and Santa Fe, New Mexico, the report said.

(Reporting by Barbara Goldberg; Editing by Ellen Wulfhorst and Greg McCune)