healthy living websites: October 2014

Is Tau the 'How' Behind Alzheimer's?

By Dennis Thompson

HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Malfunction of a key brain protein called tau is the likely culprit behind Alzheimer's disease and other forms of dementia, a new study in mice concludes.

Neurons -- highly specialized nerve cells in the brain -- appear to die when tau malfunctions and fails to clear the cells of unwanted and toxic proteins, explained Charbel Moussa, head of the Laboratory for Dementia and Parkinsonism at Georgetown University School of Medicine, in Washington, D.C.

This means drugs that replace the function of tau in these brain cells are likely to slow the progression of Alzheimer's, he said.

"A strategy like this will give us hope that we can delay or stabilize the disease progression," Moussa said.

Tau has long been a prime suspect in the search for the cause of Alzheimer's disease. The brains of Alzheimer's patients wind up clogged with twisted protein threads made of tau, particularly in regions important to memory.

But researchers have been at a loss to explain why tau might cause Alzheimer's, and whether the tangles of tau are more important than another hallmark of Alzheimer's, plaques made of a protein called amyloid beta that fill the spaces between the brain's nerve cells.

Moussa said his experiments with mice have shown that tau works to keep neurons naturally free of amyloid beta and other toxic proteins.

When tau malfunctions, the neurons begin to spit amyloid beta out into the space between the brain cells, where the protein sticks together and forms plaques, he said.

"When tau does not function, the cell cannot remove the garbage," Moussa said. The result is cell death, he explained.

Tests on the brain cells of mice revealed that removing all tau impaired the neurons' ability to clear out amyloid beta, according to findings published Oct. 31 in the journal Molecular Neurodegeneration. But if researchers reintroduced tau into brain cells, the neurons were better able to remove accumulated amyloid beta from the cells.

Moussa said his study suggests the remaining amyloid beta inside the neuron destroys the cells, not the plaques that build up outside. The mouse experiments also showed that fewer plaques accumulate outside the cell when tau is functioning.

Malfunctioning tau can occur as part of the aging process or due to genetic changes. As people grow older, some tau can malfunction while enough normal tau remains to help clear the garbage and keep neurons alive. "That explains the confusing clinical observations of older people who have plaque buildup, but no dementia," Moussa explained in a Georgetown University news release.

In this study, Moussa also explored the possible use of a cancer drug called nilotinib to force neurons to keep themselves free of garbage, with the help of some remaining functional tau.

"This drug can work if there is a higher percentage of good to bad tau in the cell," added Moussa, whose work was funded in part by a grant from Merck & Co., the pharmaceutical company.

Heather Snyder, director of medical and scientific operations for the Alzheimer's Association, said Moussa's findings are interesting but not conclusive.

"They're saying that tau may have an earlier role than we currently know. That's as far as I would go," Snyder said. "We still don't know how all the pieces come together."

Snyder said new imaging technology that allows doctors to track tau buildup in a person's brain over time may help solve this question in the future.

Also, experts say, results of animal experiments don't necessarily apply to humans.

But Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center, said the new study adds to the growing evidence that "the role of tau is fundamental in the disease process."

"Developing therapeutics for tau is a high priority," Petersen said. "Not easy, not simple, but it could be very fruitful."

More information

For more on Alzheimer's disease, visit the U.S. National Institute on Aging.

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Child's Appendix More Likely to Rupture in Regions Short of Surgeons

By Robert Preidt, HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Children and teens with poor access to general surgeons are at increased risk of suffering a ruptured appendix, and the risk is particularly high among young children, a new study finds.

If an infected appendix isn't removed quickly enough, it can burst or rupture, leading to a serious, sometimes fatal infection, according to background information from the study.

Researchers analyzed data from nearly 7,000 children younger than 18 who were diagnosed with appendicitis at surgical centers in North Carolina between 2007 and 2009. Nearly one in four of the youngsters later suffered a ruptured appendix.

The risk of ruptured appendix was 1.7 times higher among patients who were transferred to another hospital, and 1.4 times higher among those who came from areas with a severe shortage of general surgeons, fewer than three for every 100,000 people.

Young appendicitis patients with limited access to general surgeons likely have to wait longer to be transferred and start receiving care, according to the authors of the study presented this week at an American College of Surgeons meeting in San Francisco.

Compared to children older than 12, the risk of ruptured appendix was 5.6 times higher among kids age 5 and younger, and 1.3 times higher for those ages 5 to 12.

"Transfers from other hospitals tend to be younger children. Rural surgeons may feel comfortable treating a 12- or 13-year-old, but if the child is 1 month or 5 years old, they will usually be transferred," study lead author Dr. Michael Phillips, a surgery resident at the University of North Carolina at Chapel Hill, said in a College of Surgeons news release.

Such transfers can take a couple of hours, he noted.

Another reason why younger children with appendicitis are more likely to suffer a ruptured appendix is that they can't explain what's wrong with them, which could delay diagnosis, according to the release.

"In some cases, the child will have signs of appendicitis, like eating less and a fever, but parents will think it's something else. Then they send the child to a pediatrician, wait for lab tests to come back, then have an imaging study. This process can take a while," Phillips said.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about appendicitis.

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Study Shows How Toddlers Adjust to Adult Anger

By Tara Haelle

HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Toddlers can both sense adult anger and alter their behavior in response to it, new research reveals.

"Babies are like sponges," said study co-author Andrew Meltzoff, co-director of the University of Washington Institute for Learning & Brain Sciences, in Seattle. "They learn not only from their own direct social experiences but from watching the social interactions between two other people."

He said he was most surprised at how emotionally "sophisticated" the babies were at such a young age.

"This study shows that even 15-month-olds have their emotional antennae up and are scanning the social environment to understand and predict other people's emotional reactions," he said. "Young children have a kind of emotional radar that is quite striking."

Meltzoff's team conducted an experiment in which 150 toddlers, all aged 15 months, sat on their parents' laps and watched an experimenter show them how to use several toys that made different sounds.

During this demonstration, another person came in the room, sat down and began complaining about the experimenter's actions with the toys.

Then the children had an opportunity to play with the toys. When the complaining person was out of the room or had her back turned, the children quickly picked up the toys and copied the experimenter's actions.

If the complainer watched the child with a neutral expression or looked at a magazine, however, the toddlers usually waited an average of four seconds before they picked up any of the toys. They were also less likely to do the same actions they had seen the experimenter do.

"Interestingly, the infants treat this previously angry person as anger prone -- someone who might get angry at them even though she shows no signs of being angry right now," Meltzoff said. "They remember the emotional history of a person."

The findings were published in the October/November issue of the journal Cognitive Development.

The researchers also compared the children's impulsivity based on questionnaires from the parents. Children with higher ratings of impulsivity, based on the parents' answers, were more likely to do what the experimenter had done even if the complainer was watching them.

"We found great variation among the toddlers," Meltzoff said. "Some had excellent self-control, and some were a little more impulsive and could not control themselves."

It was the toddlers who had more advanced self-control who surprised Meltzoff the most, he said. The more impulsive ones, meanwhile, "just plow forward seemingly unable to control their desire to imitate the interesting action," even if doing so risks making the complainer upset, he said.

This finding is particularly important because of what is known about children's long-term development if they have difficulties with self-regulation early on, said Julie Poehlmann-Tynan, a professor of human development at the University of Wisconsin-Madison.

"For example, self-control predicts school readiness, academic achievement and social competence, among other things," she said. It's exciting, she added, that even 15-month-olds have already learned to combine emotional cues with visual or other perceptual cues of an adult they don't know and then use that to guide their behavior.

"This study suggests that parents need to consider how their toddlers are learning from what is occurring in the social world around them," she said. "It also suggests that toddlers who seem to be impulsive may need more assistance learning how to inhibit behaviors than observation alone."

One weakness of the study was that the researchers did not gather information about what conflict the children may have been exposed to, whether in the home, from media or elsewhere.

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Sleep Apnea May Steal Some of Your Memory: Study

By Robert Preidt, HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Sleep apnea may make it hard for you to remember simple things, such as where you parked your car or left your house keys, a small study suggests.

Tests on 18 people with severe sleep apnea showed that this ability -- called spatial memory -- was impaired when sleep apnea disrupted rapid eye movement (REM) sleep, even when other stages of sleep weren't affected. REM sleep is the deepest level of sleep, during which dreams typically occur.

"We've shown for the first time that sleep apnea, an increasingly common medical condition, might negatively impact formation of certain memories, even when the apnea is limited to REM sleep," study leader Dr. Andrew Varga, a clinical instructor of medicine in the division of pulmonary, critical care and sleep medicine at the NYU Langone Medical Center in New York City, said in an NYU news release.

"Our findings suggest memory loss might be an additional symptom for clinicians to screen for in their patients with sleep apnea," added Varga, who is also an attending physician in NYU's Sleep Disorders Center.

While the study found an association between sleep apnea and impaired memory, it did not prove a direct cause-and-effect link between the two.

The study was published online Oct. 29 in the Journal of Neuroscience.

People with sleep apnea experience periods of disrupted breathing during the night. Sleep apnea can occur at any stage of sleep, but is often worst during REM sleep. Some people have sleep apnea only during REM sleep, the researchers noted.

Sleep apnea affects 4 percent of Americans overall, and as many as one in four middle-aged men.

More information

The American Academy of Family Physicians has more about sleep apnea.

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Spinal Surgery Varies by Region in U.S.: Study

By Robert Preidt, HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Surgery for low back pain caused by spinal stenosis varies depending on where in the United States you live, a new report says.

"Nearly 80 percent of Americans will experience low back pain at some point in their lives, and about 30 million people a year receive professional medical care for a spine problem," co-author Brook Martin, of the Dartmouth Institute of Health Policy & Clinical Practice, said in a college news release.

In spinal stenosis, thickening of tissue surrounding the spine affects the spinal nerves, resulting in pain, according to background information in the study. Treatments include surgery, medication, physical therapy and steroid injections, the study said.

The two types of surgery for spinal stenosis are spinal decompression and spinal fusion, according to the researchers, who explain that in spinal decompression, doctors remove the tissue compressing the spinal nerves. In spinal fusion, surgeons join two or more vertebrae to stabilize the spine.

Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients, according to the news release. Even so, its use increased 67 percent among Medicare patients from 2001 to 2011 and it's now more common than spinal decompression, the researchers said.

The study's analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in Bronx, N.Y., to nearly 217 procedures per 100,000 patients in Mason City, Iowa. In general, rates of spinal decompression were highest in the Pacific Northwest and northern Mountain states.

Rates of spinal fusion varied more than 14-fold nationally, from about 9 procedures per 100,000 patients in Bangor, Maine, to about 127 procedures per 100,000 patients in Bradenton, Fla., according to the Dartmouth Atlas Project report.

"It is critical that we fully inform patients of the risks as well as potential benefits through a collaborative process between patients and physicians of shared decision making," Martin said.

Surgery is irreversible, Martin said. "Using shared decision-making encourages the exchange of information so as to optimize results," he said.

More information

The American College of Rheumatology has more about spinal stenosis.

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Kids: An Rx for Menopause's Hot Flashes?

By Amy Norton

HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Women who live with young children may be less likely to suffer hot flashes after going through surgical menopause, a new study suggests.

The finding, published recently in the journal Menopause, followed a small group of women who had their ovaries removed because they were at high genetic risk of ovarian cancer. Most of the women had already gone through menopause, but 48 had not -- which meant the surgery caused an abrupt menopause.

In that group of women, those with a young child at home tended to have less severe hot flashes and night sweats, according to the study.

"This is a very interesting study that raises some important questions," said Dr. Jill Rabin, an obstetrician/gynecologist who was not involved in the research.

One of those questions is whether the hormone oxytocin offers some protection from hot flashes, according to Rabin, co-chief of ambulatory care at North Shore-LIJ Health System in New Hyde Park, N.Y.

Oxytocin is commonly known as the "bonding hormone," because it's released during certain types of human connection -- including when mothers breast-feed or care for young children.

But, like other hormones, oxytocin is "not just a one-job molecule," said study co-author Virginia Vitzthum, a professor of anthropology at Indiana University, in Bloomington.

She explained that oxytocin also helps regulate the body's core temperature -- which, in theory, could be one reason why the women in the study who lived with children tended to have fewer hot flashes.

But this study doesn't prove oxytocin deserves the credit.

"It just hints at that," Vitzthum said.

Women who live with young kids might have other factors in their lives that help protect against more severe hot flashes, according to Vitzthum.

To name a few, differences in exercise, diet, job activities or stress levels could be at work, she said. And her team was not able to account for racial or ethnic differences, since most women in the study were white.

Vitzthum said the idea for the study stemmed, in part, from research on cultural differences in menopausal symptoms.

Women in some non-industrialized societies report far fewer hot flashes, versus those in industrialized countries. There could be any number of reasons, but one possibility is that family structure plays a role, Vitzthum said.

"Inter-generational living is very common in those cultures," she said. Grandmothers or aunts are often under the same roof as young children, and share the responsibility for caring for them.

In the United States, Vitzthum noted, the "nuclear family" is now the norm. "But certainly through most of human history, the extended family was very common," she said.

According to Vitzthum, it's possible that humans evolved so that it's not only children who benefit from those family relationships -- but older family members, as well.

The current study included 117 women, all from the Seattle area, who had surgery to remove their ovaries because they carried gene mutations that raised their cancer risk. Sixty-nine women had already gone through menopause, while the remainder had not.

About half of the women had a child at home -- either their own or a grandchild.

In general, the study found that women who were pre-menopausal before surgery tended to report less severe hot flashes after surgery if they lived with a child younger than 13.

Rabin agreed that oxytocin is only a theoretical explanation for the finding: "One issue is that [the researchers] didn't actually measure the women's oxytocin levels," she said.

But Rabin said the possible connection is worth further research -- including studies that follow women as they go through natural menopause.

According to Vitzthum, that research could take many directions. "For example, we don't think the young child would have to be genetically related to you," she said.

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Study Confirms Obesity-Breast Cancer Link for Blacks, Hispanics

By Robert Preidt, HealthDay Reporter

FRIDAY, Oct. 31, 2014 (HealthDay News) -- Obesity increases the risk of certain types of breast cancer in postmenopausal black and Hispanic women, two new U.S. studies show.

One study of more than 3,200 Hispanic women found being overweight or obese increased the risk for estrogen receptor-negative and progesterone receptor-positive breast tumors among postmenopausal women.

"We've known this for a long time for white women, but now we are seeing this also in Hispanic women," study author Esther John, a senior research scientist at the Cancer Prevention Institute of California, said in an American Institute for Cancer Research news release.

The study was presented Thursday at the research institute's annual meeting in Washington, D.C., and published Oct. 30 in the journal Cancer Epidemiology, Biomarkers & Prevention.

"Breast cancer appears to have different risk factors in younger versus older women but by far, breast cancer is more common among postmenopausal women," John said.

"This has huge implications for not just Hispanics but all women. We cannot change genetics or family history, but we can do something about obesity," she said. "You can eat less, choose healthier foods and do more physical activity. It may not be that easy but it's possible. And it's important for not just lowering breast cancer risk but for many other diseases."

The other study included more than 15,000 black women and found that being overweight or obese increased postmenopausal women's risk of ER-positive breast cancer by 31 percent. It also found that the risk was nearly double among black women who were lean as young adults and gained weight in adulthood.

The study was also released at the cancer research meeting.

"We know that breast cancer has several subtypes and there is growing evidence that these subtypes have different risk factors," study author Dr. Elisa Bandera, of Rutgers Cancer Institute of New Jersey, said in the news release. "The distribution of these subtypes and risk factors are different for African Americans and Hispanics compared to white women."

One study is not enough, said Bandera. "We need to know more about what African American women can do to prevent and survive breast cancers of all types, which are often aggressive and deadly."

More than one in two black women and nearly one in two Hispanic women in the United States are obese.

More information

The U.S. National Cancer Institute has more about breast cancer.

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What to Do With Leftover Halloween Candy

Kids look forward to trick-or-treating all year long. But when they bring home buckets full of candy and chocolate, what do you do with it all? Of course, you sneak a few pieces of your favorites, but what about the rest?

Redistribute the candy.

Many adults end up eating much of the leftover candy, which doesn’t help their waistlines. To avoid the temptation of the sweet stuff, get it out of your sight immediately. If the candy isn’t lying around, you can’t eat it!

Once your kids get home, tell them to set aside their favorite handful of treats, and distribute the rest to the next trick-or-treaters who come to your door. If you don’t get many trick-or-treaters, bring the candy to work and let your coworkers fight over their favorites.

Once the trick-or-treaters have stopped coming around, it’s time to sort through your goodies. Toss anything that’s half opened or just hazardous for kids (like those jumbo-sized jaw breakers). Also, throw away any candy that wasn’t dispensed in a wrapper. I tend to also throw out any super sticky foods that may cause cavities such as taffy and Tootsie Rolls (who needs those pricey dental bills?).

Some dentists, community centers, health clubs and pediatricians participate in Halloween buy-back programs, where they trade your child’s candy for healthier alternatives or small toys.

If one of your children has an upcoming birthday party, save some candy to put in goodie bags or stuff into the birthday piñata.

Get creative in the kitchen.

Although you don’t want to make candy the centerpiece in all of your desserts, you can use them as a fun ingredient on occasion.

Add a small amount of chocolate into cookie or cupcake batters. Opt for the dark chocolate whenever possible.

Make a chocolate bark by melting chocolate (like Hershey’s mini chocolate bars) in a double broiler or the microwave. Add raisins or other dried fruit to the mixture. Pour the mixture onto a parchment-lined baking sheet and use a spatula to spread it into an even layer. Sprinkle it with shredded coconut or chopped nuts. Place it in the refrigerator for a few hours to solidify, then remove it and break it into small, edible pieces.

Make your own trail mix with dried fruit, nuts, whole grain cereal and about 2 tablespoons of your favorite chocolate pieces.

Use a zester, nut grinder or food processor to create ground chocolate or candy for your holiday baking. Sprinkle it on hot cocoa, cookies or cupcakes.

Freeze leftover chocolate so it lasts longer.

Get creative for the holidays.

You don’t always have to eat your Halloween candy. Instead, use it for fun holiday activities appropriate for both kids and adults.

Use the colorful candy to decorate a gingerbread house or gingerbread men.

Younger kids can create a holiday card, homemade ornament or picture frame with the sweet stuff.

Use leftover candy to decorate holiday gifts.

Gather leftovers with you child’s school or with neighbors and make care packages to donate to local hospitals, nursing homes, food pantries or shelters.

Package leftover candy into care packages to send our troops. Operation Gratitude and Operation Shoebox are two organizations that accept donations for that purpose.

Be a creative teacher.

Candy can be a fun learning tool for a variety of subjects.

Science: Use unwanted candy to create hands-on science experiments.

Math: Use candy for counting, sorting or grouping.

Writing: Write a letter to "the candy fairy” asking to exchange unwanted leftover candy for a small gift.

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Health Tip: Reduce Your Risk of a Car Injury

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- More than 2.5 million Americans visited emergency departments as a result of motor vehicle crashes in 2012, according to the U.S. Centers for Disease Control and Prevention.

The agency offers these tips to help reduce your risk of injury:

The driver and all passengers always should wear safety belts, even for a very short trip.

Make sure children are safely strapped in, children age 12 and under are in the backseat, and all children are in age-appropriate safety seats.

Never drive after using drugs or drinking alcohol, and don't let others do so.

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Health Tip: Keep Certain Foods Isolated

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- Foods such as meat, seafood, poultry and eggs must be separated from other edibles to prevent possible cross-contamination with germs.

The Foodsafety.gov website offers these suggestions:

Keep these foods separate from all other foods in your grocery shopping cart.

When you check out at the grocery, make sure each of these foods is separately wrapped in a plastic bag to prevent juices from leaking.

Keep these foods in plastic bags or storage containers in the refrigerator or freezer.

Eggs should be stored in their cartons and kept in the main part of the refrigerator, not in the door.

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Ebola fears infect Louisiana medical conference

By MARILYNN MARCHIONE and JANET McCONNAUGHEY, Associated Press

NEW ORLEANS (AP) — Ebola fears have infected a medical conference on the subject. Louisiana state health officials told thousands of doctors planning to attend a tropical diseases meeting this weekend in New Orleans to stay away if they have been to certain African countries or have had contact with an Ebola patient in the last 21 days.

The order came in a letter Wednesday to the American Society of Tropical Medicine and Hygiene, which made clear it did not agree with the decision. Several doctors, including some from the World Health Organization and the Centers for Disease Control and Prevention, now may not be able to attend or present studies at the meeting, which runs Sunday through Wednesday.

State officials said a similar letter will go to organizers of the American Public Health Association, which plans its annual meeting in New Orleans Nov. 15-19.

The letter acknowledges that even people infected with the Ebola virus do not spread the disease unless they are showing symptoms. But it says that because people with a travel or exposure history to Ebola should avoid large group settings, "we see no utility in you traveling to New Orleans to simply be confined to your room."

It is signed by Kathy Kliebert, secretary of the state's Department of Health & Hospitals, and Kevin Davis, director of the Governor's Office of Homeland Security & Emergency Preparedness. It cites travel within the last 21 days — Ebola's maximum incubation period — to Liberia, Guinea or Sierra Leone as being a problem.

The tropical medicine group noted that the state's stance goes beyond CDC guidelines. Its president, Dr. Alan Magill, called the order "unfortunate" and "a pretty tough message to send out, particularly to our international colleagues," who were gathering to share knowledge on how to beat back Ebola and other global health problems.

"We certainly have folks who know this disease very well and we were looking forward to having world experts discuss it," said Magill, also an official at the Bill & Melinda Gates Foundation. Microsoft cofounder Bill Gates is to speak at the conference's opening session on Sunday.

Magill said he did not know how many of the 3,500 registered for the conference would now not be able to attend, but added, "I'm sure some people will choose not to come out of protest" to Louisiana's stance.

"I don't agree with it at all," said Dr. John Schieffelin, an infectious diseases expert at Tulane University in New Orleans who will attend the conference. He just published a study in this week's New England Journal of Medicine giving the most detailed information yet on symptoms and treatment of Ebola cases in Sierra Leone, and returned from that country in August.

"It's just one more thing that's going to slow down the science and research effort" and ultimately could hurt control of the disease, Schieffelin said of the state's policy. It's an overreaction to perceived risk and "comes off as a little xenophobic," he said.

Dr. Frank Welch, medical director for the state health department's center for community preparedness, said the state acted because the CDC just last week put stricter protocols in place for evaluating travelers from Ebola-affected countries, and some of the travelers to the upcoming medical meetings may have been exposed to Ebola before the new CDC rules.

"We have no way to assess their contact during that three weeks," and so are being "over-cautious," Welch said.

He said his department was working with conference leaders to arrange electronic presentations of studies from presenters now not able to attend in person.

"We do not want to diminish their expertise" or deprive their colleagues of the opportunity to hear from them, he said.

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Almost 1 in 5 Americans Plagued by Constant Pain, Survey Suggests

By Alan Mozes

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- Almost one-fifth of Americans do daily battle with crippling, chronic pain, a large new survey reveals, with the elderly and women struggling the most.

The poll of roughly 35,000 American households provides the first snapshot of the pain landscape in the United States, the survey authors said.

The bottom line: Significant and debilitating pain that endures for three months or more is now a common feature in the lives of an estimated 39 million Americans.

"I wasn't particularly surprised by our findings," said study author Jae Kennedy, a professor of health policy and administration at Washington State University in Spokane. "But I found it sobering that so many American adults are grappling with persistent pain."

"Going forward, it will be important to track changes in rates of persistent pain within the U.S., and compare these rates to other countries with different health care systems," Kennedy said.

Kennedy and his colleagues report their findings in the October issue of the Journal of Pain.

To get a sense of the scale of the Americans' experience with pain, the study authors analyzed responses to a 2010 National Center for Health Statistics survey.

Those who said they had experienced serious continual pain during the prior three months were the focus of the poll, rather than participants who said they had experienced short-term pain or pain that was intermittent or moderate in nature.

The result: Overall, 19 percent of the adults polled were deemed to have experienced "chronic" and severe daily pain.

That grouping did not, for the most part, include adults who said they struggled with arthritis or back and joint pain, as those people tended to say their pain was not constant and persistent, the study authors noted.

That said, the chronic pain figure exceeded 19 percent among specific groups of respondents, including those between the ages of 60 and 69, women, those who said their health was fair or poor, those who were obese or overweight, and those who had been hospitalized in the prior year.

And among those with chronic pain, more than two-thirds said their pain was "constantly present," while more than half said their pain was at times "unbearable and excruciating."

That level of physical pain can prompt psychic pain, Kennedy noted.

"Being in pain is depressing," he said in a statement. "Being in pain all the time is tiring. Being in pain all the time is anxiety-provoking. So it's plausible that pain is triggering other kinds of more psychological distress."

Kennedy suggested that for those experiencing chronic, crippling pain there are a variety of potential interventions, including physical and occupational therapy, exercise, dietary changes, weight loss, massage and psychotherapy, alongside alternative interventions such as acupuncture, yoga and chiropractic services.

Medicines, including narcotic painkillers like hydrocodone, oxycodone and morphine, can also be helpful, but only if long-term use is avoided, Kennedy said.

"We are clearly overusing opioids [narcotics]," he noted. "The U.S. consumes about 80 percent of the world's opioid supply, and 99 percent of the hydrocodone supply. These medications are effective in the short term, [such as] for managing postoperative pain, but long-term use often leads to dependency or addiction."

Bob Twillman, director of policy and advocacy for the American Academy of Pain Management, agreed, noting that the kind of crippling pain that can make it impossible for people to work tends to have many different sources, not all of which are best addressed with narcotic painkillers.

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'Informal Care' for Older Americans Tops $500B Annually, Study Finds

By Mary Elizabeth Dallas, HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- Each year, people across the United States spend an estimated 30 billion hours caring for older relatives and friends, which costs $522 billion, according to new research.

A RAND Corp. study put a price tag on the time and wages that caregivers give up every year to help older people who need assistance in daily activities. The study authors said the significant financial toll of informal care has generated interest in workplace flexibility policies.

"Our findings provide a new and better estimate of the monetary value of the care that millions of relatives and friends provide to the nation's elderly," study author Amalavoyal Chari, a lecturer at the University of Sussex and a former researcher at RAND, said in a news release from the nonprofit research organization. "These numbers are huge and help put the enormity of this largely silent and unseen workforce into perspective."

To get a better sense of the value of informal care, the researchers analyzed data from the 2011 and 2012 American Time Use Survey conducted by the U.S. Bureau of Labor Statistics. Participants of this survey were asked about their job status, as well as how much time they spent helping older relatives with their daily activities. The researchers also calculated participants' hourly pay based on their hours worked and weekly wages as well as their education, age and gender.

They found that three out of five caregivers have jobs. People younger than 65 provide 22 billion out of 30 billion hours of caregiving. This accounts for the largest portion of informal care costs, or $412 billion per year, the researchers said. To provide care, however, working adults often cut back on their hours and lose income, researchers noted.

"Our findings explain the interest in workplace flexibility policies being considered by a number of states that provide paid time off from work for caregivers, as well as programs such as Medicaid's Cash and Counseling program that allows family caregivers to be paid for their assistance," study author Dr. Ateev Mehrotra, a researcher at RAND and an associate professor at the Harvard Medical School, said in the news release.

Replacing the informal care provided by friends and relatives with unskilled workers would reduce the cost of informal care to $221 billion per year, the study published online Oct. 28 in the journal Health Services Research found. On the other hand, if skilled nurses provided this care, the cost would jump to $642 billion annually.

More information

The U.S. Congressional Budget Office provides more information on rising demand for informal health care among older people.

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Eczema Tied to Bone Fracture Risk in Study

By Steven Reinberg

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- The skin condition eczema may increase slightly the risk of broken bones and injured joints, a new study reports.

In a study of 34,500 adults, researchers found that among 7 percent of people who had an eczema flare-up in the past year, 1.5 percent had a bone or joint injury and 0.6 percent had an injury that caused a limitation of function.

Compared to people without eczema, those with the skin condition had more than double the risk of having had a fracture or bone or joint injury, according to the study.

"Adults with eczema have higher rates of injuries, including fractures and bone and joint injuries," said lead researcher Dr. Jonathan Silverberg, an assistant professor of dermatology at Northwestern University in Chicago.

Although this study found an association between eczema and bone and joint injuries, it wasn't designed to prove whether eczema is somehow a direct cause of those injuries.

Another expert said follow-up research is necessary. "Further studies would be needed to show if there's a direct effect or association of eczema with bone condition and strength over time," said Dr. Doris Day, a dermatologist at Lenox Hill Hospital in New York City.

"The skin is often a reflection of the general health and well-being of our patients. Sometimes the connection is direct, but often it's more subtle," Day said.

The study was published online Oct. 29 in JAMA Dermatology.

Eczema is a chronic inflammatory condition of the skin that causes red, itchy, scaly patches. Eczema is not contagious, and is often triggered by allergies, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).

The study included about 2,500 people with eczema and more than 32,000 without the skin condition.

The researchers found the risk of injuries increased with age and peaked at 50 to 69, he said.

"Eczema by itself was associated with higher rates of injuries. However, adults with eczema who also had sleep disturbance or psychiatric and behavioral disorders had even higher risk of injuries than those with eczema alone," Silverberg said.

Adults with eczema have a number of risk factors for injuries, including distraction caused by itch, sleep deprivation, psychological and behavioral disorders, and the use of sleep aids and steroids that may lower bone strength, he said.

Although there's no cure for eczema, treatments can help control it, which include moisturizers and topical steroids to control itching and reduce swelling, according to the AAAAI.

Oral steroids are usually reserved for more severe flare-ups, according to Day. However, over many years this can have an effect on bones and other organs, Day said.

"Adults with eczema would likely benefit from improved control of their skin disease and less use of medications that might increase the risk of injury," Silverberg said.

More information

For more on eczema, visit the U.S. National Institute of Allergy and Infectious Diseases .

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Fewer Malpractice Claims Paid in U.S.

By Robert Preidt, HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- The number of medical malpractice payments in the United States has dropped sharply since 2002, according to a new study.

And compensation payment amounts and liability insurance costs for most doctors remained flat or declined in recent years, researchers report online Oct. 30 in the Journal of the American Medical Association.

"For many physicians, the prospect of being sued for medical malpractice is a disturbing aspect of modern clinical practice," researchers, led by Michelle Mello, of Stanford Law School, wrote in a journal news release. Various reforms have attempted to stabilize malpractice insurance prices and, in the process, escalating health costs.

For this study, researchers analyzed 2002-2013 data from California, Colorado, Illinois, New York and Tennessee. Overall, the rate of paid malpractice claims decreased from 18.6 to 9.9 percent per 1,000 physicians, they found.

The estimated average annual decrease was more than 6 percent for MDs (medical doctors) and more than 5 percent for DOs (osteopathic doctors), the study found.

Meanwhile, the median indemnity, or compensation, amount of paid claims in 2013-adjusted dollars increased 5 percent annually from 1994 to 2007, the researchers said.

But since 2007, median indemnity fell by an average of 1.1 percent a year -- declining to $195,000 in 2013, they found.

There were mixed trends in liability premiums paid by doctors. In California, Illinois and Tennessee, premiums charged by each state's largest medical malpractice insurer to internists and obstetrician-gynecologists fell 36 percent from 2004 to 2013. Premiums charged to general surgeons decreased 30 percent.

Colorado saw a 20 percent drop in premiums for internists, but an 11 percent increase for ob-gyns and a 13 percent rise for general surgeons.

In New York, rates charged by the largest insurer rose 12 percent for ob-gyns, 16 percent for internists, and 35 percent for general surgeons.

The authors write that nontraditional malpractice reforms, including communication-and-resolution programs and pre-suit notification and apology laws, look promising.

Reform approaches "that accelerate the recognition of errors and the resolution of disputes are likely to further both monetary and nonmonetary goals of malpractice reform," Dr. William Sage, of the University of Texas at Austin School of Law, wrote in an accompanying journal editorial.

More information

The U.S. Agency for Healthcare Research and Quality offers a guide to health care quality.

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Leprosy Still Occurs in U.S., CDC Reports

By Steven Reinberg

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- Leprosy, although quite rare, continues to appear in the United States, a new U.S. government study reports.

Approximately 100 new cases are reported in the United States each year, researchers at the U.S. Centers for Disease Control and Prevention said. That compares to about 250,000 cases that occurred worldwide in 2008, according to the CDC.

Known since biblical times, leprosy is an infectious disease that causes skin sores, nerve damage, and muscle weakness that can worsen over time. Effective medications exist to treat the disease.

Most U.S. cases occur in people who traveled to the United States from areas of the world where the bacterial infection is endemic, the study authors said.

"It's a surprise to most people that leprosy is still in the United States," said lead researcher Dr. Leisha Nolen, an epidemic intelligence service officer with the CDC.

"Many people think leprosy is something limited to underdeveloped nations and has been eliminated from the United States," she said.

Leprosy does infect a few people born in the United States -- about 20 to 40 a year -- but is mostly a problem for people born outside the country who were infected before arriving here, Nolen said.

The rate of infection for those born in the United States hasn't changed in the past 15 years, Nolen said. Infections are mostly confined to areas where leprosy is still found, such as in Texas and Louisiana, according to past research.

In these states, the bacteria can be found on armadillos, and they can pass the infection to humans, Nolen explained.

According to the report, from 1994 to 2011, there were just over 2,300 new cases of leprosy -- also called Hansen's disease -- diagnosed in the United States.

The yearly incidence rate of leprosy from 1994 to 1996 was 0.52 cases per 1 million people in the United States. From 2009 to 2011, that rate dropped to 0.43 cases per 1 million people, the researchers found.

The rate for people born abroad is 14 times higher than that of those born in the United States, the findings showed. The study found that the highest rate is among those born in the South Pacific who traveled to Hawaii.

"The rates of leprosy in people born overseas is going down," Nolen said. "There's been a 17 percent decrease from 1994 to 2011."

"These data further emphasize the value of considering travel and residence history as part of the standard physical examination, as it may help clinicians detect otherwise potentially rare diseases in some individuals," said Richard Truman, chief of the Laboratory Research Branch of the National Hansen's Disease Program at the U.S. Department of Health and Human Services.

Leprosy is a treatable disease. "Most people think you can't do anything about it, but leprosy is a disease that's treatable with antibiotics," Nolen said.

Without treatment, however, leprosy can progress to a debilitating disease with nerve damage, tissue destruction and loss of function, according to the study.

Nolen added that leprosy is a hard disease to catch. It can only be passed through close contact with an infected person, she explained.

"It takes four to seven years before somebody develops symptoms. This bacteria grows exceptionally slowly," Nolen said.

Doctors should be aware that leprosy is still present in the United States, she said. "It's rare. It's not like they are going to see a case, but it would be tragic if they miss it," Nolen said.

Leprosy usually appears as a skin rash that is lighter than the person's normal skin, and the patient may have no feeling in that area, she explained.

Leprosy is still a problem in the United States, but it's not something to be afraid of, Nolen added. "People aren't going to be sent off to leper colonies as they were in the past. It's something that can be treated," she said.

The new study was published Oct. 31 in the CDC's Morbidity and Mortality Weekly Report.

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Ebola case highlights work of NYC disease sleuths

By COLLEEN LONG, Associated Press

NEW YORK (AP) — New York City's disease detectives were off and running the moment the call came in from a doctor who suspected he had Ebola.

As hazmat-suited emergency teams were preparing to transport Dr. Craig Spencer to Bellevue Hospital, health workers were talking to him by phone, not just about his high fever and other symptoms but also about his recent movements and contact with other people. Credits cards, subway passes and cellphone records were all clues that helped fill in a nearly hour-by-hour timeline.

New York's first case of the virus ravaging West Africa is highlighting the behind-the-scenes work of the city's team of sleuths, who track an outbreak at the source and seek to stop it from spreading.

"They're able to work with an impossibly small amount of information," said Denis Nash, an epidemiology professor who used to work at the Health Department. "They can find someone when the description is as little as ... 'a light-skinned guy with a freckle on his cheek,' and they do it discretely and professionally."

In New York, about 200 doctors, epidemiologists and other staff work together to piece together an outbreak through painstaking and detailed interviews with someone who was exposed and a retracing of whom they touched and where they walked. Depending on the suspected incubation period, they track back weeks. They triangulate to determine where the disease has spread, test to figure out the illness and come up with specialized solutions to stop it from spreading further.

In the case of Spencer, a 32-year-old Doctors Without Borders physician who had returned from the Ebola-plagued Guinea less than a week before, they had a wealth of information — and that was highly unusual, said Dr. Jay Varma, the city's deputy commissioner for disease control.

He said Spencer's precise statements and the other clues painted a picture of his whereabouts in mere hours: He took three subway lines and a cab, went jogging, walked the High Line parkway. He visited a coffee stand, a sandwich shop and a bowling alley. Plus, they knew the suspected illness, the incubation period of 21 days and the fact that a patient isn't contagious unless they are symptomatic. Spencer's fiancee and two friends who had close contact with him remain under quarantine. But no one else has developed symptoms.

"He was incredibly helpful, and he understood the situation," Varma said. "His honesty and his willingness to participate and give us every detail was really amazing."

Usually it takes longer — because it's a greater mystery.

"Often we don't know what the illness is, or someone is too sick to talk to us, so we have to reconstruct their movements in other ways," Varma said.

Or the disease spreads faster. Last year, epidemiologists asked such specific questions that tracked a fast-spreading measles outbreak down to one city intersection, where an infected person gave the airborne virus to another by simply passing them on the street. If people are sickened at a restaurant, workers run through a checklist to determine whether the foodborne illness is localized or whether, say, salmonella was coming from suppliers.

The city works closely with the Centers for Disease Control and Prevention, which has a two-year program that teaches how to trace an outbreak. There are about 160 specialists assigned to cities and states around the country.

Nash, now a professor of epidemiology at the CUNY School of Public Health, served as the CDC specialist in New York and uncovered the first West Nile outbreak in the Western Hemisphere. People were coming down with meningitis and encephalitis, and they didn't know why — he had to start from scratch figuring out what the common links were.

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4 Steps Could Quell Ebola in West Africa, Researchers Say

By Dennis Thompson

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- A full-court press involving all public health tactics known to prevent Ebola transmission will be required to quell the current West African epidemic, a new study reports.

Four practices in particular -- burying the Ebola-infected dead in a hygienic way, immediately isolating new patients, tracing people potentially exposed to the virus, and providing better protection for health care workers -- can stop the epidemic within six months, researchers believe.

If public health officials can achieve these goals 60 percent of the time, the number of new Ebola cases in Liberia could fall to seven a day by Dec. 1 and to nearly none by March 15, the researchers report in the Oct. 30 issue of the journal Science.

"If these interventions are implemented at a moderately high but not unrealistic level, this thing can be contained reasonably quickly," said co-author Jan Medlock, an assistant professor in the Oregon State University department of biomedical sciences and an expert in mathematical epidemiology and evolution of infectious disease.

The current epidemic has caused nearly 5,000 deaths out of more than 13,000 cases of Ebola infection in Liberia, Sierra Leone and Guinea.

A second study in Science reports that scientists using mice have made headway in figuring out why Ebola causes only mild symptoms in some but life-threatening reactions in others.

By breeding mice that are susceptible to Ebola's worst symptoms, researchers have shown that genetics likely play a role in people's response to the virus.

"Host genetics play an important role in disease progression," said Michael Katze, a professor of microbiology at the University of Washington School of Medicine in Seattle. "This happens to be Ebola we're talking about, but it's true with any virus."

In Medlock's study, researchers used complex mathematical models to assess how the disease is spreading, what steps are being taken to slow its progression and how effective those steps are. They focused on Liberia, the nation they said is the focal point of the epidemic.

The goal is to shift the momentum of the epidemic so that it slowly declines, by reducing the number of people who catch the virus from an infected person to fewer than one -- a figure scientists call the "basic reproductive number."

The researchers estimated that in Liberia, the Ebola reproductive number is currently 1.63, meaning two infected people will on average infect about three more people.

Unless a range of steps are successfully implemented, the epidemic will continue to gather steam, generating 224 more cases a day in Liberia through Dec. 1 and up to 348 cases a day by the end of that month, they projected.

There's no one single public health tactic that can end the epidemic, the researchers concluded.

"We found that just one wasn't likely to stop this thing within six months," Medlock said. "We really need combinations of tactics to stop the epidemic."

However, Medlock added that hygienic burial practices are particularly crucial, so much so that the researchers refer to funerals as "super-spreader events."

"We know that the bodies of Ebola victims are very infectious after they die, and funeral practices in West Africa have a lot of touching and kissing of the body, washing of the body," he said. "It seems like a very important transmission route."

Health officials are trying to encourage washing bodies with disinfectants before holding funeral services, or burying victims without a funeral, Medlock said.

In the other study, researchers found that mice bred specifically to expand their genetic diversity were more apt to display the full range of Ebola symptoms that humans suffer.

Until now, lab mice have died when exposed to Ebola but have not suffered the intense bleeding and other dire symptoms common to the virus, the study authors said.

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World Bank Pledges $100M More to Fight West Africa's Ebola Outbreak

By Dennis Thompson

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- The World Bank pledged Thursday an additional $100 million in the fight against the Ebola outbreak wreaking havoc in West Africa.

The money, which brings the World Bank's total pledge to more than $500 million, will be used to attract more foreign health care workers to the three hardest-hit countries -- Guinea, Liberia and Sierra Leone.

"The world's response to the Ebola crisis has increased significantly in recent weeks, but we still have a huge gap in getting enough trained health workers to the areas with the highest infection rates," World Bank Group President Jim Yong Kim said in a news release. "We must urgently find ways to break any barriers to the deployment of more health workers. It is our hope that this $100 million can help be a catalyst for a rapid surge of health workers to the communities in dire need."

The World Health Organization (WHO) says an estimated 5,000 international medical and support personnel are needed in the three countries in the coming months. In some cases, health care workers in the three countries are reluctant to treat Ebola patients because they lack adequate protection.

There have been an estimated 13,700 infections and about 5,000 deaths in West Africa.

The World Bank has warned that if the epidemic continues unchecked, the financial toll to the region could hit $32.6 billion by the end of 2015.

There has been a bit of encouraging news in recent days, however.

WHO officials said Wednesday that the outbreak in Liberia may be slowing.

Dr. Bruce Aylward, WHO's assistant director general, said there's been a decline in the number of burials in Liberia and no increase in laboratory-confirmed cases. He said he was cautiously optimistic that the global push to tame the epidemic may be making some progress, The New York Times reported.

"Do we feel confident that the response is now getting an upper hand on the virus?" he said in a telebriefing with reporters from the organization's Geneva, Switzerland, headquarters. "Yes, we are seeing slowing rate of new cases, very definitely" in Liberia.

Aylward cautioned against assuming that health care workers had turned the tide against Ebola in Liberia, where more than half of West Africa's infections have occurred. Ebola cases could surge again, as has happened since the epidemic began last spring.

Meanwhile, health officials in Sierra Leone said late Wednesday that the country remains "in a crisis situation which is going to get worse," the Associated Press reported.

More information

For more on Ebola, visit the World Health Organization.

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Halloween Safety Tips for Kids With Asthma

By Mary Elizabeth Dallas, HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- Wearing masks made of latex and taking hayrides are among the Halloween festivities that could be risky for children with asthma, according to the American Lung Association.

The association advises parents to be proactive about managing their child's asthma to ensure that Halloween is safe and enjoyable.

Some of the steps they recommend parents take include:

Be prepared. Hayrides and haunted houses are exciting adventures that can lead to asthma flare-ups. Make sure children carry their quick-relief inhaler with them at all times so they can use it at the first sign of worsening symptoms. Children who've had breathing problems on Halloween in the past may benefit from medication before they go trick-or-treating, the experts noted in a news release. Talk to your child's doctor about options that could help.

Keep it clean. Any costume that has been packed away for a while should be washed before a child with asthma wears it to prevent exposure to dust, mold and dust mites that can trigger asthma symptoms.

Rethink the mask. Latex is a known asthma trigger, but it's used to make many costume masks. Before buying a mask, check its label. Keep in mind that masks also make it more difficult to breathe normally. Cutting a mask in half or skipping one entirely may be the best option for kids with asthma.

Check the forecast. The air quality on Halloween night can make a difference for kids with asthma. Wearing a scarf is also a good idea since cold air can trigger an asthma attack.

Be cautious. Teach kids to not enter anyone's home while they are out trick-or-treating. Aside from being a common-sense safety precaution, this can also keep them healthy. The homes of strangers could have pets or cigarette smoke, which could trigger an asthma attack. And, for kids with food allergies along with asthma, be sure to check your little ones' candy haul for treats that could spell trouble.

More information

The U.S. Centers for Disease Control and Prevention provides more Halloween health and safety tips.

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Brain Scans Yield Clues to Chronic Fatigue Syndrome

By Mary Elizabeth Dallas, HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- There are clear differences in the brains of people with chronic fatigue syndrome and the brains of healthy people, new research indicates.

Scientists at Stanford University School of Medicine said their findings could help doctors diagnose this baffling condition and shed light on how it develops. People with chronic fatigue syndrome are often misdiagnosed or labeled as hypochondriacs.

Using three types of brain scanning technologies, "we found that [chronic fatigue syndrome] patients' brains diverge from those of healthy subjects in at least three distinct ways," said the study's lead author, Dr. Michael Zeineh, assistant professor of radiology, in a Stanford news release.

Chronic fatigue syndrome affects up to 4 million people in the United States alone, says the U.S. Centers for Disease Control and Prevention. The condition, which causes debilitating and constant fatigue that persists for six months or more, is difficult to diagnose. Other symptoms of chronic fatigue syndrome can vary from one patient to the next. They are also similar to symptoms often associated with other health issues.

"Chronic fatigue syndrome is one of the greatest scientific and medical challenges of our time," said the study's senior author, Dr. Jose Montoya, professor of infectious diseases and geographic medicine, in the Stanford release.

"Its symptoms often include not only overwhelming fatigue but also joint and muscle pain, incapacitating headaches, food intolerance, sore throat, enlargement of the lymph nodes, gastrointestinal problems, abnormal blood-pressure and heart-rate events, and hypersensitivity to light, noise or other sensations," he said.

Montoya and his team have been following 200 people with chronic fatigue syndrome for several years, hoping to improve diagnosis and treatment. In order to gain a better understanding of the condition, the researchers used MRI technology to compare the brains of 15 of these patients with 14 similar people without the condition or any related symptoms.

"If you don't understand the disease, you're throwing darts blindfolded," said Zeineh. "We asked ourselves whether brain imaging could turn up something concrete that differs between [chronic fatigue syndrome] patients' and healthy people's brains. And, interestingly, it did."

The study, published in the Oct. 28 issue of Radiology, found patients with chronic fatigue syndrome had less overall white matter (nerve tracts that carry information from one part of the brain to another) than the people who didn't have the condition.

Chronic fatigue syndrome is thought to involve chronic inflammation, which may be due to an unidentified viral infection. Since such an infection can take a toll on white matter, this finding was not surprising, the researchers said.

Using advanced imaging techniques, however, the study's authors also identified a specific brain abnormality among the patients with chronic fatigue syndrome. This abnormality was found in an area of the brain that connects the frontal lobe and temporal lobes, called the right arcuate fasciculus.

There was a strong link between the severity of this abnormality and the severity of chronic fatigue syndrome, the researchers said.

The study also found that patients with chronic fatigue syndrome had a thickening of the gray matter in two areas of their brain connected by the right arcuate fasciculus.

The researchers said that despite the strength of their findings, the results should be confirmed with more research. "This study was a start," Zeineh said. "It shows us where to look."

More information

The U.S. Centers for Disease Control and Prevention provides more on chronic fatigue syndrome.

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Study Compares 2 Common Weight-Loss Surgeries

By Robert Preidt, HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- A comparison of two of the most common types of weight loss surgery found that laparoscopic gastric bypass helped patients shed more excess pounds than adjustable gastric banding, but carried a higher risk of short-term complications and long-term hospitalizations.

Gastric-bypass surgery makes the stomach smaller and reroutes the small intestine, so your body does not absorb all the calories from food you eat, according to the National Institutes of Health. Gastric banding is a type of weight-loss procedure in which an adjustable band is placed around the top of the stomach to create a small stomach pouch.

There is ongoing debate about the risks and benefits of the two types of weight loss surgery, and previous studies have yielded conflicting findings, according to the researchers. The study analyzed data from more than 5,800 patients in the United States who had laparoscopic gastric bypass and nearly 1,200 who had gastric banding.

Overall, patients who got the laparoscopic gastric bypass procedure lost almost twice the amount of weight as those who got the banding procedure, the study found.

However, there were more complications with bypass vs. banding. Within a month after surgery, 3 percent of gastric bypass patients had experienced one or more major complications, compared to 1.3 percent of gastric banding patients, the study found.

Longer-term follow-up found that in the gastric banding group, 0.2 percent of patients died, about 12 percent were hospitalized again, and about 14 percent had one or more subsequent interventions. In comparison, 0.3 percent of patients getting bypass died, about 20 percent faced rehospitalization, and 5.5 percent required another procedure.

"We found important differences in short- and long-term health outcomes for the [gastric banding] and [gastric bypass] procedures across 10 health care systems in the United States," wrote a team led by Dr. David Arterburn of Group Health Research Institute in Seattle. "Severely obese patients should be well informed of these differences when they make their decisions about treatment," they said.

The study was published online Oct. 29 in the journal JAMA Surgery.

The findings are important but may already be outdated, one expert said.

"Since the time this study commenced, there has been a large shift in procedure selection," said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City. "Although the article states that banding and bypass are the two most common procedures, that is no longer true -- bands have dropped in popularity."

"At their peak, they represented over 40% of all bariatric procedures," Roslin said. "Today, that number is less than 20%. The reason is less weight loss and a high rate of [later need for band] extraction, which approaches 5 percent per year."

And he said that a procedure called "vertical sleeve gastrectomy has surpassed gastric bypass as the most popular stapling procedure." Sleeve gastrectomy is a surgery that reduces the size of the stomach.

According to Roslin, "a major issue with great cumulative studies is that they take time to perform. By the time the information is reported, fields have continued to grow and, hopefully, advance."

Another expert said that it's important to match the right patient with the procedure that best suits him or her.

"The study confirms what those of us in the field have observed in our patient populations," said Dr. Collin Brathwaite, chief of the Division of Minimally Invasive and Bariatric Surgery at Winthrop-University Hospital in Mineola, N.Y.

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Scientists Set Their Sights on First Whole-Eye Transplant

By Alan Mozes

HealthDay Reporter

THURSDAY, Oct. 30, 2014 (HealthDay News) -- In the world of 21st-century medicine, organ transplantation is nothing new.

The first kidney transplant took place in 1950, followed by the first liver transplant in 1963 and the first human heart transplant in 1967. By 2010, doctors had even managed the transplantation of a patient's entire face.

One major organ still eludes the transplant surgeon, however: the entire human eye. But if one team of U.S. scientists has its way, that dream may become reality, too.

"Until recently, eye transplants have been considered science fiction," said Dr. Vijay Gorantla, an associate professor of surgery in the department of plastic surgery at the University of Pittsburgh. "People said it was crazy, bonkers."

However, "with what we now know about transplantation and, more importantly, nerve regeneration, we are finally at the point where we can have real confidence that this is something that actually can be pursued and eventually achieved," he said.

Whole-eye transplants would be of enormous benefit for many of the 180 million blind or severely visually disabled people around the world, including nearly 3.5 million Americans, experts say.

"Macular degeneration and glaucoma are the root cause of much the world's visual impairment," explained Dr. Jeffrey Goldberg, director of research at the Shiley Eye Center at University of California, San Diego.

Certainly, there are therapies that often help restore sight in these cases, or in people who've lost sight through injury. "But for some people the eye is too damaged or too far gone," Goldberg said. "For patients with a devastating eye injury where there's no remaining connective optic nerve -- or perhaps not even an eyeball in their eye socket -- restorative approaches are simply not enough."

In these cases, transplantation of a healthy donor eye would be a solution. "It's a scientific long shot," Goldberg said. "But it's a very attractive long shot."

So, Gorantla and Goldberg -- and their two universities -- have teamed up to push whole-eye transplantation from theory into practice. The effort is funded by the U.S. Department of Defense.

One of the biggest challenges is how to regenerate and regrow delicate optical nerves.

"The chief problem," Goldberg explained, "is that when you switch out an eyeball you have to completely cut all connections between the optic nerve and the eye. So then you need to reconnect the donor eye's nerve fibers back to the recipient's brain in order to achieve vision restoration. But we know that once you make that cut, the nerve fibers just do not regrow on their own. That doesn't happen automatically."

"That's what distinguishes an eye transplant from most other types of transplants," Gorantla added. In other organ transplants, the chief hurdle is simply reconnecting a proper blood supply. "For example, if you get the plumbing connected and the blood going, then a transplanted heart will beat in the recipient patient immediately," Gorantla said.

"But an eye transplant actually has more parallels with a hand or face transplant," he said. The eye may appear healthy because of a renewed blood supply, but without reconnecting the optic nerve, "there's no motor activity and no sensation or eyesight," Gorantla said. "The result is functionless and lifeless."

Luckily, various laboratories "have made significant progress" in fostering the long distance regrowth of nerve fibers, Goldberg said. "In animals with optic nerve injury or degeneration we've even started to see fibers regrow all the way back to the brain," he noted.

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Health Tip: Dress Kids in Safe Halloween Costumes

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- Halloween costumes may be scary and spooky, but they should still be safe. Parents should make sure costumes don't obstruct vision or increase the risk of falls.

The Safekids.org website offers these suggestions:

Select costumes and treat bags that are light in color, and decorate them with reflective tape.

Skip the mask and opt for face paint instead.

Make sure every child carries a flashlight or glow stick.

Choose costumes that fit properly and aren't too long.

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Health Tip: Why People Seek Counseling

By Diana Kohnle, HealthDay Reporter

(HealthDay News) -- Counseling can be an effective way to deal with life's many problems and challenges.

The American Academy of Family Physicians says counseling may help people cope with these issues:

Depression, grief or loss.

Intimacy, relationships, fertility, infidelity or divorce.

Anxiety, stress, anger, compulsion or addiction.

Problems with family, career or phobias.

Eating disorder, illness or chronic pain.

Domestic violence.

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Voters' Views on Obamacare Split Along Party Lines

By Robert Preidt, HealthDay Reporter

WEDNESDAY, Oct. 29, 2014 (HealthDay News) -- Americans' opinions about the Affordable Care Act are sharply divided along political lines, a new study finds.

Democratic voters are strongly in favor of the Affordable Care Act (ACA), according to the researchers. Almost three-quarters of Democrats want the next Congress to move ahead with the ACA. Thirty percent want Congress to implement the current law, while 44 percent want to expand the scope of the ACA.

Among Independent voters, one-third want the law repealed, and 27 percent want it scaled back. Eight percent of Independents want the current law implemented, and 26 percent want the ACA expanded, according to the findings published online Oct. 29 in the New England Journal of Medicine.

Fifty-six percent of Republican voters want the next Congress to repeal the law, and another 27 percent want it scaled back, according to the research.

These findings come from 27 public opinion polls conducted by 14 organizations, according to the study.

"The intensity of partisan feeling about the ACA in this election could make the next phase of its implementation a very contentious issue in the next Congress," study co-author Robert Blendon, professor of health policy and political analysis at Harvard School of Public Health, said in a university news release.

Health care is considered the third most important issue in the Congressional elections on Nov. 4, the polls revealed.

The study also found that even though millions of previously uninsured Americans now have coverage, public approval of the Affordable Care Act has not improved since it was enacted four years ago.

The number of Americans who believe that the federal government is responsible for ensuring that all Americans have health insurance declined from 64 percent in 2007 to 47 percent in 2014, and is even lower (41 percent) among likely voters, according to the study.

Support for universal health coverage is 70 percent among Democratic voters and 12 percent among Republicans.

"The polling results point clearly to why the election outcome will matter for the ACA. Democrats, were they to be in the majority in Congress, would reflect the views of their party's voters in favor of moving ahead with the implementation of the law, with a high priority on achieving universal coverage," Blendon said.

"With Republicans in the majority, they would see repealing or scaling back the ACA as reflecting the views of their core voters. In addition, they would likely place a lower priority than Democrats on achieving universal coverage the upcoming congressional term," he said.

More information

The U.S. National Library of Medicine has more about health insurance.

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First Vaccine Approved for B Strains of Meningitis

By Scott Roberts, HealthDay Reporter

WEDNESDAY, Oct. 29, 2014 (HealthDay News) -- The first vaccine to protect against a type of meningococcal bacteria that can cause meningitis has been approved by the U.S. Food and Drug Administration.

When Neisseria meningitidis bacteria infect the bloodstream or lining that surrounds the brain and spinal cord, it can cause life-threatening illness. The bacteria typically are transmitted by coughing, kissing or sharing utensils, especially in close living quarters such as college dormitories.

Of some 500 U.S. cases of meningitis recorded in 2012, 160 were caused by serogroup B, the FDA said in a news release. Trumenba protects against four strains in serogroup B.

If a person develops an infection, antibiotics may help reduce the risk of death or permanent complications, but treatment must begin immediately, the agency said.

The newly approved Trumenba vaccine is sanctioned for people aged 10 through 25, the FDA said.

Trumenba was evaluated in clinical studies among more than 6,000 participants in the U.S., Europe and Australia. The most common side effects were injection-site pain and swelling, headache, diarrhea, muscle and joint pain, fatigue and chills.

The new meningitis vaccine, granted accelerated approval, will be further evaluated by the manufacturer against additional serotype B strains, the FDA said.

Trumenba is manufactured by Wyeth Pharmaceuticals, a Philadelphia-based subsidiary of Pfizer.

More information

Visit the FDA to learn more.

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FDA Approves New Vaccine to Protect Against Meningitis

By Robert Preidt, HealthDay Reporter

WEDNESDAY, Oct. 29, 2014 (HealthDay News) -- A new vaccine that could help prevent some cases of life-threatening meningococcal disease was approved by the U.S. Food and Drug Administration on Wednesday.

Trumenba is approved to protect people between the ages of 10 and 25 from invasive meningococcal disease caused by Neisseria meningitidis serogroup B bacteria.

The bacteria can infect the bloodstream (sepsis) and the lining that surrounds the spinal cord and brain. It is a leading cause of bacterial meningitis, and infection can occur through coughing, kissing or sharing eating utensils.

Of the 500 cases of meningococcal disease reported in the United States in 2012, 160 were caused by serogroup B, according to the U.S. Centers for Disease Control and Prevention.

Antibiotics can reduce the risk of death or serious long-term problems in patients with meningococcal disease, but immediate medical treatment is crucial. Until now, vaccines in the United States covered four -- A, C, Y and W -- of the five main N. meningitidis serogroups that cause meningococcal disease.

"Recent outbreaks of serogroup B meningococcal disease on a few college campuses have heightened concerns for this potentially deadly disease," Dr. Karen Midthun, director of the FDA's Center for Biologics Evaluation and Research, said in an agency news release.

In 2013, outbreaks of meningitis at the University of California-Santa Barbara (UCSB) and Princeton University prompted those institutions to get special permission from the FDA to use a vaccine that had been sanctioned in Europe but not in the United States.

According to USA Today, a total of 12 cases occurred in those two outbreaks. A UCSB lacrosse player had to have his feet amputated due to the meningitis infection, the paper reported. Amputations occur because the bacteria can trigger blood clots that reduce blood flow and can cause gangrene.

However, Midthun said that "the FDA's approval of Trumenba provides a safe and effective way to help prevent this disease in the United States."

The FDA's accelerated approval of the new vaccine from Wyeth Pharmaceuticals Inc. was based on three studies in the United States and Europe that included about 2,800 teens. After vaccination with Trumenba, 82 percent of the teens had antibodies in their blood that killed four different N. meningitidis serogroup B strains, compared with less than 1 percent of teens before vaccination.

The four strains targeted by the vaccine are the same ones that cause serogroup B meningococcal disease in the United States, according to the FDA.

The safety of Trumenba was assessed in 4,500 participants in studies in the United States, Europe and Australia. The most common side effects were pain and swelling at the injection site, headache, diarrhea, muscle and joint pain, fatigue and chills.

More information

The U.S. Centers for Disease Control and Prevention has more about meningococcal disease.

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