healthy living websites: 2014

Common Breast Biopsy Finding May Be More Dangerous Than Thought

By Kathleen Doheny

HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Women who have a pre-cancerous condition known as atypical hyperplasia of the breast are at higher risk of developing breast cancer than experts had believed, a new study finds.

Hyperplasia is an overgrowth of cells. When it occurs in a distorted pattern, it's called atypical hyperplasia. This condition is found in about one-tenth of the more than one million breast biopsies with benign findings done in the United States each year, according to researchers from the Mayo Clinic.

In the new study, the researchers found that about 30 percent of the women with atypical hyperplasia developed breast cancer in the 25 years after the diagnosis.

While experts have always known that atypical hyperplasia increases the risk of breast cancer, the new finding gives women with the condition more solid information about the extent of the risk, said study researcher Dr. Lynn Hartmann, a professor of oncology at the Mayo Clinic in Rochester, Minn.

Before the study, experts believed that women with atypical hyperplasia had about a four times higher risk of breast cancer, she said. That doesn't tell women their specific individual risk, however, Hartmann noted.

In the study, Hartmann's team followed nearly 700 women diagnosed with atypical hyperplasia at the Mayo Clinic between 1967 and 2001. After an average follow-up of more than 12 years, 143 women had developed breast cancer.

Hartmann's team validated the findings with a separate group of women with the condition at Vanderbilt University. Both sets of data found that around 30 percent of the women with atypical hyperplasia developed breast cancer.

As the extent of the hyperplasia increased, so did the risk, the investigators found.

The new research gives women some valuable information, according to two experts who reviewed the findings. One strength of the study was the "sizable sample of women followed for a long time," said Robert Smith, director of cancer screening for the American Cancer Society.

"We've always known their risk was higher," Smith said of women with the condition. However, the new study provides long-term data, he said, and shows a risk higher than most experts believed it to be.

Dr. Laura Kruper, a breast surgeon and co-director of the Breast Cancer Program at City of Hope Cancer Center in Duarte, Calif., added, "I think the news is atypical hyperplasia is much more serious than we have been taking it. When you say a cumulative risk of 30 percent at 25 years, that is pretty serious," Kruper said.

Overall, about one in eight U.S. women, or 12 percent, will develop breast cancer in their lifetime, according to estimates from the American Cancer Society.

"We as a medical community need to pay more attention to this," Kruper said of the higher risk finding.

What should women do who are diagnosed with the condition? They can discuss with their doctor whether to use chemopreventive medicines, such as tamoxifen or aromatase inhibitors, which are given to women who have a higher than average risk of breast cancer, the experts agreed.

Many of the women in the study developed a type of cancer known as estrogen receptor-positive, which requires estrogen to grow, Hartmann noted. That would suggest that taking the chemopreventive medicines -- which work by reducing estrogen -- would lower that risk, she said.

Women can also discuss with their doctor whether to get a screening MRI in addition to a mammogram, the experts suggested. Under the current guidelines from the American Cancer Society, Smith said, women with atypical hyperplasia are put into an intermediate-risk group. The guidelines currently say there isn't enough evidence to recommend for or against MRI as an additional screening, Smith said.

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Defective Hormone Linked to Chronic Obesity in Baby

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- A small number of extremely obese people may be fat because their bodies produce a malfunctioning form of the appetite-controlling hormone leptin.

That's the conclusion of a case study that appears in the Jan. 1 issue of the New England Journal of Medicine.

The researchers base this new theory on a 2-year-old boy of Turkish descent with an insatiable appetite. He was chronically obese for much of his short life.

At first doctors were puzzled by the case, since the boy appeared to have high blood levels of leptin, the hormone the body releases when a person has eaten enough, said Dr. Martin Wabitsch, a researcher in the Division of Pediatric Endocrinology and Diabetes at the University of Ulm in Germany.

A genetic sequencing test revealed that the boy produces a mutated form of leptin that can't effectively signal to the central nervous system that no more food is needed, Wabitsch said.

"The leptin is produced and secreted in a normal way, but it does not bind and does not activate the satiety receptor in the central nervous system, due to the mutation," he said.

When doctors treated the boy with injections of synthetic leptin, he started eating less and experienced substantial weight loss, the study authors reported.

Wabitsch said this condition likely is very rare, but added that he already has identified a second and third case that he will write about in another upcoming article.

"I am sure there are many other patients who have this disease with biologically inactive leptin, and they are not detected because doctors test the leptin in their blood and find there is no deficiency," he said.

Doctors have known about the role that leptin plays in appetite since the 1990s, Wabitsch said, but studies aimed at treating obesity through leptin injections have tended to fail.

That's because some people who have leptin-associated obesity have receptors that don't receive the hormone's signal properly, he said. It doesn't matter how much healthy leptin is circulating in their system -- their nervous system can't receive the message that the person is full.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, agreed with Wabitsch, and added that the wider clinical implications of this case study are "minimal."

"Leptin therapy itself has had little efficacy for obesity, but still may be important as part of a cocktail," Roslin said. "For most, obesity is related to environmental factors that are altering our genetic expression. Pharmaceutical [drug] solutions are coming, but are not yet ready to make a significant impact."

Wabitsch said future research should focus on the "feedback circle" of appetite that's driven by hormones like leptin and ghrelin, which increases appetite when the body needs fuel.

"In the future, people will focus on stimulating the leptin receptor with other drugs," he said. "Our body weight and our appetite is regulated by hormones, and this feedback circle is very important. An individual has only limited possibilities in controlling appetite and body weight by their own willpower. Anything you can interfere with in this circle will really have an effect on your appetite and your body weight."

In the meantime, doctors faced with an obese child who can't stop eating should consider the possibility that the child might have this leptin mutation, Wabitsch added.

More information

For more on childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

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Stem Cell Therapy Fixes Post-Surgical Airway Abnormality

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Using stem cells derived from a patient's own bone marrow, researchers have repaired a fistula -- a potentially fatal tissue abnormality -- in the man's lower airway.

"This is another interesting new therapeutic approach for stem cells," said lead researcher Dr. Francesco Petrella, deputy director of thoracic surgery at the European Institute of Oncology in Milan, Italy.

The patient, a 42-year-old firefighter, developed the fistula after surgeons removed a lung as part of treatment for mesothelioma cancer. A fistula is abnormal tissue connecting an organ, blood vessel or intestine to another structure. In this case, the fistula developed between the lower airway and the tissue that surrounds the lungs.

"Our clinical experience supports the idea that stem cells could be effectively used to close some tissue defects developing after very complex surgical procedures, thus restoring a functioning airway," Petrella said.

A fistula that develops after chest surgery is serious and even deadly, Petrella said. Current treatments involve removing ribs and taking medications for months or years, he explained.

"Less invasive approaches like endoscopic glue injections have only poor results, so our proposed techniques could improve quality of life in these patients," Petrella said.

Sixty days after stem cell therapy, the firefighter's fistula was healed, the researchers said. The hole seen before stem cell therapy was no longer visible, having been replaced by new tissue created by the stem cell implant, they explained.

Some people are born with a fistula. Other causes of fistulas include complications from surgery, injury, infection and diseases, such as Crohn's disease or ulcerative colitis.

Petrella believes that this same stem cell technique could be used to treat fistulas that develop elsewhere in the body.

"For example, I think it could be used to treat fistulas in the esophagus as well as in the stomach or colon, and fistulas that connect the lower portion of the large intestine with the rectum and vagina," he said.

Petrella describes the process in the Jan. 1 issue of the New England Journal of Medicine.

Mariano Garcia-Arranz, a senior researcher at the Health Research Institute Foundation Jimenez Diaz in Madrid, Spain, said the article confirms the effectiveness of stem cells in the treatment of fistulas.

But the type of fistula treated in this study is very rare, he said, adding that more study is needed before stem cells are routinely used as a treatment.

"However, so far, all cases that have been treated with stem cells have been successful," he said.

More information

For more about fistulas, visit the U.S. National Library of Medicine.

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Little Change in Fast Food Calorie Counts, Salt Content

By E.J. Mundell, HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- An investigation into the nutrition offered in meals from three major fast food chains finds little change in calories, salt or saturated fat from 1996 to 2013.

A team led by Alice Lichtenstein, director of the U.S. Department of Agriculture's Cardiovascular Nutrition Laboratory, looked at the nutrition of four popular fast food menu items -- fries, cheeseburgers, grilled chicken sandwiches and regular cola. Overall, the researchers focused on 27 items, including small, medium and large fries and cola beverages, a grilled chicken sandwich, and 2-ounce and 4-ounce cheeseburgers.

According to the researchers, the average calorie content, salt content and saturated fat content of these items stayed more or less the same over the 17-year period.

Two positive trends were noted, however. First, levels of unhealthy trans fats in French fries declined over time, the team found. That was probably due to changes in frying fat, and "the decline in trans fat we saw between 2005 and 2009 appears to be related to legislative efforts," Lichtenstein said.

Second, "there is a perception that restaurants have significantly expanded their portion sizes over the years, but the fast food we assessed does not appear to be part of that trend," Lichtenstein, who is also a professor at the Friedman School of Nutrition Science and Policy at Tufts University, Boston, said in a Tufts news release.

According to Lichtenstein, the real danger in terms of obesity and other health issues comes when fast food items are ordered together.

Levels of calories, salt and saturated fat "are high for most of the individual menu items assessed, particularly for items frequently sold together as a meal," she said, and this is "pushing the limits of what we should be eating to maintain a healthy weight and sodium intake."

Nutritionists recommend that most people eat around 2,000 calories a day. "Among the three chains, calories in a large cheeseburger meal, with fries and a regular cola beverage, ranged from 1,144 to 1,757 over the years," Lichtenstein said.

This means a single meal could add up to 88 percent of a person's daily caloric requirements for an entire day. "That does not leave much wiggle room for the rest of the day," Lichtenstein said.

What's more, salt content in the cheeseburger meal averaged 91 percent of a person's recommended daily intake, the researchers found.

Still, there was wide variance among chains, Lichtenstein's team found. Depending on where you ate, small orders of fries could vary by 110 calories and by 320 milligrams of sodium.

Those differences matter, Lichtenstein pointed out, because "a 100-calorie difference per day can mean about a 10-pound weight change per year."

The fast food industry can do more to help boost Americans' health, she said.

"Restaurants can help consumers by downsizing portion sizes and reformulating their food to contain less of these overconsumed nutrients. This can be done, gradually, by cutting the amount of sodium, and using leaner cuts of meat and reduced-fat cheese," Lichtenstein said.

"From what we hear, some fast food chains are heading in that direction and also introducing new healthier options," she added. "If taken advantage of, these changes should help consumers adhere to the current dietary recommendations."

Results of the investigation, funded by the USDA, were published Dec. 31 in Preventing Chronic Disease.

More information

There's more on maintaining a healthy weight at the U.S. Centers for Disease Control and Prevention.

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Exercise May Cut Fall Risk for Some Parkinson's Patients

By Amy Norton

HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Exercises that focus on balance and leg strengthening may help some people with Parkinson's disease avoid falls, according to a new clinical trial.

The study, reported online Dec. 31 in Neurology, found that the benefits were limited to people with milder Parkinson's symptoms. The exercise program -- done mostly at home -- cut their risk of falling by about 70 percent over six months.

But experts said that doesn't mean exercise is no help to people with more advanced Parkinson's.

It's possible they may need an exercise program with more supervision, said lead researcher Colleen Canning, an associate professor at the University of Sydney in Australia.

That possibility still needs to be studied, Canning added. But what seems clear, she said, is that "one size does not fit all" when it comes to exercise therapy for Parkinson's.

Parkinson's disease is a chronic movement disorder that causes tremors, stiffness in the limbs, and problems with balance and coordination, according to the Parkinson's Disease Foundation. About 60 percent of people with the disorder fall at least once a year, according to Canning's team -- and that can have consequences ranging from serious injury to fear of being active.

Yet physical activity is important for people with Parkinson's, said Dr. Roy Alcalay, a neurologist and medical advisor to the Parkinson's Disease Foundation in New York City.

That's partly because people with Parkinson's -- who are typically older than 50 -- should exercise for the sake of their cardiovascular health and mental well-being, explained Alcalay, who was not involved in the study.

"So we usually recommend exercise, just like we do for the general population without Parkinson's," said Alcalay.

Plus, he added, there is evidence that exercise could provide particular benefits for people with Parkinson's. In lab animals, physical activity seems to shield brain cells from some of the damage seen in Parkinson's, Alcalay noted.

And recent studies of Parkinson's patients have found that cardiovascular exercise, such as walking, can help ease physical and mental symptoms -- including stiffness, balance problems and depression.

"This study provides a couple new pieces," Alcalay said. "One is that for people with less severe Parkinson's, exercise does reduce falls. For people with more severe disease, though, this minimal-supervision program probably doesn't apply."

For the study, Canning's team randomly assigned 231 Parkinson's patients to either stick with their usual care or add an exercise program. That group took a monthly class with a physical therapist, where they learned balance and leg-strengthening exercises.

But most of the time, Canning said, the exercisers were on their own; they were told to fit in 40 to 60 minutes of exercise, three times a week -- with some of those sessions guided by a therapist who visited them at home.

After six months, the researchers found, there was no clear benefit for the study group as a whole. The picture looked different, however, when they focused on the 122 patients with milder Parkinson's symptoms.

Among those patients, 52 percent of exercisers had a fall over six months. That compared with 76 percent of those who did not exercise.

"This large effect was achieved with only 13 percent of exercise sessions supervised by a physical therapist," Canning said. "The results of our study suggest that early intervention for people with Parkinson's disease should be extended to include minimally supervised balance and strengthening exercises as a falls-prevention strategy."

"Early" is the key word, according to Canning. "We should not be waiting until the person has already fallen," she said.

Only an association was found between exercise and risk of falling among Parkinson's patients; the study did not prove cause and effect.

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Preventing Diaper Rash

By Robert Preidt, HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Diaper rash is a common problem for babies, but parents can take steps that help keep skin from getting red and inflamed.

"The best way to prevent and treat diaper rash is to keep your baby's skin as dry and clean as possible," Dr. Lawrence Eichenfield, chief of pediatric and adolescent dermatology at the University of California, San Diego, said in an American Academy of Dermatology news release.

"With the right care, diaper rash should clear in about three to four days," he added.

The most important preventive measure is to change wet or dirty diapers as soon as possible. This reduces moisture on the skin, which can inflame a rash. Be gentle when cleaning the diaper area and use water and a soft washcloth or baby wipes that are alcohol- and fragrance-free.

After cleaning, let your baby go diaper-free for as long as possible so that the skin can dry and heal.

Use zinc oxide diaper cream. If your baby has severe diaper rash, apply the cream as if you're frosting a cake, Eichenfield said. You don't need to remove the cream with each diaper change. You can fully remove it at the end of the day.

If the baby develops signs of a skin infection, call a doctor or dermatologist. Signs of infection may include fever, blisters, pus that drains from the rash, a rash that does not go away or worsens after treatment, and a baby who is in pain or hard to console.

"Babies have very delicate skin, and sometimes despite our best efforts, diaper rash still occurs," Eichenfield said. "If your baby's diaper rash is not going away, or if you have questions or concerns about caring for your baby's skin, consult a board-certified dermatologist."

More information

The American Academy of Family Physicians has more about diaper rash.

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Health Highlights: Dec. 31, 2014

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Former President George H.W. Bush Released From Hospital

President George H.W. Bush was released from a Houston-area hospital Tuesday, according to published reports.

The 90-year-old former president was hospitalized on Dec. 22 for breathing problems. A spokesperson for Bush said the hospital stay was just a precaution. By Monday, his breathing had returned to normal.

A statement from his office said:

"President Bush was released from the Houston Methodist Hospital today. He is now resting at home, grateful to the doctors and nurses for their superb care."

Bush is the oldest living former U.S. president.

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Falling Cancer Death Rate Means 1.5 Million Lives Saved Over 20 Years

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Progress in the war against cancer has triggered a 22 percent drop in U.S. deaths over the past two decades, translating to about 1.5 million lives saved, a new American Cancer Society report finds.

Even so, the annual report also predict that within a few years, cancer will overtake heart disease as the leading killer of Americans.

That's because "the decrease in mortality rates from heart disease has been much larger than the decrease in mortality from cancer," said Dr. Ahmedin Jemal, the cancer society's vice president of surveillance and health services research.

"Cancer is a collection of maybe 200 diseases," he explained. "It's not like heart disease, where you have maybe some variation but it is a single entity compared to cancer."

In 2011, the most recent year for which statistics are available, heart disease claimed the lives of more than 308,000 men and 288,000 women in the United States, while cancer killed more than 302,000 men and 274,000 women.

The cancer report estimates there will be more than 1,658,000 new cancer cases and over 589,000 cancer deaths in the United States in 2015 -- about 1,600 cancer-related deaths a day.

However, those numbers are still a significant improvement on the past: The report found that cancer death rates declined from about 215 per every 100,000 people in 1991 to about 169 per 100,000 in 2011.

Convincing Americans to quit smoking has been the major driver in reducing cancer deaths, Jemal said. The number of smokers has been cut in half, and now represents fewer than one of every five people in the United States.

As a result, the lung cancer death rates dropped 36 percent between 1990 and 2011 among males, and 11 percent between 2002 and 2011 among females.

Increased use of early detection tools -- such as mammography, colonoscopy and cervical exams -- has also had a tremendous impact on the war against cancer, Jemal said.

Gains for men slightly exceeded those for women. Between 2007 and 2011, the average annual decline in cancer death rates was larger for men (1.8 percent) than women (1.4 percent), the report found.

Jemal also noted that during the past two decades, deaths from colon and prostate cancer have been nearly cut in half, and breast cancer deaths have dropped by a third.

"Really, it's due to screening, as well as improved treatment," he said. "It's really remarkable."

Progress varied by geographic region, however. The smallest declines in cancer deaths generally occurred in the South, where drops were about 15 percent. The biggest advances took place in Northeastern states, with the cancer death rate dropping 25 percent to 30 percent in Maryland, New Jersey, Massachusetts, New York and Delaware.

States that made less progress in fighting cancer likely have large populations of people who are poor or uninsured, which means they don't have access to the kind of health care that can detect or prevent cancer, Jemal believes.

In addition, these states often have policies that hamper cancer prevention -- for example, cigarette taxes may be too low to discourage smoking. "If you look at the southern states, their excise taxes on tobacco are the lowest in the nation," Jemal said.

The overall rate of cancer cases (incidence) remained stable for women between 2007 and 2011, but declined by 1.8 percent per year for men.

Men experienced relatively rapid declines in cases of colon cancer (3.6 percent per year), lung cancer (3 percent per year) and prostate cancer (2.1 percent per year) during that period, the report found.

But there's been no change in incidence rates for breast cancer. And the report found that certain cancers are even on the rise. For example, thyroid cancer cases increased an average 4.5 percent per year between 2007 and 2011, and liver cancer cases have increased by more than 3 percent.

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New Year Often Ushers in Pledge to Quit Drinking

By Robert Preidt, HealthDay Reporter

WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- People with drinking problems often make a New Year's pledge to stop or cut back on their drinking, but actually doing it can be a struggle, an addiction expert says.

"Twenty percent of the people who make New Year's resolutions revert back to their old behaviors within a month," Janina Kean, president and CEO of High Watch Recovery Center in Kent, Conn., said in a center news release.

She offered advice for people who want to bring their drinking under control.

"Drinking problems are overcome through residential inpatient rehabilitation programs, outpatient programs and Alcoholics Anonymous, so it is best to seek help via these avenues," Kean said.

"Always seek treatment from evidence-based programs. These consist of a program with a medical license, and a clinical team run by a psychiatrist board-certified in addiction medicine, master's prepared therapists, and a registered nurse team to administer medications. The program should also be able to recognize and treat co-occurring disorders as well as have an educational treatment program for families," she advised.

The level of care required by a person is determined by the severity of their drinking problem.

"Someone with a severe substance use disorder will more than likely need a residential rehabilitation program, whereas people with a mild to moderate issue may be able to achieve remission with an outpatient program and Alcoholics Anonymous," Kean said.

If you relapse during the holiday season, don't be too hard on yourself. Instead, learn to forgive yourself. If you can't bring your drinking under control again, you may have to go back into treatment, she said.

"Oftentimes, problem drinking is a symptom of a greater underlying problem. Just stopping to drink can bring these issues to the surface, so you must seek treatment for these issues as well, whether they are depression, anxiety, etcetera," Kean said.

More information

The U.S. National Institute on Alcohol Abuse and Alcoholism has more about alcohol use disorders.

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Top UK doctor: Ebola screening should be improved

Health Tip: Why Am I Gaining Weight?

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- Whether you gain weight depends on more than just the foods you eat, and how often.

The Weight-loss Information Network says other factors that can influence weight gain include:

Having family members who are obese.

Whether you drive more than you walk.

Whether you dine out more than you cook at home.

Getting insufficient sleep.

Taking certain medications that can increase hunger or affect how well you burn calories.

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Health Tip: Move Around on a Plane

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- When you're stuck in an airplane seat, your blood can pool in your feet, increasing the risk of developing a blood clot.

The American Council on Exercise suggests how to reduce your risk:

If your flight is three hours or longer, take a walk through the cabin at least every 30 minutes when it's safe to do so.

When sitting down, stretch your legs as much as possible.

Make sure clothing fits loosely and comfortably.

If you nap, don't sleep for longer than 30 minutes.

Ask for water instead of caffeine or alcohol.

If you have a layover, take a brisk walk through the airport.

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Parent's Suicide Attempt Makes Child's Much More Likely: Study

By E.J. Mundell, HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- When a parent has a history of attempting suicide, the odds of a suicide attempt in their child rises fivefold, compared to the offspring of people without such histories, a new study finds.

Reporting in the Dec. 30 online edition of JAMA Psychiatry, researchers led by Dr. David Brent of the University of Pittsburgh Medical Center tracked more than 700 young and adult-aged children (ages ranged from 10 to 50) of 334 parents with mood disorders, such as depression or bipolar disorder.

A total of 191 of the parents had attempted suicide in the past. Forty-four of the offspring had attempted suicide in the past. Another 29 of the offspring attempted suicide during the study's nearly six-year follow-up period, according to the report.

The investigators found that a history of suicide attempts in a child was strongly associated with a similar history in that child's parent -- even after they accounted for any mood disorder that might be shared by both parent and child.

Behaviors involving "impulsive aggression" were closely tied to mood disorders, Brent's team found, "and could be targeted in interventions designed to prevent youth at high familial risk from making a suicide attempt."

Two experts said the study puts the spotlight on "at risk" children.

"For parents who have a history of depression, bipolar disorder and/or suicide attempts, they should be aware of the potential risk for their children and be proactive in having an evaluation if the child is experiencing depression or other psychiatric symptoms," said Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York City.

"Just as parents seek professional help if they are concerned about their child's physical health, parents should be proactive in observing their children's mental health and seeking a professional evaluation if they are concerned," Borenstein said.

Dr. Scott Krakower is assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y. He said, "if adolescents show signs or symptoms of a mood disorder, it is important that they receive treatment for this as soon as possible. Parents battling with a mood disorder should also seek treatment, to help foster a better relationship with their children."

As for warning signs, Krakower said that "impulsive aggression is often overlooked and can raise the risk for suicide. So, it is important to make sure that youth receive treatment to help learn better ways to regulate their emotions."

More information

There's more on the warning signs of suicide at the National Suicide Prevention Lifeline.

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Flu Now Epidemic in U.S., With 15 Child Deaths Reported

By Steven Reinberg

HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- The flu has reached epidemic levels in the United States, with 15 children dead so far this season, the federal Centers for Disease Control and Prevention reported Tuesday.

Every state will likely have flu cases within the next few weeks, and more deaths are expected, said Dr. Michael Jhung, a medical officer in CDC's influenza division.

"We are in the middle of flu season," Jhung said. "It's a safe bet that we are going to see flu activity continue to increase for a few more weeks. We are going to see every state in the country affected by flu."

Flu reaches epidemic levels in the United States every year, Jhung said. Whether this flu season will be more severe or milder than previous ones won't be known until April or May, he noted.

The number of children's deaths from flu varies by year, Jhung added. "In some years we see as few as 30, in other years we have seen over 170. To have 15 reported at this point in the season is, unfortunately, not unexpected," he said.

Whether more children are dying of flu this year won't be known until the end of the flu season, around March or April, Jhung said.

The South, Midwest and Western states have been especially hard hit this flu season. At least six children have died in Tennessee and four in Minnesota, according to published reports.

The predominant flu strain this season is the H3N2 virus, the CDC says. This virus is not well-matched to this year's flu vaccine, but what part this mismatch is playing in flu deaths isn't known, Jhung said.

The CDC recommends that everyone 6 months and older get a flu shot. It's not too late to get vaccinated, Jhung said. More than one type of flu is circulating, and the vaccine protects against at least three strains of circulating virus, he added.

"If you encounter one of those viruses where there is a very good match, then you will be well-protected," he said. "Even if there isn't a great match, the vaccine still provides protection against the virus that's circulating."

People at risk of flu-related complications include young children, especially those younger than 2 years; people over 65; pregnant women; and people with chronic health problems, such as asthma, heart disease and weakened immune systems, according to the CDC.

Common flu symptoms can include fever, chills, cough, sore throat, muscle aches and fatigue. Vomiting and diarrhea are seen more often in children with flu than adults.

Most people recover from flu anywhere from a few days to a bit less than two weeks. But others suffer life-threatening complications, such as pneumonia, according to the CDC.

Parents should take flu seriously, and get medical help if they feel their child is very sick, Jhung said.

"People should have a low threshold and contact the health care system, whether that means going to the emergency room or calling their doctor," he said. "That should be done early."

Warning signs might include a cough that disrupts sleep, a fever that doesn't come down with treatment, or increased shortness of breath, according to the U.S. Food and Drug Administration.

Adults and children with bad flu can be treated with antiviral medications, such as Tamiflu (oseltamivir) and Relenza (inhaled zanamivir), Jhung said. "Those work best when they are given very quickly. So if you do have signs and symptoms of flu, reach out to a health care provider and get evaluated," he said.

Flu seasons are unpredictable, according to the CDC. Each year, on average, 5 percent to 20 percent of the U.S. population gets the flu and more than 200,000 people are hospitalized from complications. During a 30-year period, from 1976 to 2006, estimates of flu-related deaths in the United States ranged from a low of about 3,000 to a high of about 49,000 people, the agency said.

More information

For more on flu, visit the U.S. Centers for Disease Control and Prevention.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/flu-now-epidemic-in-us-with-15-child-deaths-reported

Drug to Treat Serious Infections May Harm Kids' Kidneys, Study Says

By Mary Elizabeth Dallas, HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- Treating children who have drug-resistant bacterial infections with high doses of the antibiotic vancomycin may raise the risk of kidney damage, a new study says.

Researchers said the drug should be used cautiously.

"Our results bear out the difficult balancing act between ensuring the dose is high enough to successfully treat these serious and, at times, life-threatening infections against the small but real risk for kidney damage," said the study's senior investigator, Carlton Lee, a pediatric clinical pharmacist at the Johns Hopkins Children's Center in Baltimore.

"Ultimately, what we really need are new drugs that achieve the same therapeutic effect without taking a toll on the kidneys and other organs," Lee said in a Hopkins news release.

Vancomycin is only used to treat infections that don't respond to other medications. One of these bacteria is MRSA (methicillin-resistant Staphylococcus aureus), which led to new dosing guidelines for the antibiotic in 2009.

At high doses, vancomycin can reach levels in the blood necessary to fight resistant germs and prevent serious complications associated with drug-resistant infections. This study was launched to assess the effects of these high doses on children.

Researchers examined data on 175 children treated with vancomycin between 2009 and 2010. The kids had invasive drug-resistant infections in the skin, bone, heart, lung and brain, or bloodstream infections caused by MRSA. While taking the drug they underwent routine blood tests to assess their kidney function. Fourteen percent developed kidney damage, the study authors found.

The higher the dose of vancomycin, the greater the risk for kidney damage, the researchers reported in the December issue of Annals of Pharmacotherapy.

How long the children were treated with vancomycin also played a role. On average, the children in the study who developed kidney damage were treated with vancomycin for eight days -- twice as long as those who did not have kidney damage.

For each additional day on the drug, the risk of kidney damage increased by 11 percent. Simultaneous use of vancomycin with certain other drugs also raised the risk of kidney damage, the study concluded.

The researchers noted, however, that vancomycin has been used for three decades and can save lives. They added that kidney damage associated with the drug is often reversible once treatment ends.

But they cautioned that newer and safer treatments are needed for drug-resistant bacterial infections in children.

"The results of our study highlight the need for trials that provide pediatric experts with the evidence needed to make informed treatment and dosing decisions, ones that are based on solid data in children rather than on extrapolation from adult patients," study lead author Elizabeth Sinclair, a pediatric clinical pharmacy specialist at Texas Children's Hospital who conducted the research while at Hopkins, said in the news release.

More information

The U.S. National Institutes of Health has more about the antibiotic vancomycin.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/drug-to-treat-serious-infections-may-harm-kids-kidneys-study-says

Better Pain Relief After Knee Replacement Surgery?

By Mary Elizabeth Dallas, HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- Postoperative pain is always a concern after knee replacement surgery, but a new study suggests a strategy that might give patients another way to ease discomfort.

Researchers at Henry Ford Hospital in Detroit note that the painful recovery process following knee replacement surgery is a persistent problem.

However, the research team found that injecting a newer, long-acting numbing medicine, known as liposomal bupivacaine, into the area surrounding the knee helps patients recover more quickly and boosts their satisfaction with the procedure.

"Patients had pain relief for up to two days after surgery and better knee function compared with the traditional method," said the study's senior author, Dr. Jason Davis, a joint replacement surgeon at Henry Ford West Bloomfield Hospital, in a hospital news release.

The study involved more than 200 patients who underwent knee replacement surgery and were then tracked for pain control during the first two days after their procedure.

Half of the patients received traditional pain control, in which a common numbing medicine is injected via a pump into the groin area. Although this method can cause leg weakness, it prolongs pain control for two days after surgery, the researchers said.

"Pain control [using this method] came at the price of weakness and made patients somewhat tentative when walking during their hospital stay," Davis noted.

The rest of the patients received the liposomal bupivacaine injection, targeted to the site of their surgery. Unlike the traditional pain control method, the newer, long-acting numbing medicine enabled patients to begin walking comfortably just hours after surgery, the study showed.

This technique "optimizes pain control early on," said Davis. "Function-wise, it was a lot easier for patients to move around more confidently. In the past decade, we've made major advancements in pain control for knee replacement surgery. This option is a promising, viable one for our patients."

Two experts not connected to the study had mixed opinions about the results.

"Innovative approaches to pain control have markedly improved the early recovery after knee replacement," said Dr. Matthew Hepinstall, an orthopedic surgeon at Lenox Hill Hospital in New York City.

"This study confirms prior studies showing that local anesthetic injections can provide analgesia similar to nerve blocks after knee replacement, without the delayed rehabilitation that some patients experience with femoral [leg] nerve blocks," he said.

But Hepinstall stressed that only further research will let doctors know for sure that the more expensive liposomal drug is better than conventional methods at reducing postoperative pain.

Dr. Jan Koenig is chief of joint replacement surgery at Winthrop-University Hospital in Mineola, N.Y. He said that one "underreported problem with the liposomal bupivacaine time-release analgesia is that we see a lot of rebound pain about day three when it wears off."

The study was presented recently at the American Association of Hip and Knee Surgeons annual meeting in Dallas. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Institutes of Health provides more information on what to expect during recovery from knee replacement surgery.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/better-pain-relief-after-knee-replacement-surgery

Your Birth Year Could Influence Your Odds for Obesity, Study Suggests

By Dennis Thompson

HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- The year in which you're born might affect the activity of a gene that could raise your odds for obesity, a new study finds.

Members of families who share an obesity-prone mutation of the FTO gene are more likely to carry extra weight if they were born after 1942, the researchers found.

"You could have a family where your father might be born in 1920 and you were born after 1942, and you look exactly like him, and only on the basis of the food and environment around you, you will have a higher BMI than your father," said lead author Dr. James Niels Rosenquist, an instructor at Harvard Medical School and psychiatrist with Massachusetts General Hospital in Boston. BMI (body mass index) is a standard measurement of weight and height.

According to the researchers, prior studies have linked variations in the FTO gene to a propensity toward overweight and obesity. For example, federal researchers earlier this year reported that people with mutated FTO genes are more likely to eat high-calorie or fatty foods as they age, compared to people without the mutations.

While the study couldn't prove cause-and-effect, the findings suggest that changes in American culture may be boosting the obesity threat tied to the FTO gene mutation.

To take a multi-generational look at obesity risk, the researchers relied on the Framingham Heart Study, a decades-old study of more than 10,000 parents, children and even grandchildren hailing from the town of Framingham, Mass.

About two-thirds of the more than 5,100 children born to the original Framingham participants have had their DNA sequenced. This allowed the research team to determine which families carried the obesity-prone versions of the FTO gene.

The researchers compared people's genes to changes in BMI measurements taken over time, and then compared that to the years participants were born.

Rosenquist's team found no link between the FTO gene and obesity for people born prior to 1942. However, they found a very strong link between the gene and obesity in those born after 1942 -- a link twice as strong as reported in previous studies.

Dr. Mitchell Roslin is chief of obesity surgery at Lenox Hill Hospital in New York City. He said that science is beginning to show that genes alone may not determine a person's fate. Instead, genes often appear to respond to outside influences, so there's a combination of environment and genetics at play.

"While the genetic code is determined, factors in the environment that impact genes determine how they are expressed [activated]," Roslin explained. "Obesity certainly appears very much determined by these factors. Animal experiments have shown when foods given to pregnant mothers are altered, propensity for obesity in offspring changes. Studies like this show similar things occur in humans."

The new study could not point to any specific differences in America pre- and post-World War II that might affect the FTO gene and create increased obesity risk. But Rosenquist believes that Americans' increasingly sedentary lifestyles, a shift from a manual labor workforce to a service economy, and increased access to high-calorie foods all might play a role.

"The findings lend credence to the belief that our current obesity epidemic can be linked to major environmental changes that have occurred over the last 50 or so years," added Christine Santori, a registered dietitian and program manager of the Center For Weight Management at North Shore-LIJ's Syosset Hospital in Syosset, N.Y.

"The study doesn't identify which factors are specifically related to gene expression, but one can look to changes in our workforce, sedentary lifestyle, how our food is manufactured, and our reliance on highly processed calorically dense foods as points of future research," she said.

The findings are reported Dec. 29 in the journal Proceedings of the National Academy of Sciences.

More information

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/your-birth-year-could-influence-your-odds-for-obesity-study-suggests

Middle-Aged Worse at Texting-While-Driving, Study Shows

By Alan Mozes

HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- The risky mix of texting and driving may be more problematic for middle-aged drivers than it is for younger drivers, according to new research.

However, that doesn't mean texting and driving is OK for any age group, the study authors stressed.

"First and foremost we don't want to misrepresent this in any way that promotes texting and driving among young drivers," said study co-author Randall Commissaris, an associate professor in the department of pharmaceutical sciences at Wayne State University in Detroit. "But today more and more older people are texting, not just teens and those in their 20s and 30s. And a lot of these older people are doing it while driving," he added.

"So we systematically road-tested a range of drivers, from age 18 to 59," Commissaris explained. "And we found that while about 25 percent of the youngest drivers would go into an oncoming lane or onto the shoulder while texting, it was virtually 100 percent among the oldest drivers."

Results of the study are published in the January issue of Accident Analysis and Prevention.

To explore how texting affected drivers of different ages, the researchers ran 50 men and women through a series of computerized road tests.

Texting ability varied, according to the study. Seven described their texting ability as limited -- meaning they had to search for the keys and typed with one finger. Sixteen said their texting skills were good, though they described using two hands to text. Twenty-seven volunteers were in the "skilled" texter category, meaning they're able to handle sending texts with one hand, according to the study.

The researchers divided the volunteers into four age categories: 18 to 24; 25 to 34; 35 to 44; and 45 to 59. To test their driving skills, they were asked to "drive" a four-door fully outfitted driving simulator that created a virtual, but realistic, roadway experience. The driving simulator mimicked driving on a two-lane country road. There were no stop signs or stop lights. And, there were no oncoming cars in the opposite lane, the study reported.

Each volunteer drove for a half-hour test session. During that test, they were asked to drive several minutes at roughly 50 to 60 miles per hour while engaging in brief text conversations conducted with one hand.

Overall, two-thirds of drivers committed "lane excursions," meaning they crossed into another lane with oncoming traffic or on to a shoulder, according to the study. Among skilled texters, about half of the volunteers committed lane excursions.

But digging deeper, investigators found that nearly all of those in the 45 to 59 group made such driving mistakes.

This compared with about one-quarter of those between the ages of 18 and 24, according to the study. About 40 percent of those 25 to 34, and 80 percent of drivers between 35 and 44 made lane excursions, suggesting that the ability to handle the texting distraction got continually worse with age.

The researchers found no differences in driving and texting ability between genders.

Exactly why older drivers fared worse remains unclear, although the research team suggested that older drivers may simply spend more time looking at their phones, or may be generally less able to multitask.

"The findings were very surprising to us," said Commissaris, "because most of the literature on distracted driving suggests that mature drivers are better able to manage distractions. Whether it's being involved in a cellphone conversation, talking with passengers, or checking maps."

But, he added, "this study suggests that we really need to make sure that older drivers don't take the attitude that they're somehow better able to manage this particular distraction. They're not."

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/middle-aged-worse-at-texting-while-driving-study-shows

Bats May Have Triggered Ebola Outbreak in West Africa, Study Says

By Mary Elizabeth Dallas, HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- The Ebola epidemic in West Africa may have started with virus-infected bats, a new study says.

Ebola epidemics are "zoonotic" in origin, spreading to humans through contact with bats or larger wildlife, according to the researchers in Germany.

But their investigation ruled out larger wildlife as the source of the 2014 outbreak, which began in the Guinean village of Meliandou.

"We monitored the large mammal populations close to the index village Meliandou in southeastern Guinea and found no evidence for a concurrent outbreak," said the study's leader, Fabian Leendertz, from the Robert Koch Institute in Berlin, in an institute news release.

Bats, however, do have contact with humans in Meliandou. And one type of bat in particular -- free-tailed insectivorous bats -- may be a plausible source of transmission, the researchers determined.

So far the Ebola virus has killed about 7,700 people and sickened 20,000, mostly in the West African countries of Sierra Leone, Guinea and Liberia.

The study, published Dec. 30 in EMBO Molecular Medicine, was conducted by a multidisciplinary team of researchers. Over a four-week field mission in Guinea last April, the researchers examined human exposure to bats. They also surveyed local wildlife and collected sample bats in Meliandou and nearby forests.

Interviews with local residents revealed that direct contact with fruit bats through hunting and eating meat is common in the affected regions of Africa. But the researchers determined that fruit bats are not the likely source of the outbreak.

The first case of infection in Meliandou was a 2-year-old boy. Food-related transmission would have affected adults before or at the same time as the boy, the researchers explained.

However, a large colony of free-tailed insectivorous bats lived in a hollow tree near the toddler's home. Villagers reported that children played in and around the tree, which could have led to significant exposure to bats, the study said.

More information

The U.S. Centers for Disease Control and Prevention provides more information on Ebola.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/bats-may-have-triggered-ebola-outbreak-in-west-africa-study-says

Ebola, Obamacare Top U.S. Health News for 2014

By E.J. Mundell

HealthDay Managing Editor

TUESDAY, Dec. 30, 2014 (HealthDay News) -- It started as a deadly but little-known outbreak in West Africa, but the lethal and unchecked spread of the Ebola virus dominated U.S. headlines for much of 2014, making it one of the year's top health news stories.

According to the latest World Health Organization figures, nearly 20,000 reported cases of Ebola -- including more than 7,700 deaths -- have occurred since the outbreak began earlier this year in Guinea, Liberia and Sierra Leone. By September, the first of 11 cases treated in the United States began to worry Americans, and two cases acquired in the United States -- nurses treating an Ebola-infected patient at a Dallas hospital -- sparked fears the disease might spread in this country.

Under criticism for what some considered an uneven response to the threat, the U.S. Centers for Disease Control and Prevention in December designated 35 specially equipped hospitals across the United States as Ebola treatment centers.

While the survival rate for patients treated in the United States has been much higher than in West Africa -- nine out of 11 patients beat their illness here -- the U.S. still faces the potential for more cases to come, experts say.

"As long as Ebola is spreading in West Africa, we must prepare for the possibility of additional cases in the United States," CDC Director Dr. Tom Frieden said earlier this month.

The other big health story of the year: the continued rollout of the Affordable Care Act (ACA), also known as Obamacare. By the end of the year, the Obama Administration said, 10 million Americans had gained health care coverage, with nearly 2 million new enrollees signing up for coverage for 2015.

But there were some serious bumps along the way. Following withering criticism for the bungled launch of the HealthCare.gov website in 2013, Health and Human Services Secretary Kathleen Sebelius resigned her post in April.

Key judicial battles over Obamacare were won and lost, as well. In June, the U.S. Supreme Court, citing religious objections, ruled that family-owned companies could opt out of a provision of the ACA that would have required them to offer insurance coverage for contraception.

And in July, two federal appeals courts came to opposite rulings on the use of financial subsidies for people who bought health insurance through the federal HealthCare.gov exchange -- signaling a possible future showdown on the issue before the Supreme Court. With Republicans winning control of Congress in November, more battles over Obamacare may be yet to come.

Other top health news stories for 2014, as compiled by the editors at HealthDay, included:

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/ebola-obamacare-top-us-health-news-for-2014

Many Consumers Misled About Bogus Weight-Loss Supplements, Survey Says

By Mary Elizabeth Dallas, HealthDay Reporter

TUESDAY, Dec. 30, 2014 (HealthDay News) -- Think a pill you saw advertised on the Internet can miraculously help you shed unwanted pounds? You're not alone: A new Consumer Reports survey finds many Americans are misinformed about the quality and effectiveness of these supplements.

"The barrage of advertising leads us to think there's a magic way to melt away 10 pounds -- even when we have no evidence that supplements work," Dr. Pieter Cohen, a physician at Harvard Medical School who studies supplements, said in a Consumer Reports news release.

"The labels on weight loss supplements look like those on over-the-counter medications, and the supplement facts are organized like nutrition facts labels," he added. "There's no way for consumers to tell the difference."

So it's perhaps not surprising that the new survey of nearly 3,000 Americans found that about 20 percent of respondents were misinformed, believing, erroneously, that the U.S Food and Drug Administration guarantees the safety and effectiveness of weight-loss supplements.

All of that scientific-looking labeling "gives you the sense the products are being scrutinized by the FDA," Cohen said, even though the agency plays no such role when it comes to supplements.

More than a quarter of respondents to the survey said they had tried a weight-loss product in the past, and believed the product was safe and would help them lose more weight than other methods.

About 25 percent also believed the products have fewer side effects than over-the-counter or prescription medications. But the same survey suggests that's just not true: About half of those polled who said they had tried a weight-loss supplement said they also developed at least one symptom such as rapid heart rate, jitteriness, constipation/diarrhea, or dry mouth.

Cohen said, "of all dietary supplements, the ones for weight loss seem to cause the most harm -- sometimes liver failure and even death."

The survey showed that more than one-third of those taking weight-loss supplements were also taking a prescription medication for another condition. Many people taking weight-loss supplements don't inform their doctor, and that could raise the risk for drug-drug interactions and potentially serious complications.

"These products can interact with prescription medications, but consumers often feel that supplements are different from prescription drugs, and doctors don't ask about them," said Cohen.

Complicating matters, weight-loss products may contain drugs that have been banned by the FDA. In another recent study, the researchers found that 27 supplements recalled by the agency were still being sold. Of those products, two-thirds being sold for weight loss contained some type of banned ingredient.

In the end, "there's no way to know what's in the bottle," Cohen said. "You're at the mercy of the manufacturer."

And what about the drugs' effectiveness at shedding unwanted pounds? Claims that these products will help people burn more fat or calories have not been validated by the FDA, the researchers said.

Like food, weight-loss supplements are generally considered safe until shown to be dangerous, the report's authors said.

According to the survey, one-third of those polled didn't lose any weight. Although another one-third lost some weight, only 9 percent reported losing all the weight they wanted to lose and kept it off. But, the weight-loss supplements probably had little to do with their weight loss success, the study's authors suggested.

"If you've spent money on something you think will help, you'll probably pay more attention to what you're eating," explained Cohen. "Taking the pill acts as a reminder."

The respondents who said they lost at least some weight while taking a weight-loss supplement were typically following a diet or exercise program, the survey revealed.

More information

The U.S. National Center for Complementary and Alternative Medicine provides more information on weight-loss supplements.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/many-consumers-misled-about-bogus-weight-loss-supplements-survey-says

Health Tip: Taking Care of Someone With Flu

Health Tip: If Snoring Keeps You up at Night

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- Snoring can be disruptive for you and your partner, and it may be a warning sign of sleep apnea.

The National Sleep Foundation offers these suggestions that may help prevent the problem:

Lose any excess weight.

Before bed, avoid medications such as antihistamines, sleeping pills and tranquilizers.

Have your last meal or snack at least three hours before bed, and your last alcoholic beverage at least four hours before.

Adhere to a regular sleep schedule.

Roll onto your side, instead of sleeping on your back.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/30/health-tip-if-snoring-keeps-you-up-at-night

Pollution Plagues Annual Pilgrimage to Mecca

By Robert Preidt, HealthDay Reporter

MONDAY, Dec. 29, 2014 (HealthDay News) -- Air pollution in Mecca rises sharply each year when millions of Muslims make the annual holy pilgrimage (hajj) to the Saudi Arabian city, a new study shows.

"Hajj is like nothing else on the planet. You have 3 to 4 million people -- a whole good-sized city -- coming into an already existing city," Isobel Simpson, a research chemist in the atmospheric chemistry laboratory at the University of California, Irvine, said in a university news release.

"The problem is that this intensifies the pollution that already exists. We measured among the highest concentrations our group has ever measured in urban areas -- and we've studied 75 cities around the world in the past two decades," she added.

The researchers took air samples in various locations in Mecca during the 2102 and 2013 hajjes in October. The results showed high levels of various air pollutants, many of which can cause serious health problems.

"There's carbon monoxide [CO] that increases the risk of heart failure. There's benzene that causes narcosis and leukemia. But the other way to look at it is that people are not just breathing in benzene or CO, they're breathing in hundreds of components of smog and soot," Simpson said.

Air pollution was worst inside the Al-Masjid Al-Haram tunnel, where pedestrians, hotel workers and security personnel are exposed to fumes from idling vehicles, often for hours, the researchers said.

The tunnel was where researchers recorded the highest level of carbon monoxide -- 57,000 parts per billion. That reading during the 2012 hajj is more than 300 times the normal background levels of carbon monoxide in the region, according to the news release.

Saudi officials are taking steps to improve the situation, the researchers said.

The study was presented recently at a meeting of the American Geophysical Union in San Francisco and published in the journal Environmental Science & Technology.

"Air pollution is the cause of one in eight deaths and has now become the single biggest environmental health risk globally," study co-author Haider Khwaja, of the University at Albany in New York, said in the news release.

"There were 4.3 million deaths in 2012 due to indoor air pollution and 3.7 million deaths because of outdoor air pollution, according to [the World Health Organization]. And more than 90 percent of those deaths and lost life years occur in developing countries," he said.

More information

The U.S. Environmental Protection Agency has more about the health effects of air pollution.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/29/pollution-plagues-annual-pilgrimage-to-mecca

Stem Cell Therapy for MS Shows Promise

By Dennis Thompson

HealthDay Reporter

MONDAY, Dec. 29, 2014 (HealthDay News) -- An experimental therapy that kills off and then "resets" the immune system has given three years of remission to a small group of multiple sclerosis patients, researchers say.

About eight in 10 patients given this treatment had no new adverse events after three years. And nine in 10 experienced no progression or relapse in their MS, said lead author Dr. Richard Nash of the Colorado Blood Cancer Institute at Presbyterian/St. Luke's Medical Center in Denver.

"I think we all think of this as a viable therapy," Nash said. "We still need to perform a randomized clinical trial, but we're all pretty impressed so far, in terms of what we've seen."

In multiple sclerosis, the body's immune system for some unknown reason attacks the nervous system, in particular targeting the insulating sheath that covers the nerve fibers, according to the U.S. National Institutes of Health. People with the more common form, called relapsing-remitting MS, have attacks of worsening neurologic function followed by partial or complete recovery periods (remissions).

Over time, as the damage mounts, patients become physically weak, have problems with coordination and balance, and suffer from thinking and memory problems.

This new therapy seeks to reset the immune system by killing it off using high-dose chemotherapy, then restarting it using the patient's own blood stem cells. Doctors harvest and preserve the patient's stem cells before treatment, and re-implant them following chemotherapy.

"Because many of the immune cells are being killed off, there's an immune reset following the treatment," Nash said.

Nash and his colleagues came up with the idea based on similar treatment that blood cancer patients receive. "We knew what a profound effect the high-dose therapy and transplant could have on the immune systems of patients with lymphoma and myeloma," he said.

Three years ago, a group of 24 patients with relapsing-remitting MS underwent the therapy. Researchers plan to follow them for five years, to see how well the treatment performs.

So far, 78 percent of the patients have been event-free, which the researchers define as survival without death or disease from a loss of neurologic function, clinical relapse or new nervous system lesions caught on imaging scans.

About 90 percent of patients have enjoyed progression-free survival, and 86 percent have not suffered a clinical relapse, the researchers reported Dec. 29 in JAMA Neurology.

Nash said this therapy could revolutionize treatment for multiple sclerosis, which has depended on expensive biologic and targeted therapy drugs that block the immune system.

"The agents we use aren't expensive. The major expense is the supportive care," Nash said, noting that the adverse reactions and health risks are the same as those experienced by cancer patients receiving bone marrow or stem-cell transplants. "Everything else has just gotten so much more expensive, in terms of the agents out there. Treating MS may have become more cost-effective."

However, Nash noted that the therapy still has not been proven to create lasting improvement. "I'm sure we're going to be getting a lot of phone calls from patients, but we're still in the investigative stage for this," he said.

Another expert agreed. Bruce Bebo, executive vice president for research at the National Multiple Sclerosis Society, said that the research is interesting but needs more follow-up.

"There may be something to this, but the jury is out until we see results from a larger, better-controlled trial," he said.

Bebo also said this approach will have to be tested against current MS drug therapies.

"It comes with significant risk. They're using pretty strong chemotherapy drugs to wipe out your immune system, and it does come with a risk of mortality," he said.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/29/stem-cell-therapy-for-ms-shows-promise

Poverty Makes Diabetes Care Tougher, Study Reports

By Steven Reinberg

HealthDay Reporter

MONDAY, Dec. 29, 2014 (HealthDay News) -- People with diabetes who have difficulty paying for food, medicine and other basic needs also have trouble managing their diabetes, a new study finds.

Those who have trouble paying for food or medicine had the highest risk of poor diabetes control, according to the study. Poor control means higher blood sugar, cholesterol and blood pressure than normal, the researchers said.

"Despite insurance coverage, unmet basic needs were common, associated with worse diabetes control, and high use of expensive health services," said lead author Dr. Seth Berkowitz, a research fellow in medicine at Harvard Medical School.

"If we do not try to address these needs specifically, we may make little progress in improving health for vulnerable diabetes patients," he said.

Historically, patients come in for office visits or hospitalizations, but most of their time -- the time that determines their overall health -- is spent outside the health care system, Berkowitz noted.

Health care systems are being held accountable for health outcomes, but these outcomes may be determined by situations that most health care systems have limited experience dealing with, he said.

"This study suggests that simply increasing access to health care that does not address root causes of illness may be missing a big piece of what patients need to stay healthy and manage their illnesses," Berkowitz said.

However, Berkowitz thinks that the Affordable Care Act may help address these needs.

"Changes in health care financing could encourage health care delivery systems to think about population health management in a way that gives room to address issues not classically thought of as medical, like unmet basic needs," he said.

Medicaid is likely to be helpful, especially for prescription medication coverage, he said.

As for where people can turn for help, Berkowitz said that unfortunately, there isn't a single easy answer.

Social services -- both public and private -- in the United States are a "patchwork" so the answer will be different for each person, he said.

The report was published Dec. 29 online in JAMA Internal Medicine.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said, "As can be expected, the more 'insecurities,' the worse the outcomes."

"This study also proves that diabetes is a complex disease to treat and social variables play an important role that cannot be easily controlled by the government," he said.

For the study, Berkowitz's team collected data on more than 400 people with diabetes. They were seen at two community health centers in Massachusetts from June 2012 through October 2013.

The researchers found that 19 percent of the patients said they had trouble affording food; 28 percent said they had problems paying for medications; 11 percent had problems paying for a place to live, and 14 percent had difficulty paying utility bills. Nearly 40 percent of those surveyed had difficulty paying for one of these needs, the researchers found.

Almost half of the respondents -- 46 percent -- had trouble with diabetes management.

The researchers found that financial problems affected diabetes management in varying ways.

For example, having problems affording food significantly upped the odds of poor diabetes control and increased clinic visits, but did not affect visits to the emergency room or hospitalizations.

Trouble paying for medicine was also linked to poor diabetes control and more emergency room visits, but did not affect clinic visits, the researchers noted.

Problems paying for housing or utilities were associated with more clinic visits, but not with poor diabetes control or with emergency room visits, according to the study.

More information

For more information on diabetes, visit the U.S. National Library of Medicine.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/29/poverty-makes-diabetes-care-tougher-study-reports

1 in 3 People With Type 1 Diabetes Still Produce Insulin, Study Says

By Mary Elizabeth Dallas, HealthDay Reporter

MONDAY, Dec. 29, 2014 (HealthDay News) -- Although it's widely accepted that people with type 1 diabetes produce no insulin, a new study suggests otherwise: Roughly one-third produce the hormone long after they are diagnosed.

Residual insulin production can last for more than four decades, researchers reported recently in the journal Diabetes Care. Their findings could help avoid the misdiagnosis of type 1 diabetes as the more common type 2 diabetes and improve treatments for blood sugar control, they suggested.

"Other studies have shown that some type 1 diabetes patients who have lived with the disease for many years continue to secrete insulin, and the assumption has been that these patients are exceptional," said study senior author Dr. Carla Greenbaum, director of T1D Exchange Biobank Operations Center, a repository of type 1 diabetes biological samples, in Seattle.

"For the first time, we can definitively say that these patients are a true subset of the type 1 diabetes population, which has major clinical and health policy implications," she said in a journal news release.

Worldwide, about 35 million people in the United States have type 1 diabetes, the researchers said. The autoimmune disease causes the destruction of insulin-producing cells in the pancreas, which means patients must take insulin injections or use an insulin pump.

The researchers examined type 1 diabetes samples from more than 900 people ranging in age from 5 to 88, and found that C-peptide, a byproduct of insulin production, was present in patients of all ages.

But C-peptide was found more often and in higher concentrations in those diagnosed as adults. Among those who had type 1 diabetes for three to five years, C-peptide was present in 78 percent of those diagnosed after 18 years of age, and in less than half of those diagnosed before age 18.

Additionally, 16 percent of those diagnosed as an adult and 6 percent of those diagnosed as a child had residual C-peptide more than four decades later, the researchers found. They concluded there are key differences in type 1 diabetes diagnosed during childhood and type 1 diabetes that develops during adulthood.

"These findings lend further credence to research underway on targeted therapies that could prolong insulin production, helping type 1 diabetes patients better manage their disease and reduce complications," study co-author Asa Davis, a T1D Exchange program manager, said in the news release. "For example, potential immunotherapy treatments are already being studied with this goal in mind, and our findings underscore that those diagnosed at a young age may be more likely to benefit from such new approaches."

The researchers also said their findings could have major policy implications, noting that many type 1 diabetes may not meet the insulin pump requirements of federal and private insurers, which are based on lack of insulin production.

More information

The American Diabetes Association provides more information on type 1 diabetes.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/29/1-in-3-people-with-type-1-diabetes-still-produce-insulin-study-says

Preventing Emergency Surgeries Could Save $1 Billion

By Mary Elizabeth Dallas, HealthDay Reporter

MONDAY, Dec. 29, 2014 (HealthDay News) -- Strategies to reduce the number of emergency surgeries in the United States could save up to $1 billion in health care costs over a decade, new research suggests.

The study also found that surgeries planned ahead of time (elective surgery) are less risky for patients and generally have better outcomes.

"The costs of surgical care represent nearly 30 percent of total health care expenditures and they are projected to total more than $900 billion by 2025," study author Dr. Adil Haider, director of the Center for Surgery and Public Health at Brigham and Women's Hospital in Boston, said in a hospital news release. Haider was at the Center for Surgical Trials and Outcomes Research at Johns Hopkins University while conducting the study.

"If 10 percent of these emergency surgeries had been performed electively, the cost difference would have been nearly $1 billion over 10 years," Haider said.

"Importantly, elective procedures are better for patients, too, who experience lower rates of mortality and better outcomes. There is a tremendous opportunity to both save lives and decrease costs," he added.

The researchers looked at three common operations for the study. One is a procedure to repair the main artery in the abdomen (aortic aneurysm repair). The second is heart surgery to restore blood supply to the heart (coronary artery bypass graft). The third operation was surgery to remove part of the large intestine (colon resection).

The researchers analyzed data on more than 600,000 patients. All had one of these procedures between 2001 and 2010.

The researchers compared the hospital costs and risk of death when surgeries were planned versus when they were performed in an emergency.

Emergency surgery was 53 percent more expensive for colon resection than elective surgery. Emergency procedures were 30 percent more expensive for abdominal aortic aneurysm repair and 17 percent more expensive for coronary artery bypass graft, the researchers found.

People who had planned surgery also had lower rates of death than patients who had emergency procedures.

Results of the study were published online in the Annals of Surgery.

More information

The U.S. Centers for Disease Control and Prevention provides more information on health expenditures.

from U.S. News - Health http://health.usnews.com/health-news/articles/2014/12/29/preventing-emergency-surgeries-could-save-1-billion

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