By Steven Reinberg
SATURDAY, Aug. 30, 2014 (HealthDay News) — In a head-to-head comparison, an experimental drug was more effective than standard treatment at preventing deaths and hospitalizations in heart failure patients.
According to the study authors, the trial was stopped early because of the marked benefit of the new drug, dubbed LCZ696.
In the trial, 26.5 percent of those getting the standard medication, enalapril (Vasotec), either died or were hospitalized due to heart failure, compared with 21.8 percent of those on the new drug. Enalapril belongs to a class of blood pressure-lowering medications known as ACE inhibitors.
“LCZ696 could become the new gold standard, replacing ACE inhibitors,” said lead researcher Dr. John McMurray, a professor of cardiology at the British Heart Foundation Cardiovascular Research Center at the University of Glasgow, in Scotland.
LCZ696 combines two blood pressure drugs — an angiotensin II receptor blocker (ARB) and the neprilysin inhibitor known as sacubitril.
“We found that LCZ696 was superior to the gold-standard ACE inhibitor for heart failure — an ACE inhibitor being the absolute cornerstone of treatment for this problem,” he said.
Not only did LCZ696 beat enalapril, but it did that even when added to other treatments, McMurray noted.
“The new treatment was very well tolerated, with no significant safety concerns,” he added.
The report was published online Aug. 30 in the New England Journal of Medicine, to coincide with a presentation at the European Society of Cardiology annual meeting in Barcelona. The trial was funded by Novartis, the maker of LCZ696.
Dr. Mariell Jessup, a professor of medicine at the University of Pennsylvania’s Perelman School of Medicine, said, “There is new hope for heart failure.”
She added, “We have not had a new drug for heart failure for many years. LCZ696 is a unique compound that may represent a new approach.”
Doctors have relied on ACE inhibitors for over two decades, she said. According to Jessup, who wrote an accompanying editorial, “Newer drugs that work via alternate pathways may [show] benefit beyond the medical therapy that is used today.”
For the study, over 8,400 patients with heart failure were randomly chosen to receive LCZ696 or enalapril.
Over an average of 27 months of follow-up, LCZ696 reduced the risk of hospitalization for heart failure by 21 percent, compared to enalapril, the findings showed.
Moreover, among the 1,251 people who died from heart disease during the trial, 558 were taking LCZ696 (13.3 percent) and 693 were taking enalapril (16.5 percent), the researchers noted.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, commented, “The results of this study are terrific news for patients with heart failure, and represent landmark findings.”
If approved by the U.S. Food and Drug Administration, this new medication should help doctors improve outcomes for the millions of men and women with chronic heart failure worldwide, he said.
Visit the American Heart Association for more on heart failure.
FRIDAY, Aug. 29, 2014 (HealthDay News) — Astronauts may be at heightened risk of illness because space travel appears to disrupt human immune systems, a new study suggests.
That could be a real problem on any long missions to asteroids, the moon and Mars undertaken in the future, because getting a cold or flu while in space can be dangerous, NASA researchers say.
They found that the distribution of immune cells in the blood of International Space Station crew members remains relatively unchanged during their time in space. However, some immune cell activity is much lower than normal, while other activity is heightened.
The NASA team described the space station crew members’ immune systems as being “confused.” Reduced immune cell activity may prevent an appropriate response to threats from germs or viruses, while increased activity may lead to excessive responses that result in problems such as increased allergy symptoms and persistent rashes.
Astronauts’ immune systems are likely being altered by many factors associated with the overall spaceflight environment, added Brian Crucian, a biological studies and immunology expert at NASA.
“Things like radiation, microbes, stress, microgravity, altered sleep cycles and isolation could all have an effect on crew member immune systems,” he said in a NASA news release. “If this situation persisted for longer deep space missions, it could possibly increase risk of infection, hypersensitivity, or autoimmune issues for exploration astronauts.”
Crucian and his colleagues analyzed the blood plasma of 28 space station crew members before, during and after their missions. The study was published recently in the Journal of Interferon & Cytokine Research.
It’s not known if the immune system changes that occur during spaceflight increase astronauts’ risk for health problems during long missions, and further research is needed to determine if that is the case, Crucian said.
The U.S. National Institute of Allergy and Infectious Diseases has more about the immune system.
FRIDAY, Aug. 29, 2014 (HealthDay News) — If you have bunions, taking care of them now can help you avoid more serious treatment later, an expert says.
A bunion is a bump that forms on the joint of the big toe when bone or tissue moves out of place and extends beyond the normal anatomy of the toe. Left untreated, bunions can cause debilitating pain and may require surgery to correct, said Brent Rosenthal, a podiatrist and podiatric surgeon at CentraState Medical Center in Freehold, N.J.
To prevent bunions, avoid wearing shoes with pointed triangular tips and don’t wear high heels for long periods of time each day, Rosenthal said. You should know your correct shoe size, which can increase with age, weight gain and pregnancy, he added.
If you do develop a bunion, start wearing shoes with a wide and deep toe box. Shoe inserts may reduce symptoms and prevent the bunion from getting worse, according to Rosenthal.
He also suggested using over-the-counter, non-medicated bunion pads whenever you wear shoes. If the bunion is inflamed and sore, apply ice packs several times a day, he said.
If these initial treatments don’t help, see a podiatrist, a doctor who specializes in conditions of the feet and ankle. The doctor might prescribe an anti-inflammatory drug and/or cortisone injection to ease pain and inflammation. Ultrasound therapy is widely used to treat bunion-related soft tissue damage.
If these therapies fail, surgery may be required to relieve pressure and repair the toe joint, said Rosenthal, who noted that recovery from the surgery takes time and discomfort can last weeks.
The U.S. National Library of Medicine has more about bunions.
By Dennis Thompson
FRIDAY, Aug. 29, 2014 (HealthDay News) — An experimental Ebola drug previously given to two American aid workers successfully cured a group of monkeys infected with the deadly virus in laboratory tests, researchers report.
The drug, ZMapp, prompted recovery in all 18 monkeys who received it, even if they didn’t get the medication until five days after infection.
ZMapp even cured monkeys with advanced cases of Ebola who were days or even hours away from death, said study senior author Gary Kobinger, chief of special pathogens for the Public Health Agency of Canada.
“The level of improvement was beyond my own expectations,” Kobinger said, noting that the drug cleared the liver damage, excessive bleeding and horrible rashes that are the hallmarks of Ebola infection.
This study provides some scientific evidence for the effectiveness of ZMapp, which aid workers Dr. Kent Brantly and Nancy Writebol both received under “compassionate use” guidelines after contracting Ebola while in Liberia fighting the current outbreak in West Africa.
Brantly and Writebol successfully fended off the virus. They were flown home for treatment in the United States, and last week were released from hospital care in Atlanta.
The results of the monkey trial were published Aug. 29 in the journal Nature.
Because Brantly and Writebol were given ZMapp outside of a clinical trial, physicians and public health officials have been reluctant to fully credit the drug with their recovery. Further clouding the picture, a Liberian doctor and a Spanish priest subsequently died from Ebola despite receiving the drug.
“We hope that initial safety testing in humans will be undertaken soon, preferably within the next few months, to enable the compassionate use of ZMapp as soon as possible,” the researchers concluded in their paper.
The West Africa outbreak is the largest ever for Ebola, with 3,069 infected and 1,552 dead. The World Health Organization (WHO) estimates that more than 20,000 people could become infected before the end of the outbreak.
In the face of this health-care crisis, a WHO expert panel ruled earlier this month that it would be ethical to treat Ebola patients with experimental medications like ZMapp.
“Given the severity of this condition and the fact that there’s nothing else available, this is as good as it gets,” Dr. Ambreen Khalil, an infectious disease specialist with Staten Island University Hospital in New York City, said of the results from the ZMapp monkey trial. “Our focus should be now on the people who are rapidly dying in Africa. In those patients, ZMapp should be used, based on this study.”
ZMapp is a cocktail of three laboratory-produced antibodies, which have been derived from two previous antibody cocktails for Ebola, Kobinger said.
In the study, researchers infected 21 rhesus monkeys with an Ebola strain similar to the one raging through West Africa. Then they administered ZMapp to 18 of the monkeys starting on days three, four or five after infection. The monkeys received three doses of the drug at three-day intervals.
All 18 animals treated with ZMapp survived, regardless of how sick they had become. The three monkeys not treated with ZMapp all died by day eight.
Because the Ebola virus strain used to infect monkeys in this experiment is different to the strain in the current West African outbreak, the researchers also performed lab tests that showed that ZMapp does bind to the new virus strain and would likely be as effective against it, Kobinger said.
ZMapp is the only experimental treatment that has been deployed against Ebola during this outbreak, but others could be on the way.
The U.S. National Institutes of Health and drug manufacturer GlaxoSmithKline are expected to announce that they are starting the first human trials of a potential Ebola vaccine, NBC News reported Wednesday.
For more on the Ebola virus, visit the U.S. Centers for Disease Control and Prevention.
FRIDAY, Aug. 29, 2014 (HealthDay News) — Prostate cancer patients lacking knowledge about the disease have difficulty making good treatment decisions. This can lead to worse quality of care and long-term results, new research suggests.
The study included 70 men, with a median age of 63. All were newly diagnosed with localized prostate cancer.
Poor understanding of the disease was associated with greater difficulty deciding which treatment to choose and less confidence that the treatment would be effective, the study found.
“For prostate cancer, there is no one right answer when it comes to treatment. It comes down to the right answer for each specific patient, and that is heavily dependent on their own personal preferences,” study first author Dr. Alan Kaplan, a resident physician in the urology department at the University of California, Los Angeles, said in a university news release.
“Men in general, and specifically economically disadvantaged men, have a hard time deciding what their preferences are, how they feel about any possible complications and what the future after treatment might be like. If you don’t know anything about your disease, you’ll have a really tough time making a decision,” Kaplan explained.
The findings, published in the Sept. 1 print issue of the journal Cancer, suggest that doctors need to identify and educate men with little knowledge about prostate cancer in order to help them feel more comfortable making treatment decisions.
“If you get shot in the gut, there aren’t many options. You go into the operating room to get fixed up,” Kaplan said. “With prostate cancer, there are lots of options and not all are right for everybody.”
Treatment options for prostate cancer include surgery, radiation, and burning or freezing tumors. Or, patients might choose active surveillance. That means they don’t receive treatment but are closely monitored for changes in their cancer.
Prostate cancer is the second most commonly diagnosed cancer in men. This year, about 233,000 American men will be diagnosed with prostate cancer, and nearly 30,000 will die from the disease, according to the university news release.
The U.S. National Cancer Institute has more about prostate cancer treatment.
If you’ve ever blamed a bad mood on low blood sugar, you’re onto something—being “hangry” (hungry and angry) is a real thing.
Researchers from The Ohio State University and the University of Kentucky put it to the test with married couples, measuring their blood glucose levels daily for 21 days and having them secretly stick pins in a voodoo doll of their spouse each evening (up to 51 pins at a time, depending on how peeved they felt). Those whose glucose levels ranked in the bottom 25% stabbed more than twice as many pins into their “spouse doll” as those in the top 25%.
At the end of the 21 days, the couples came into the lab to play a computer game against each other in separate rooms. The winners could blare an unpleasant noise at their partners, as loudly and for as long as they wanted. Once again, people who had lower average levels of glucose were more aggressive, willing to blast their mate at a louder volume and for a longer time than those with higher levels.
RELATED: 29 Days to a Healthier Relationship
“Glucose gives the brain the energy to exercise control,” explains lead study author Brad Bushman, PhD, professor of communications and psychology at Ohio State. When you’re hungry, glucose levels drop, making it harder to rein in hostility.
To keep bickering with your partner to a minimum, “the next time there’s a sensitive issue to bring up, discuss it over dinner rather than on an empty stomach,” Bushman advises. You’ll have a happier belly—and maybe even a happier relationship.
RELATED: 12 Foods That Control Your Appetite
Regardless of which team you root for on The Voice, there’s one thing we can all agree on: We’d turn our chairs around to glimpse Shakira’s smokin’ hot body.
One move that helps keep the 37-year-old mom (and host of seasons 4 and 6) in stage-ready shape is the Jackknife with a Twist. “It challenges the body from every angle and especially hits the core,” says Anna Kaiser, founder of AKT inMotion in New York City, who trains the pop star.
Here’s how to do it: Start in a plank position (palms under shoulders, back flat, and legs extended behind you) with your shins on top of a stability ball (A). Press down on the ball with your shins as you lift your hips toward ceiling, then bend your knees and bring them in toward your left shoulder while twisting your midsection (B). Extend your legs and return to a plank. Do 30 reps, alternating sides. Do 3 sets 3 to 5 times a week.
RELATED: 20 Ways to Do a Plank
Let’s face it: “No one orders the taco salad because they think it’s the most delicious thing on the menu,” says Stephanie Middleberg, RD, founder of Middleberg Nutrition in New York City. “They get it because they believe it’s the healthiest.”
But to make that base of nutritionally skimpy iceberg lettuce more appealing, restaurants often load it with dressing and what Middleberg calls the “Mexican-food fat trifecta”: cheese, guac, and sour cream.
And don’t overlook the crispy tostada shell. “Too much fat from the wrong sources, including deep-fried foods, can be a recipe for heart disease,” Middleberg says.
You’re better off with the beef burrito (tortilla, meat, cheese, rice and beans), which has more protein, less than half the fat and fewer calories. It’s not exactly light, though, so wrap some up to go. You’ll still feel muy satisfied.
FRIDAY, Aug. 29, 2014 (HealthDay News) — The West African Ebola outbreak took a more deadly turn Friday with the World Health Organization announcing an estimated 500 new cases this week — the biggest jump in infections so far.
Most of the new cases arose in Liberia, the U.N. health agency said, but cases in Guinea and Sierra Leone also rose sharply, the Associated Press reported.
“There are serious problems with case management and infection prevention and control,” according to the WHO report. “The situation is worsening in Liberia and Sierra Leone.”
Senegal — a prime tourist destination in the region — has also now recorded its first case, an infected university student from Guinea who sought treatment at a hospital in Senegal’s capital city, Dakar, the AP reported.
According to Senegal’s Health Minister, Awa Marie Coll Seck, the young man had had contact with Ebola patients in Guinea and has now been placed under quarantine. Tests have confirmed he is infected with Ebola virus, the AP said.
The news follows a WHO update released on Thursday that warned that the deadly Ebola outbreak hitting five West African nations could eventually infect more than 20,000 people.
Already the largest Ebola outbreak ever, the viral infection has produced 3,069 cases so far and killed 1,552 people in Guinea, Liberia, Nigeria and Sierra Leone, with Senegal now added to that list.
Nearly 40 percent of the total number of reported cases have occurred in the past three weeks, the health agency said.
“This far outstrips any historic Ebola outbreak in numbers. The largest outbreak in the past was about 400 cases,” Dr. Bruce Aylward, WHO’s assistant director-general for emergency operations, said at a news conference, the AP reported.
In the meantime, many American universities say they plan to run extra health checks on college students arriving from the affected region.
According to the AP, about 30 students from Nigeria are expected to arrive this semester at the University of Illinois. According to Dr. Robert Palinkas, director of the university’s health center, the Nigerian students will be asked to undergo a temperature check for signs of fever and to have a private discussion about Ebola when they arrive at the university health center for required immunization paperwork and tuberculosis testing.
Health experts stress that the threat to U.S. college students remains very small, but Palinkas told the AP that the added precautions should reassure parents.
“Parents are comforted to know that there is a screening process, that we are alert for it, that we are prepared for it,” he said, “and that we’re doing everything we can without infringing on the rights of anybody to make sure their son or daughter is going to have the lowest risk possible.”
Similar precautions are being conducted at the University at Buffalo in New York, Mercer University in Georgia, Liberty University in Lynchburg, Va., and the University of Akron in Ohio, the AP said.
In response to the crisis, WHO unveiled a battle plan Thursday that calls for stopping Ebola transmissions within six to nine months, while “rapidly managing the consequences of any further international spread,” the WHO said in a news release.
The plan calls for spending $489 million over the next nine months and enlisting 750 international workers and 12,000 national workers, the AP reported.
Also Thursday, the U.S. National Institutes of Health (NIH) said it would begin testing an experimental Ebola vaccine in humans next week. It will be tested in 20 healthy adults in Maryland to see if it’s safe and able to produce an appropriate immune system response.
The vaccine was developed by the U.S. National Institute of Allergy and Infectious Diseases and drug maker GlaxoSmithKline. It will also be tested on healthy volunteers in Great Britain and the West African nations of Gambia and Mali, the NIH said.
Unlike diseases such as tuberculosis or flu, Ebola isn’t spread by breathing air from an infected person. Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animals, according to the WHO.
Ebola, one of the world’s most virulent diseases, kills up to 90 percent of people it infects. Symptoms include a sudden fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, poor kidney and liver function and, in some cases, both internal and external bleeding.
Many of those killed during the current Ebola outbreak have been health care workers.
According to the CDC, health care workers must be able to recognize a case of Ebola and be ready to use “isolation precautions or barrier nursing techniques.” Barrier nursing techniques include:
- wearing protective clothing, such as masks, gloves, gowns, and goggles;
- using infection-control measures, including complete equipment sterilization and routine use of disinfectant;
- isolating patients with Ebola from contact with unprotected persons.
The aim of these techniques is to avoid contact with the blood or secretions of an infected patient, the CDC said.
For more on Ebola virus, visit the U.S. Centers for Disease Control and Prevention.
Make crunches less boring by adding a yoga element: belly-flattening Boat Pose. This move from E! host Maria Menounos’ circuit routine will help you get toned, taut abs. Just remember to keep your chin up to avoid neck strain.
Here’s how to do it: Lie faceup with your hands behind your head, elbows pointing forward and legs long. Engage your abs and crunch up, bringing your elbows and knees together. Keeping your lower back pressed firmly into floor, slowly extend your legs and arms to 45 degrees, then return to start. Repeat for 1 minute.Try this move: Crunch to Boat Pose
Have a little more time to break a sweat? You can do this exercise as part of a fat-melting circuit. Watch Maria Menounos, author of Every Girl’s Guide to Diet and Fitness, show you how to do a speedy, 7-move exercise routine. Do this circuit two to three times to get a great workout in less than 20 minutes.
FRIDAY, Aug. 29, 2014 (HealthDay News) — Researchers have discovered that people with dyslexia have disrupted network connections in their brains.
Dyslexia — the most commonly diagnosed learning disorder in the United States — causes problems with reading and writing.
Previous research showed that brain activity is disrupted in people with dyslexia, but most of those studies focused only on a small number of brain regions.
This new study used functional MRI to analyze how multiple brain regions use networks to communicate with each other, something called functional connectivity.
The researchers scanned and compared the brains of children and adults with and without dyslexia, and found that the two groups had many differences in the connections between different brain regions.
People with dyslexia had less connectivity between a number of brain regions involved in reading, according to the study released online Aug. 28 in the journal Biological Psychiatry.
“As far as we know, this is one of the first studies of dyslexia to examine differences in functional connectivity across the whole brain, shedding light on the brain networks that crucially support the complex task of reading,” study author Emily Finn, a neuroscience Ph.D. student at Yale University School of Medicine, said in a journal news release.
“Compared to typical readers, dyslexics had weaker connections between areas that process visual information and areas that control attention, suggesting that individuals with dyslexia are less able to focus on printed words,” she explained.
The U.S. National Institute of Neurological Disorders and Stroke has more about dyslexia.
FRIDAY, Aug. 29, 2014 (HealthDay News) — The way that parents respond to their infant’s babbling might affect the baby’s language development, a new study suggests.
Over six months, researchers observed the interactions between 12 mothers and their infants during free play. The sessions were 30 minutes long and happened twice a month. The infants were 8 months old at the start of the study.
When parents listened and responded to a baby’s babbling, infants began to form complex sounds. The babies whose parents responded to babbling also started using language more quickly, according to the study published recently in the journal Infancy.
Language skills developed more slowly in babies whose mothers didn’t make as much effort to understand their babbling, and instead sometimes directed their infants’ attention to something else.
The results show that parents who actively interact with their babbling baby can hasten the child’s language development, according to the researchers.
“It’s not that we found responsiveness matters. It’s how a mother responds that matters,” study corresponding author Julie Gros-Louis, an assistant professor of psychology at the University of Iowa, said in a university news release.
The study shows that “social stimulation shapes at a very early age what children attend to. And if you can show the parent can shape what an infant attends to, there is the possibility to shape what the child is sensitive to. They are learning how to learn,” study co-author Andrew King, a senior scientist in psychology at Indiana University, said in the news release.
The American Speech-Language-Hearing Association has more about speech and language development.
FRIDAY, Aug. 29, 2014 (HealthDay News) — Selling cigarettes in plain packages doesn’t increase the use of low-cost or illegal tobacco and doesn’t harm sales in small stores, according to new research from Australia.
Those problems were predicted by the tobacco industry when it tried to prevent Australia from becoming the first country in the world to introduce plain packaging for tobacco products in 2012. Similar legislation is being considered in Ireland, New Zealand and the U.K.
Researchers surveyed nearly 2,000 adult smokers in Australia before and after the plain-packaging rule was implemented. The results showed that the smokers continued to buy their tobacco from the same places, according to the study released online on Aug. 28 in the BMJ.
Nearly two-thirds of smokers bought their tobacco from supermarkets in 2011 and 2013. The proportion of those who bought tobacco at small, independent stores rose from just over 9 percent in 2011 to just over 11 percent in 2013.
The use of low-cost Asian brands hovered around 1 percent in both 2011 and 2013. The use of illegal unbranded tobacco was dropped slightly to less than 2 percent between 2011 and 2013.
In 2013, about 3 percent of smokers said they had bought at least one possibly contraband pack within the previous three months, and nearly 2 percent said they had bought from informal sources — such as a market stall or the back of a van — once or twice over the past 12 months.
“This study provides no evidence of the unintended consequences of standardized packaging predicted by opponents [having] happened one year after implementation,” the study authors concluded.
The American Cancer Society offers a guide to quitting smoking.
FRIDAY, Aug. 29, 2014 (HealthDay News) — The main strain of a common antibiotic-resistant infection in Europe, the Middle East and North Africa originated in sub-Saharan Africa, a new study says.
Researchers studied so-called community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, which occur in healthy people who have not recently been hospitalized. These infections typically affect the skin and can be transmitted through person-to-person contact or through touching contaminated objects such as clothing or towels.
The predominant strain of CA-MRSA in Europe is called CC80. It was identified in the late 1990s, and has since been detected throughout the Middle East and North Africa. There also have been sporadic reports of the strain in Asia, Australia and South America, the study authors noted.
The researchers analyzed samples of CC80 from 22 countries in Asia, North and sub-Saharan Africa, Europe and the Middle East, and found that it originated from a single sub-Saharan ancestor.
The CC80 strain likely started to spread from sub-Saharan Africa to other regions starting in the mid-1980s because of increased migration of people from sub-Saharan Africa to other countries and growth in the number of European tourists traveling to this part of Africa, according to the researchers.
The study was published Aug. 26 in the online journal mBio.
“With increasing levels of CA-MRSA reported from most parts of the Western world, there is a great interest in understanding the origin and factors associated with the emergence of these epidemic lineages,” lead author Marc Stegger, of the microbiology and infection control department at Statens Serum Institute in Denmark, said in a news release from the American Society for Microbiology.
“Our study determined that a single descendant of a methicillin-sensitive ancestor circulating in sub-Saharan Africa rose to become the dominant CA-MRSA clone in Europe, the Middle East and North Africa,” Stegger said.
The U.S. National Library of Medicine has more about MRSA.
By Randy Dotinga
FRIDAY, Aug. 29, 2014 (HealthDay News) — About one in five patients operated on for broken bones or other orthopedic trauma shops around for additional painkillers after surgery, a new study finds.
Less-educated patients and patients who had used narcotic painkillers previously were several times more likely to be “doctor shoppers,” said study lead author Dr. Brent Morris, a shoulder and neck surgeon in Lexington, Ky. Overall, he said, the study suggests that doctors aren’t talking to one another about the painkiller needs of their patients.
“There needs to be coordination if additional pain medications are needed,” he said. “Patients should not be receiving multiple narcotic pain medication prescriptions from multiple providers without coordinating with their treating surgeon.”
Use of narcotic painkillers for nonmedical purposes is a serious concern in the United States. Unintentional overdose deaths increased 124 percent from 1999 to 2007 largely because of prescription narcotics, according to background information in the study.
Doctor shoppers go to multiple physicians in search of prescription medications, often narcotic painkillers, anti-anxiety drugs such as Xanax, or medications to treat attention deficit hyperactivity disorder (ADHD), said Julie Worley, an assistant professor of nursing at Rush University in Chicago, who has studied the trend.
Patients who doctor-shop are often addicted to painkillers or looking to get drugs they can sell, Worley said. Most states track prescriptions of narcotic painkillers to prevent abuse, but the systems “have many issues and aren’t foolproof,” she said. In addition, she said, physicians are often wary of confronting their patients.
In the new study, published in the August issue of the Journal of Bone & Joint Surgery, researchers examined the medical and pharmacy records of 130 patients ages 18 to 64 who sought treatment at Nashville’s Vanderbilt University Medical Center in 2011.
They looked at painkiller prescriptions for three months before admission and six months after discharge. All of the patients suffered from single orthopedic injuries such as broken legs, ankles and arms.
“The surgeon that performed the operation is typically responsible for pain control immediately after surgery,” Morris said. “Pain control after this type of surgery often requires narcotic pain medications for the first several weeks.”
Overall, 21 percent of the patients tried to get narcotic painkillers from more than just the surgeon who treated them. Patients who weren’t college-educated were 3.2 times more likely to try to get the drugs from more than one doctor, and those who had used narcotic painkillers before were 4.5 times more likely.
The doctor shoppers — who were mostly white males — used narcotics for about 3.5 months after surgery whereas single-provider painkiller users took them for four weeks on average, the study found. Many obtained seven or more narcotic prescriptions compared to two prescriptions for single-provider patients.
Whether the doctor shoppers had legitimate pain needs isn’t clear from the study. “The ER is definitely an area where people doctor-shop. But I don’t know that they’re going to be having an orthopedic trauma to get drugs,” said Worley.
It’s possible, she said, that some of the patients went to other doctors, perhaps their own physicians, in search of painkillers.
Whatever the reasons, Morris and Worley called for more reliable systems to prevent patients from abusing narcotic painkillers.
Worley said physicians should be wary of patients who pay with cash since doctor-shoppers with insurance are more easily detected. It’s also helpful to check patients for needle marks and to use more extensive drug test procedures to make sure patients aren’t sneaking in someone else’s urine, she said.
Morris added that one important way to help identify patients who are doctor-shopping is by using a prescription drug-monitoring program. Nearly all states have an active prescription drug-monitoring program, “but only seven states actually mandate use of these programs,” he said.
“Physicians and patients have to work together,” he added, “to establish reasonable expectations for pain control and to identify at-risk patients early on to allow appropriate interventions.”
For more about painkiller abuse, see the U.S. National Institute on Drug Abuse.
By Steven Reinberg
THURSDAY, Aug. 28, 2014 (HealthDay News) — Too much salt in the diet may worsen symptoms of multiple sclerosis (MS), a new study from Argentina suggests.
“Many environmental factors affect MS, such as vitamin D, smoking and Epstein Barr virus infection. Our study shows that high salt intake may be another environmental factor affecting MS patients,” said lead researcher Dr. Mauricio Farez, of the Raul Carrea Institute for Neurological Research in Buenos Aires.
Multiple sclerosis is a disease of the nervous system that causes weakness, visual disturbances, trouble with balance, numbness and thinking and memory problems. The most common form is called relapsing-remitting MS, meaning symptoms subside and then become worsen.
Earlier research found that salt may alter autoimmune response, which is involved in the development of MS.
Farez cautioned that this study does not show that salt causes MS to worsen, but there does seem to be an association.
“This is a small observational study showing a relationship between salt intake and MS disease activity, and these data need to be further validated in larger studies, including different populations,” he said.
For the study, Farez’s team measured the levels of sodium (the main component of salt), creatinine and vitamin D in the blood and urine of 70 patients with the relapsing-remitting form of MS. Creatinine is a marker of inflammation, and low levels of vitamin D have been associated with MS.
Sodium intake was divided into three levels: less than 2 grams daily, between 2 and 4.8 grams a day, and more than 4.8 grams daily. Current guidelines for heart disease prevention recommend a maximum sodium intake of 1.5 grams to 2.4 grams per day. At the upper end, that’s just under half a teaspoon of table salt a day.
Farez’s group found that people with daily sodium intake of between 2 and 4.8 grams and those who consume more than 4.8 grams — a little less than a teaspoon of salt — were up to four times more likely to have more episodes of worsening MS symptoms as those who consumed the least salt.
To check the progression of the disease in patients’ brains, the researchers analyzed X-rays and scans. They found that patients who had the highest salt intake were about 3.4 times more likely to have their disease worsen, compared with those with the lowest salt intake.
Similar results were found in a second group of 52 MS patients, the researchers added.
“It is too soon to say that MS patients should cut their salt intake,” Farez said. “Our findings could serve as a basis for clinical trials with salt restriction in MS patients,” he said.
The report was published Aug. 28 in the Journal of Neurology, Neurosurgery and Psychiatry.
Salt’s influence on MS is a subject of increasing interest, said Nicholas LaRocca, vice president of health care delivery and policy research at the National Multiple Sclerosis Society.
“At this stage you really can’t assign cause and effect, but it’s beginning to look like there is a significant role of salt in MS disease activity and progression,” he said.
The mechanism for this association isn’t known, LaRocca said. Salt may make the immune system more prone to the disease, he suggested.
He agreed that there isn’t enough evidence to recommend that MS patients reduce salt in their diet.
“However, in a more general sense, we should all be watching our salt intake. We should all be careful about consuming excessive amounts of salt,” he said.
For the study, salt intake was estimated from sodium excreted in urine samples the participants provided three times over nine months. In addition, the researchers tracked the course of the patients’ MS from 2010 to 2012.
After accounting for factors such as smoking, age, gender, length of time after diagnosis, weight, treatment and vitamin D, the link between more salt and worsening MS remained, the researchers said.
For more on MS, visit the National Multiple Sclerosis Society.
THURSDAY, Aug. 28, 2014 (HealthDay News) — Arguments between parents may damage their relationships with their children, a new study indicates.
Parents in more than 200 families were asked to make daily diary entries for 15 days. At the end of each day, mothers and fathers rated the quality of their marriage and their relationship with their children.
On days when parents reported conflict and tension in their marriage, their dealings with their children were also strained, according to the study recently published in the Journal of Family Psychology.
However, there were notable differences between mothers and fathers. Marital conflict affected mothers’ relationships with their children for just one day.
“In fact, in that situation, moms appeared to compensate for their marital tension. Poor marital quality actually predicted an improvement in the relationship between the mom and the child. So, the first day’s adverse spillover is short-lived for moms,” study author Chrystyna Kouros, an assistant professor in the psychology department at Southern Methodist University, Dallas, said in a university news release.
It was a different story with fathers.
“In families where the mom was showing signs of depression, dads on the other hand let the marital tension spill over, with the result being poorer interactions with their child, even on the next day,” Kouros said.
The study shows that the quality of their marriage affects each parent’s ties with their children.
“We see from the findings that the marriage is a hub relationship for the family,” Kouros said. “The quality of that relationship spills over into each parent’s interactions with the child. So if mom and dad are fighting, it will show up initially — and in some cases on the second day — in a poorer quality relationship with their kids.”
The U.S. National Library of Medicine has more about parenting.
By Steven Reinberg
THURSDAY, Aug. 28, 2014 (HealthDay News) — The vast majority of American babies are getting the vaccines they need to protect them from serious illnesses, federal health officials said Thursday.
More than 90 percent of children are getting the vaccines that prevent measles, mumps, and rubella (MMR); polio; hepatitis B and chickenpox (varicella), according to the U.S. Centers for Disease Control and Prevention.
“Nationally, vaccination among children 19 to 35 months of age remains stable or has increased for all of the recommended vaccines, and that’s really good news,” said Dr. Melinda Wharton, acting director of CDC’s National Center for Immunization and Respiratory Diseases.
“There is still room for improvement,” she added. “Coverage is not as high as we would like it to be for doses of vaccines and boosters given in the second year of life.”
Wharton suggested one way to improve vaccine coverage could be with electronic medical records to help doctors keep track of when vaccinations are needed.
While some parents are reluctant to have their children vaccinated, or don’t believe in vaccines at all, Wharton doesn’t see this as a major problem. “The number of children who do not get any vaccine remains low and stable at less than 1 percent,” she said.
Vaccines are essential in preventing sickness and death, the CDC said. “Among children born during 1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations and 732,000 deaths during their lifetimes,” the CDC report stated.
The new findings were published in the Aug. 29 issue of the CDC’s Morbidity and Mortality Weekly Report.
The report also found that:
- the vaccination rate for rotavirus — which causes gastrointestinal problems such as diarrhea and vomiting — increased slightly from nearly 69 percent in 2012 to about 73 percent in 2013;
- the vaccination rate for one or more doses of the hepatitis A vaccine rose from just under 82 percent in 2012 to 83 percent in 2013. And the rate for hepatitis B vaccines rose from nearly 72 percent to 74 percent for the same time period.
While initial vaccination rates are high, getting second doses and booster shots that are needed when children are 2 years old remains a challenge, Wharton said.
These vaccines include the DTaP vaccine, which prevents diphtheria, tetanus and pertussis (whooping cough); Hib, which protects against haemophilus influenzae type b, which can cause severe diseases like meningitis — an infection of the fluid and lining around the brain and spinal cord; and the PCV vaccine, which prevents pneumococcal disease, which can trigger ear infections and meningitis.
Poor children are less likely to get booster shots, and the full series of polio, rotavirus and hepatitis B vaccines, according to the report.
Wharton said most insurance plans cover vaccines. People who can’t afford them can turn to the federal Vaccines for Children Program, which provides vaccines for free.
Vaccine coverage also varies by state and vaccine, the CDC report found.
When the researchers looked at immunizations against 11 different diseases — including chickenpox, measles and polio — coverage ranged from a high of 82 percent in Rhode Island to 57 percent in Arkansas. Also, 17 states had less than 90 percent coverage with the measles/mumps/rubella vaccine.
For one disease, measles, which has made a recurrence in the United States, national coverage with at least one dose of the measles/mumps/rubella vaccine was 92 percent. While this seems high, one in 12 children did not receive the first dose of the MMR vaccine on time, putting lots of kids at risk for measles, the CDC noted.
As of Aug. 22, there had been 592 measles cases reported in the United States this year, the most since 1994, according to the CDC.
Measles is most often introduced into the United States by unvaccinated Americans who travel overseas to areas where measles is endemic. Measles can spread quickly in communities with unvaccinated and under-vaccinated people, the CDC pointed out.
Dr. Adriana Cadilla, a pediatrician at Miami Children’s Hospital, said, “We still have a ways to go, but it’s good to know that we’re headed in the right direction” with childhood vaccinations.
Despite that progress, there are still some parents who oppose vaccinations, Cadilla said. “Those who are refusing are the ones that increase the risk to their communities,” she said.
Since vaccines have made a lot of diseases rare, many parents don’t have experience with how devastating they can be, she explained. “Vaccines are safe, and make sure your children are getting vaccinated,” she added.
The U.S. Centers for Disease Control and Prevention has more on childhood vaccinations.
THURSDAY, Aug. 28, 2014 (HealthDay News) — Lack of sleep not only puts teens at risk for poor grades, it also puts them at increased risk for obesity, researchers warn.
The study authors analyzed data collected from more than 10,000 Americans when they were aged 16 and 21. Nearly one-fifth of them got less than six hours of sleep a night when they were age 16, and this group was 20 percent more likely to be obese at age 21 than those who got more than eight hours of sleep per night at age 16, the investigators found.
Although lack of exercise and too much time spent watching television were also risk factors for obesity, these behaviors did not account for the link between lack of sleep and obesity, according to the study published online recently in the Journal of Pediatrics.
“Lack of sleep in your teenage years can stack the deck against you for obesity later in life. Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer,” study author Shakira Suglia, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, said in a university news release.
“The message for parents is to make sure their teenagers get more than eight hours a night. A good night’s sleep does more than help them stay alert in school. It helps them grow into healthy adults,” Suglia added.
Teens should get nine to 10 hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.
It’s known that daytime sleepiness and fatigue affect what and how people eat by triggering cravings and altering appetite. For example, sleep-deprived people find it easier to buy calorie-laden fast food rather than preparing a healthy meal.
The U.S. Centers for Disease Control and Prevention has more about sleep.
WEDNESDAY, Aug. 27, 2014 (HealthDay News) — Overconfident people are better at convincing others that they’re more talented than they really are, and therefore are more likely to get promotions and reach high-level positions, a new study indicates.
The researchers added that these “self-deceived” people are also more likely to overestimate other people’s abilities and to take greater risks.
And finally, people who underestimate themselves are regarded as less capable by their colleagues, according to the British researchers. Their findings were published Aug. 27 in the journal PLoS One.
The study included 72 university students who, on the first day of a course, were asked to predict their own and other students’ final marks. Fifteen percent of the students made accurate predictions, 45 percent underestimated their scores and 40 percent were overconfident.
Students who predicted higher marks for themselves were also predicted to have higher grades by others, whether or not that turned out to be true.
“These findings suggest that people don’t always reward the most accomplished individual but rather the most self-deceived. We think this supports an evolutionary theory of self-deception,” study co-lead author Vivek Nityananda, a research associate at Newcastle University, said in a university news release.
“It can be beneficial to have others believe you are better than you are and the best way to do this is to deceive yourself — which might be what we have evolved to do,” Nityananda added.
“This can cause problems as overconfident people may also be more likely to take risks,” he said.
Study co-author Dr. Shakti Lamba, of the University of Exeter, added: “If overconfident people are more likely to be risk prone then by promoting them we may be creating institutions, such as banks and armies, that are more vulnerable to risk.”
The American Academy of Pediatrics explains how to help children develop healthy self-esteem.