Stand-Up Advice for Preventing Back Pain

By Robert Preidt, HealthDay Reporter



SUNDAY, Nov. 30, 2014 (HealthDay News) -- Age-related wear and tear of the spine is a common cause of back pain, but there are things you can do to reduce your risk of back injury and discomfort, an expert says.


"Many people with lower backaches say symptoms disrupt their daily routines; however, everyday habits may be the factors causing the pain," said Dr. Michael Gleiber, an orthopedic spine surgeon and American Academy of Orthopaedic Surgeons spokesman.


"It's important to identify some of those behaviors, avoid them and adapt healthy ones," he said in an academy news release.


Do regular exercise to strengthen your back and core muscles. If you have acute back pain, don't do strenuous exercise, but get up and move around, Gleiber said. Being in bed or inactive for too long could cause your back pain symptoms to get worse.


Try to avoid lifting heavy objects. If you have to do heavy lifting, use proper technique. Do not bend over. Keep your back straight and bend at your knees, he advised.


Maintain a healthy body weight. Being overweight or obese places added stress on your lower back, research shows.


Watch your posture. Your ears should be in line with the top of your shoulders, and your shoulders in line with your hips. Your upper arms should hang relaxed and close to your body, and your hands should be in line with your lower arms.


More than 65.8 million American adults reported having low back pain, according to a 2012 National Health Interview Survey.


More information


The U.S. Office of Disease Prevention and Health Promotion has more about preventing back pain.


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Holiday Overindulgence Risky for People With Type 2 Diabetes

By Robert Preidt, HealthDay Reporter



SATURDAY, Nov. 29, 2014 (HealthDay News) -- Overindulging in holiday food can pose serious risks for people with type 2 diabetes, an expert warns.


"If you are someone who is not in good control of your diabetes throughout the year, the holiday season can really make your situation worse," Dr. Laila Tabatabai, an endocrinologist with Houston Methodist Hospital, said in a hospital news release.


"If you are not mindful, eating foods with too many carbohydrates or sugars can send your blood sugar levels into a dangerously high range," she cautioned.


There are a number of ways that people with diabetes can prevent their blood sugar levels from soaring during the holidays.


"Try to eat two or three special things that you only see during the holiday season, like grandma's dressing or your aunt's special dessert, and avoid sampling everything," Tabatabai said. "If you have to bring a dish, fix something healthy that you like. This way you know there will be at least one healthy thing for you to eat."


It's a good idea to avoid "white" carbohydrates such as pasta, bread, rice and potatoes, according to Tabatabai. Healthy substitutes include whole grains, brown rice, fruits and vegetables. It's also important to limit portion sizes.


"For those who choose to drink alcohol, a few adult beverages are OK if you alternate your drinks with water, seltzer, diet soda, etc. Be aware of mixed drinks because many contain juices or high sugar additives that you might not realize and they could cause a spike in your blood sugar levels," Tabatabai said.


She added that family and friends are likely to be accommodating about your food choices if you're open and honest with them about your diabetes.


"There is no reason for a person with type 2 diabetes to miss out on the joy of eating around the holidays," Tabatabai concluded. "Planning ahead and being smart with your choices will give you the chance to eat the foods you want while maintaining healthy glucose levels."


More information


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


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Too Few Seniors Check Their Medical Records Online

By Robert Preidt, HealthDay Reporter



FRIDAY, Nov. 28, 2014 (HealthDay News) -- Too few American seniors go online to check their health records, a new study suggests.


Many doctors offer patients online access to certain parts of their electronic medical records, including immunization records, lab results, safe and correct use of medications and reminders for visits and screenings.


However, this study suggests that older Americans are being left behind when it comes to the benefits of electronic medical records.


University of Michigan researchers analyzed data from the long-running Health and Retirement Study at the university, and found that less than a third of adults aged 65 and older use the Internet for health information, and barely 10 percent of those with a low level of health literacy -- the ability to navigate the health system -- go online for health-related matters.


The findings were published recently in the Journal of General Internal Medicine.


"In recent years we have invested many resources in Web-based interventions to help improve people's health, such as electronic health records designed to help patients become more active participants in their care. But many older Americans, especially those with low health literacy, may not be prepared for these new tools," study author Helen Levy, a research associate professor at the university's Institute for Social Research, said in a university news release.


"Our findings suggest that there's a digital divide when it comes to health care. Older adults with low health literacy especially represent a vulnerable population that's at high risk of being left behind by the advance of technology," she added.


"Health information technology promises significant benefits, but it also comes with the risk that these benefits won't be shared equally," study senior author Dr. Kenneth Langa, a professor of internal medicine at the University of Michigan Medical School and research investigator at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System, said in the news release.


"The Internet is becoming central to health care delivery, but older Americans with low health literacy face barriers that may sideline them in this era of technology. Programs need to consider interventions that target health literacy among older adults to help narrow the gap and reduce the risk of deepening disparities in health access and outcomes," Langa said.


More information


HealthIT.gov has more about information health technology.


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Best to Be Honest About Your Relationship With Your Boss

By Robert Preidt, HealthDay Reporter



FRIDAY, Nov. 28, 2014 (HealthDay News) -- Your job performance will be better if you and your boss have the same opinion about your relationship, even if it's a bad one, a new study finds.


Researchers interviewed 280 employees and their bosses separately so that neither knew what the other said. The workers ranged from cashiers to senior managers in a number of industries, including automotive, retail and financial services.


The researchers found that employees were less motivated at work when they believed they had a good relationship with their boss, but the boss had a different opinion, or if the reverse was true.


Worker motivation was higher when the employee and boss had the same opinion about their relationship, even if it was poor, said the study published recently in the Academy of Management Journal.


"Seeing eye-to-eye about the employee-supervisor relationship is equally, if not more, important than the actual quality of the relationship," lead investigator Fadel Matta, a management researcher at Michigan State University's College of Business, said in a university news release.


"Some people would say it's better to fake it, but our results indicate that the opposite is true," Matta said. "At the end of the day, it's better for everyone to know where they stand and how they feel about each other."


More information


The American Psychological Association offers tips for dealing with difficult bosses.


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How to Help Someone Grieving in the Holiday Season

By Robert Preidt, HealthDay Reporter



FRIDAY, Nov. 28, 2014 (HealthDay News) -- Holiday joy can be lost on someone grieving the death of a loved one. But supportive family and friends can help the bereaved cope with this difficult period, experts say.


"One of the best ways to help those who are grieving during the holidays is to let them know you care and that their loved one is not forgotten," J. Donald Schumacher, president and CEO of National Hospice and Palliative Care Organization, said in a news release from the group.


Here are some suggestions from the organization:


Be supportive of how the person chooses to approach the holidays. While some may wish to continue traditions, others may want to avoid them and do something new.


Offer to help with holiday activities such as decorating, baking and shopping. These tasks can seem overwhelming for someone who is grieving.


Invite the person to your home during the holidays, or ask them to attend a religious service or to volunteer with you. Doing something for others -- such as working with children or helping at a soup kitchen -- may help the bereaved feel better about the holidays.


Be willing to listen, and never tell someone that they need to get over the death of their loved one. Stay in touch through phone calls, visits and cards, and remind the bereaved that you're thinking about them and their loved one who died.


"Lending an ear and holding a hand can be one of the greatest gifts we can give," Schumacher said.


More information


The U.S. National Institutes of Health has more about coping with grief.


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Health Tip: Monitor Your Child's Fat and Cholesterol Consumption

By Diana Kohnle, HealthDay Reporter


(HealthDay News) -- Children, like adults, should avoid too much fat and cholesterol in their diets.


The American Academy of Pediatrics offers these suggestions:



  • Make sure there are always fresh fruit and vegetables readily available for your child.

  • Offer your child whole-grain cereals and breads, low-fat dairy and healthier starches such as potatoes, rice and pasta.

  • Skip high-fat toppings, such as butter, gravy and sour cream. Instead, top foods with low-fat cottage cheese, low-fat yogurt or Parmesan cheese.

  • Feed your child lean, healthy proteins, such as skinless poultry, and lean pork, beef, and fish.

  • For dessert, opt for frozen fruit bars or frozen yogurt.

  • Use non-stick cooking sprays, margarine and vegetable oils.


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Want Kids to Eat Better? Get Them Cooking

By Alex Kramer

HealthDay Reporter



THURSDAY, Nov. 27, 2014 (HealthDay News) -- Getting kids involved in the kitchen, through cooking classes or at home, may make them more likely to choose healthy foods, according to a recent review.


Cooking programs and classes for children seem to positively influence children's food preferences and behaviors, according to the new research. And, although the review didn't look at long-term effects of such programs, the findings suggest that such programs might help children develop long-lasting healthy habits.


"It is important to expose children to healthy foods in a positive way," said Derek Hersch, the lead author of the study who also works with a cooking education program called Food Explorers at the Minnesota Heart Institute Foundation. "Creating habits and behaviors at this age is the most important part of it."


This research comes at a time when childhood obesity rates have been rising rapidly. More than one-third of adolescents in the United States were obese in 2012, according to the U.S. Centers for Disease Control and Prevention (CDC). This trend has been caused, at least in part, by a significant decrease in the amount of meals that people consume at home since the 1980s, according to background information in the study. People are more likely to eat at restaurants, where meals are more calorie-dense and less nutritious, the study noted.


Sara Haas, a spokesperson with the Academy of Nutrition and Dietetics, noted that time is a factor. "It has a lot to do with eating more convenience foods because parents are lacking time, and may not have learned to cook healthy meals," she said.


Cooking education programs, such as Food Explorers, teach children about new healthy foods and how to prepare them. They also stress the importance of eating five fruits and vegetables every day. A volunteer parent explains a new food to the group, and the kids make something based on the lesson, such as fruit skewers or spinach salad. Depending on the program, kids may be sent home with information about healthy foods to bring to their parents, the review explained.


"If you get them involved in cooking, they are 100 percent interested and want to do more -- it's amazing," said Haas, who is also a chef.


Hersch and his study team reviewed eight other studies that tested different types of cooking education programs. Children in these classes were between 5 and 12 years old, according to the review. Hersch's goal was to learn more about developing an efficient program to encourage healthy food choices that last a lifetime.


"We found that it is particularly important to expose kids to healthy foods on a number of occasions," Hersch said. "This makes them feel comfortable with the new foods, which helps them build healthy habits."


Because each study included in the review was designed somewhat differently, it was difficult for the researchers to make any strong conclusions. However, some of the trends the researchers saw included increased consumption of fruits, vegetables and dietary fiber, a greater willingness to try new foods and increased confidence in the ability to prepare foods.


Hersch and the study authors recently published their findings in the CDC's Preventing Chronic Disease: Public Health Research, Practice and Policy.


Both Hersch and Haas emphasized the importance of getting parents involved in their children's eating habits. Parents who are unable to enroll their kids in a cooking class can achieve similar benefits by having their kids help them while they prepare meals at home, Hersch noted. Children are more comfortable at home, which makes them more receptive to new foods because they will make the connection to a positive experience, according to Hersch.


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Don't Let Chronic Heartburn Spoil Your Thanksgiving Feast

By Mary Elizabeth Dallas, HealthDay Reporter



THURSDAY, Nov. 27, 2014 (HealthDay News) -- Planning on seconds at Thanksgiving Day dinner this year? If you suffer from chronic heartburn -- clinically known as gastroesophageal reflux disease (GERD) -- a few steps may help minimize the aftereffects.


Dr. Jordan Josephson, an ear, nose and throat specialist at Lenox Hill Hospital in New York City, offers up these tips to help manage GERD on Thanksgiving:



  • Pace yourself. Rather than have one big meal, have at least two small meals throughout the day. It's also a good idea to have a healthy snack of veggies before the main course is served.

  • Don't eat just before bedtime. Bigger meals should be eaten at least three hours before going to sleep to avoid an acid reflux flare-up.

  • Opt for water. Rather than soda or wine, drink water to avoid aggravating your symptoms. Drinking plenty of water will also aid in digestion and help you stay hydrated.

  • Limit certain foods. Do not overindulge on carbohydrates like bread, pasta and rice. It's also a good idea to avoid spicy or tomato-based foods as well as foods high in fat.

  • Avoid caffeine. To prevent a flare-up of GERD symptoms, pass on the coffee or other caffeinated beverages.

  • Don't smoke. Smoking irritates the lining of the stomach, esophagus, nose and sinuses.

  • Leave the belt at home. Tight or restrictive clothing or accessories can increase heartburn-related discomfort.

  • Walk. Taking a stroll before or after Thanksgiving dinner can aid in digestion and boost metabolism.

  • Gargle with salt water. At the end of the day, gargling with salt water can help remove acid and soothe stomach irritation.


More information


The U.S. National Institutes of Health provides more information on GERD.


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Health Tip: Keep Your Feet Happy

Health Tip: Skate Safely

By Diana Kohnle, HealthDay Reporter


(HealthDay News) -- Read to lace up your ice skates and enjoy some winter exercise? Make sure you're prepared.


The National Safety Council offers these suggestions:



  • Make sure skates support your ankles well and fit comfortably.

  • Take skates to have blades professionally sharpened before skating season starts.

  • Only skate in areas that are prepared and safe for skating.

  • Make sure you know the basics, such as how to stop safely.

  • Take breaks when you feel cold or tired.

  • Dress warmly.

  • Never skate alone.


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Steer Clear of Cold Meds for Babies, FDA Advises

By Robert Preidt, HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- Most babies and young children don't need medicines if they have a cold, the U.S. Food and Drug Administration says.


Over-the-counter (OTC) cold and cough medicine should not be given to children younger than 2 because they could cause serious and potentially deadly side effects, the agency warned.


American adults average about three colds a year, but children get them more often. When children get a cold, parents might want to give them pain relievers, decongestants and other medicines, but often the best approach is rest and care, the FDA said in a news release.


"A cold is self-limited, and patients will get better on their own in a week or two without any need for medications. For older children, some OTC medicines can help relieve the symptoms -- but won't change the natural course of the cold or make it go away faster," Dr. Amy Taylor, a medical officer in FDA's Division of Pediatric and Maternal Health, said in the news release.


Antibiotics are useless because they treat bacterial infections, while colds are usually caused by viruses.


Coughs are a normal symptom of a cold and actually provide some benefits, Taylor noted.


"Coughs help the body clear the mucus out of the airway and protect the lungs; so you don't want to suppress all coughs," she said.


Non-drug treatments to ease coughs in children with colds include giving them plenty of fluids, especially warm drinks to soothe the throat.


While most children with colds do not need to see a doctor, Taylor said parents should call the doctor if they see any of these symptoms:



  • A fever in an infant aged 2 months or younger, or a fever of 102 Fahrenheit or higher at any age.

  • Signs of breathing problems, including nostrils widening with each breath, wheezing, fast breathing or the ribs showing with each breath.

  • Blue lips, ear pain, not eating or drinking, signs of dehydration.

  • Excessive crankiness or sleepiness, a cough that lasts for more than three weeks, or worsening condition.


"You have to know your child," Taylor said. "With small infants, fever is a major concern, and you need medical advice. If you are worried about your child's symptoms, at any age, call your pediatrician for advice."


More information


The American Lung Association has more about the common cold.


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Early Trial Promising for Ebola Vaccine

By Dennis Thompson

HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- An experimental Ebola vaccine appears to be safe and produces an immune system response that could protect people against the deadly virus, according to early clinical trial results reported by the U.S. National Institutes of Health.


The success of the phase I clinical trial for the vaccine paves the way for field-testing it in the Ebola-stricken West African nations of Liberia and Sierra Leone as early as January, said Dr. Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases.


The genetically engineered vaccine caused no major side effects in 20 healthy adults who received a dose in September at the NIH Clinical Center in Bethesda, Md., the researchers report in the Nov. 26 issue of the New England Journal of Medicine.


The vaccine also created an immune system response in humans very similar to that of monkeys who, once inoculated, survived lab tests that exposed them to potentially fatal doses of Ebola, Fauci said.


"All in all, one can say this is a successful vaccine, from the standpoint of phase I," Fauci said. "Now the critical question is, will it work?"


Ebola has killed more than 5,450 people during the West African epidemic, according to the World Health Organization. In response, international efforts to develop a preventive vaccine have accelerated.


The current vaccine, developed by the Institute of Allergy and Infectious Diseases and GlaxoSmithKline, is based on a virus called chimpanzee-derived adenovirus, which causes a common cold in chimps but has no effect on humans.


Researchers have spliced portions of Ebola's genetic material into the chimp virus, to trick the immune system into creating Ebola-attacking antibodies without exposing the body to the virus itself.


The clinical trial enrolled volunteers aged 18 to 50. Ten volunteers received a low-dose injection of the vaccine, while another 10 received the same vaccine at a higher dose.


Within a day of vaccination, two people who got the higher dose developed a fever, which was "short-lived and easily handled," Fauci said.


"There were no real red flags when it comes to safety," he said.


At two weeks and four weeks following vaccination, the researchers tested the volunteers' blood to determine if anti-Ebola antibodies were generated. All 20 volunteers developed such antibodies within four weeks of receiving the vaccine, but antibody levels were higher in those who received the higher-dose vaccine.


"The results of the vaccine trial are promising and show that this particular vaccine is able to induce protective levels of immunity," said Dr. Amesh Adalja, a senior associate with the Center for Health Security at the University of Pittsburgh Medical Center. "The trial also begins to provide a basis for selecting the optimal dose needed to achieve protection against Ebola."


Two other phase I trials for the vaccine are ongoing in the United Kingdom and Mali, with results expected by year-end, the NIH said.


But based on the success of the Bethesda trial, researchers hope to begin delivering the experimental vaccine to people in Liberia and Sierra Leone within a couple of months, Fauci said.


Fauci could not say how many people would receive the vaccine in the field trials. "We don't have the exact number," he said. "In order to determine efficacy, you'll have to vaccinate thousands of people, not just hundreds of people."


The vaccine in question is one of two experimental Ebola vaccines that experts have said could be ready in time to combat the current epidemic.


The second vaccine, also genetically engineered, is based on a virus common to cattle and horses called vesicular stomatitis virus (VSV). This is in the same family as the rabies virus but causes only flu-like symptoms in infected humans.


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Guinea, hit by Ebola, reports only 1 cholera case

By MICHELLE FAUL, Associated Press


CONAKRY, Guinea (AP) — The health workers rode on canoes and rickety boats to deliver cholera vaccines to remote islands in Guinea. Months later, the country has recorded only one confirmed cholera case this year, down from thousands.


The rare success, overshadowed by the Ebola outbreak that has ravaged Guinea and two other West African countries, is being cautiously attributed to the vaccinations and to hand-washing in the campaign against Ebola.


Helen Matzger of the Bill & Melinda Gates Foundation said Guinea's experience is encouraging other countries to accept the cholera vaccine and has led the GAVI Alliance — which works to deliver vaccines to the world's poor — to invest in a global stockpile and the U.N. World Health Organization to increase that stockpile to about 2 million doses.


Matzger, the foundation's senior program officer for vaccine delivery, said she was amazed at the ease and efficiency with which the vaccine was delivered to very remote islands.


She said she was on a wobbly boat that made the first delivery, along with Dr. Sakoba Keita, a Cuban-trained Guinean physician who was responsible for Guinea's epidemics surveillance before being appointed the West African nation's Ebola czar.


"In many instances in global health, you see one brave individual who is willing to do something that's different because they think it will have an impact, and Dr. Sakoba was that person," Matzger said in a telephone interview from her Seattle office.


In March, the World Health Organization, with support from UNICEF and Doctors Without Borders, vaccinated some 200,000 fishermen on islands north of Conakry, the capital, where they gather from Guinea and neighboring Sierra Leone and Liberia during the fishing season, said Julien Labas, in charge of UNICEF's campaign for clean water, sanitation and hygiene. The area had been identified as a major transmission source for cholera since the fishermen set up temporary shelters and have no toilets or clean water.


In 2012, amid a cholera outbreak that sickened 7,350 people and killed 133 of them in Guinea, the World Health Organization carried out a study using the Indian-made vaccine Shanchol on 40 patients. The vaccine is delivered by drops into the mouth and requires two doses two weeks apart. One dose costs $1.85, according to Matzger.


A report published in The New England Journal of Medicine earlier this year said that study found the vaccination provided "significant protection against cholera." Matzger said some studies show that if vaccination is provided for 70 percent of a target population, that effectively protects about 98 percent of the people. The vaccine is effective for about three years.


Advocates say the vaccine should be used in tandem with campaigns for clean water and sanitation.


In Guinea, UNICEF works with a local organization to produce chlorine, has a project to manually drill boreholes at half or a third the cost of commercial drilling, and has developed a smartphone app to map the state of all water points.


WHO estimates there are 3 million to 5 million cholera cases a year worldwide, and 100,000 to 120,000 deaths.


Experts in Guinea are cautious in explaining why Guinea has had only one confirmed case.


"It could be related to the vaccination campaign, and I also think the Ebola outbreak might have an indirect impact," Labas said. He also noted that cholera epidemics come and go.


Guineans have taken to stringently washing their hands in chlorinated water to help halt the transmission of Ebola, which has killed more than 1,100 people in the country where the latest outbreak started nearly a year ago. Ebola is contracted by direct contact with an infected person's bodily fluids. Hotels, shops and restaurants oblige patrons to wash their hands in chlorinated water before they can enter.


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U.S. Adult Smoking Rate Drops to New Low: CDC

By Steven Reinberg

HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- Fewer American adults are smoking cigarettes than ever, health officials said.


In fact, the rate of cigarette smoking has dropped from about 21 percent in 2005 to 18 percent in 2013. That means the number of cigarette smokers dropped from 45.1 million to 42.1 million, despite the increasing population, according to the U.S. Centers for Disease Control and Prevention (CDC).


However,"we still have a long way to go, and if we don't bend the curve down faster, over 5.5 million kids who are alive today will die prematurely from tobacco-related disease," said Dr. Tim McAfee, director of the CDC's Office on Smoking and Health.


Smoking is a major -- and modifiable -- risk factor for death and disease, he said.


"Smoking has a major impact on people's lives," McAfee said. "If you're a smoker you're at risk of dying 11 to 12 years earlier than if you are not a smoker," he said.


Although cigarette smoking is at a 50-year low, in some groups the proportion of smokers is higher than the average, McAfee said.


"Leading the pack, cigarette use is highest among those below the poverty level at almost 30 percent, compared to 17.8 percent in the general population," he said.


Other groups that continue to smoke at higher than average levels are the less educated, American Indians/Alaska Natives, men, people who live in the South or Midwest, people who have a disability, people with mental health issues, those who abuse drugs or alcohol, and people who are lesbian, gay or bisexual, McAfee said.


Tobacco companies target some of these groups, he said.


"Particularly among the lesbian/gay/bisexual community and people with substance abuse, there is evidence that, for decades, the tobacco industry has consciously pursued marketing campaigns aimed at these vulnerable populations," he said.


McAfee said effective strategies that reduce smoking include increasing the cost of cigarettes, increasing taxes on cigarettes and passing more smoke-free laws. In addition, education, anti-smoking media campaigns and providing better access to tobacco cessation programs are essential, he said.


The bulk of the burden to cut smoking falls on states, but they spend less than 2 percent (about $500 million) of the $25 billion they get from tobacco taxes and the tobacco settlement on anti-smoking programs, he said.


The report was published online on Nov. 26 in the Morbidity and Mortality Weekly Report.


Susan Liss, executive director for the Campaign for Tobacco-Free Kids, said, "It's not surprising that there has not been more recent progress. States have cut and severely underfunded tobacco prevention and cessation programs. In addition, progress at the state level in enacting higher tobacco taxes and smoke-free laws has slowed greatly."


Still, most of the news from the new report was good. According to the data, not only has the number of smokers decreased, but those who smoke, smoke less.


The researchers found that the proportion of those who smoke every day decreased from 81 percent in 2005 to 77 percent in 2013. In addition, the number of smokers who smoke only on some days increased from 19 percent in 2005 to 23 percent in 2013.


The average number of cigarettes smoked each day also decreased from 17 in 2005 to 14 in 2013, the report said.


Moreover, the number of smokers who smoked 20 to 29 cigarettes per day dropped from 35 percent in 2005 to 29 percent in 2013. And, the number who smoked fewer than 10 cigarettes per day increased from 16 percent in 2005 to 23 percent in 2013, the researchers found.


Dr. Norman Edelman, a senior consultant for scientific affairs at the American Lung Association, said it is significant that smokers are smoking less.


"That means that we are not left with hardcore smokers who have to have their pack a day or more," he said. "This suggests that there is still room to decrease the smoking rates."


More information


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Don't Let High Altitude Ruin Your Holiday Trip

By Randy Dotinga, HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- When you're planning your holiday get-away, don't forget to factor high altitude into your vacation sports -- such as skiing or hiking, a sports medicine specialist cautions.


Outdoor explorers may fail to take altitude into account when visiting high-altitude recreation areas, which puts them at risk of developing fatigue and other symptoms related to being high above sea level, according to Dr. Melissa Tabor, an assistant professor of sports medicine and osteopathic principles and practice at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.


"No matter how great of an athlete you are, if you are coming from sea level or lower altitudes to a higher altitude area, you need to prepare," Tabor said in a news release provided by the American Osteopathic Association. Tabor recently gave a presentation on preparing for high-altitude activities at the Osteopathic Medical Conference in Seattle.


People under 50 more likely to get altitude sickness, Tabor said.


Folks should be on the lookout for signs of altitude sickness: nausea, vomiting, dizziness, fatigue, sleep disturbances and poor eating. Other more serious symptoms include confusion, inability to walk, shortness of breath and coughing blood. In extreme cases, altitude sickness can even cause death, according to Tabor.


Fortunately, treatment is often simple -- move to a lower altitude, she noted.


To lower your risk of developing altitude sickness, Tabor suggests these cautions:



  • Acclimate to higher altitude by spending days -- or weeks, if possible -- at a higher altitude before any strenuous activity.

  • Plan ahead and get information about the location where you're traveling. You may be able to find websites created by mountain resorts and local governments with details about ascending and descending.

  • Climb slowly and check guidelines from the Wilderness Medical Society.

  • Listen to your body and don't climb any more if you feel lightheaded or have a headache. Descend within two to four hours if the symptoms don't go away.

  • Stay hydrated and drink before you're thirsty.

  • Consider renting a portable hyperbaric chamber to help you adjust to altitude.

  • Talk to a doctor for advice and possible prescriptions for medications that may help you adjust to altitude.


More information


For details about preparing for traveling to high altitude, try the U.S. Centers for Disease Control and Prevention.


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EPA Issues Tougher Rules on Ozone Emissions

By E.J. Mundell, HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- New regulations to reduce emissions of the smog-causing pollutant ozone from power plants and factories were issued Wednesday by the U.S. Environmental Protection Agency.


Ozone has been linked to asthma, heart disease and premature death.


The new rules would lower the current limit for ozone pollution from 75 parts per billion to between 65 to 70 parts per billion, the EPA said.


"Bringing ozone pollution standards in line with the latest science will clean up our air, improve access to crucial air quality information and protect those most at risk," EPA Administrator Gina McCarthy said in an agency news release.


According to the New York Times, the latest ozone emission limits are still less of a reduction than the 60 parts per billion limit sought by environmental groups. However, the EPA proposal will also ask for public comment on a 60-parts-per-billion limit, which means the final regulation could be lower than what is being proposed, the Times reported.


Reductions in ozone emissions have been sought by public health groups for years.


"The EPA's proposal to strengthen the standard is a step forward in the fight to protect all Americans from the dangers of breathing ozone pollution, especially to protect our children, our older adults and those living with lung or heart disease," Harold Wimmer, president of the American Lung Association, said in a statement.


However, Wimmer believes the new rules don't go far enough. "We are concerned that EPA did not include 60 parts per billion in the range, though it was the clear recommendation of independent scientists as well as health and medical societies, including the American Lung Association," he said.


"The scientific record clearly shows that a standard of 60 parts per billion would provide the most public health protection," Wimmer added. "We will continue to push the agency to adopt standards based on the scientific evidence."


However, industry groups claim the new limits would harm the economy and provide little public health benefit.


"Air quality has improved dramatically over the past decades, and air quality will continue to improve under the existing standards," Howard Feldman, director of regulatory affairs for the American Petroleum Institute, which lobbies for the oil industry, told the Times.


"The current review of health studies has not identified compelling evidence for more stringent standards, and current standards are protective of public health," he said.


But two lung health experts agreed with the ALA that the new standards are long overdue.


"It is welcome news that air pollution will be lessened by this legislation," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "It is well known that asthma is linked to ozone. Even atherosclerosis [hardening of the arteries] has been linked to air pollution in urban environments."


Dr. Marc Wilkenfeld is chief of the division of occupational and environmental medicine at Winthrop-University Hospital in Mineola, N.Y. He agreed that, "a reduction in ozone levels is a critical factor in improving public health. The reduction will ultimately save lives."


The new ozone standards are the latest in a series of EPA moves to reduce air pollution. Next year, the agency is expected to finalize two new rules meant to reduce climate change-causing greenhouse gas emissions from coal-fired power plants, the Times reported.


More information


There's more on air pollution at the American Lung Association.


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Your Dog Really Is Listening to You

By Amy Norton

HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- While people have long believed their dogs understand what they're saying, a new study suggests they are processing the meaning and emotion of words in a human-like way.


Past research has shown that dogs respond to different parts of human speech -- including the actual content and the emotional tone, said study author Victoria Ratcliffe.


But her team's findings give a deeper insight into the canine brain, according to Ratcliffe, a Ph.D. candidate at the University of Sussex in the United Kingdom.


For one, the study found, dogs seem to process multiple components of human speech all at once. What's more, their brains are human-like in the way they distinguish the information in words from the emotional tone.


That does not mean dogs are actually understanding all the words people say, Ratcliffe stressed.


But, she said, the findings do suggest that "dogs may dissociate and process speech components in a way that is broadly comparable to humans."


Ratcliffe and colleague David Reby report their findings in the Nov. 26 issue of Current Biology.


The results probably won't shock dog owners, noted Nicholas Dodman, a professor of animal behavior at the Tufts University Cummings School of Veterinary Medicine in North Grafton, Mass.


"No, dogs are not going to read books or compose sonnets," said Dodman, who was not involved in the study. "But they can take quite a bit out of what we're saying. They are picking up certain sounds that have meaning for them. They're also picking up the tenor of what we're saying," he explained.


"I'd say it's a testament to their abilities as sentient beings," Dodman added.


For the study, Ratcliffe and Reby had dogs listen to human speech from two speakers placed on either side of the animal. The speech either had meaning to the dog (the very British command, "Come on then") or no meaning.


The quality of the speech was also manipulated: Sometimes it was stripped of the trappings of the human voice, to emphasize the meaning of the words; sometimes the emotional tone was exaggerated.


The researchers found that when they broadcast "come on then" with the meaning emphasized, the dogs typically turned their heads to the right-side speaker. That, according to Ratcliffe, indicates they were processing the words with a bias toward the left hemisphere of the brain -- which in humans is the half that picks up the sound and syntax of words.


On the other hand, when the emotional tone of the speech was exaggerated, the dogs turned to the left -- which indicates that the brain's right hemisphere was dominant. And in humans, the right hemisphere processes the intonation and emotional quality of speech.


"To me," Dodman said, "this is another step in our realization that dogs are more attuned to us than we've previously recognized."


That's important for a few reasons, according to Ratcliffe. "Developing our understanding of how dogs perceive human speech is obviously beneficial in improving our communication with them," she said.


But there are also implications for understanding humans and other mammals. "In evolutionary terms," Ratcliffe said, "we can directly compare humans and dogs to see which attributes of speech perception are uniquely human, or part of a shared mammalian history that encompasses dogs as well."


For people who live with dogs, the findings probably just validate what they've already "intuitively known," according to Dodman. But he said scientific studies of canine behavior are important.


And as these findings suggest, he said, "dogs have been studying us for a long time."


More information


The ASPCA has tips for understanding your dog.


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Spotting Hearing Problems in Infancy May Boost Reading Skills in Deaf Teens

By Robert Preidt, HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- Deaf teens have stronger language and reading skills if their hearing problems were detected at an early age, a new study suggests.


Researchers looked at a group of deaf children in England who were diagnosed with permanent hearing loss through an infant screening program conducted in the 1990s.


A follow-up of the children at age 8 found that those who were screened by the time they were 9 months old had better language and reading skills than deaf children who weren't screened as infants.


This new study assessed the children at age 17, and found the gap in language and reading skills between the screened and unscreened groups had doubled since age 8.


The findings are published Nov. 25 in the Archives of Disease in Childhood.


"Our previous work has shown that children exposed to newborn hearing screening had, on average, better language and reading abilities at age 8 years. We are now able to show that this screening program can benefit these children into their teenage years," study leader Dr. Colin Kennedy, a professor of neurology and pediatrics at the University of Southampton in England, said in a university news release.


"We believe that the early superiority in the reading skills of the children who were screened may have enabled them to read more demanding material more frequently than their peers with later confirmed hearing difficulties, thus increasing the skill gap between the two groups," he explained.


"Screening all babies for hearing impairment at birth enables families to have the information they need to support their baby's development, leads to benefits of practical importance at primary school and now, secondary school and further education," Kennedy concluded.


More information


The U.S. Centers for Disease Control and Prevention has more about hearing loss in children.


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Obesity Tied to Half a Million Cancers Worldwide, Report Shows

By Robert Preidt, HealthDay Reporter



WEDNESDAY, Nov. 26, 2014 (HealthDay News) -- Obesity is associated with close to 500,000 new cancer cases worldwide each year, and nearly two-thirds of obesity-related cancers occur in North America and Europe, a new report shows.


The analysis of data from 184 countries showed that excess weight was associated with 345,000 (5.4 percent) of new cancers in women in 2012, and 136,000 (1.9 percent) of new cancers in men in 2012.


Among women, postmenopausal breast, endometrial and colon cancers accounted for nearly three-quarters (250,000 cases) of obesity-related cancers, while colon and kidney cancers accounted for more than two-thirds (nearly 90,000 cases) of obesity-related cancers in men.


Excess weight was associated with about 8 percent of cancers in women and 3 percent of cancers in men in developed nations, compared with 1.5 percent of cancers in women and 0.3 percent of cancers in men in developing nations.


In 2012, the highest number of obesity-related cancers was in North America, with more than 110,000 (23 percent of the worldwide total), while the lowest number was in sub-Saharan Africa, with 7,300 cases (1.5 percent of the global total). In Europe, there were 66,000 obesity-related cancer cases.


Rates of obesity-related cancers varied widely among countries. Among men, rates were particularly high in the Czech Republic (5.5 percent of new cancer cases in 2012), Jordan and Argentina (4.5 percent), and the U.K. and Malta (4.4 percent). Among women, rates were highest in Barbados (12.7 percent), Czech Republic (12 percent), and Puerto Rico (11.6 percent).


Rates were lowest in the countries of sub-Saharan Africa, with less than 2 percent in men and less than 4 percent in women, according to the study published Nov. 25 in The Lancet Oncology.


"Our findings add support for a global effort to address the rising trends in obesity. The global prevalence of obesity in adults has doubled since 1980. If this trend continues, it will certainly boost the future burden of cancer, particularly in South America and North Africa, where the largest increases in the rate of obesity have been seen over the last 30 years," study leader Dr. Melina Arnold, of the International Agency for Research on Cancer, said in a journal news release.


"If 3.6 percent of all cancers are associated with [overweight and obesity], that is nearly half a million cancers, but this number is large mainly because the world population is large," Dr. Benjamin Cairns, from the University of Oxford in the U.K., wrote in an accompanying editorial.


"Global health resources specifically for cancer prevention are not so large, and the resources targeted at obesity must be balanced against those for other important causes of cancer, particularly infections and tobacco use, which are each associated with much larger proportions of cases," he said.


While the study showed an association between obesity and the rising number of cancer cases worldwide, it did not prove a cause-and-effect link.


More information


The U.S. National Cancer Institute has more about obesity and cancer risk.


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Health Tip: Plan a Healthy Thanksgiving Menu

Health Tip: Kick Unhealthy Eating Habits

Most Americans With HIV Don't Have Virus Under Control, CDC Says

By Dennis Thompson

HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Fewer than one-third of Americans living with HIV had the virus under control in 2011, with many either not receiving regular medical care or unaware they carry the virus, a new U.S. study finds.


The U.S. Centers for Disease Control and Prevention study estimates that 70 percent of the 1.2 million Americans living with HIV in 2011 did not have their virus under control, even though combination drug therapies can effectively suppress the virus before it can develop into full-blown AIDS.


A combination of indifference and lack of access to medical care appeared to outweigh ignorance as a driving factor in cases of uncontrolled HIV, researchers from the CDC's National Center for HIV/AIDS reported Tuesday.


"For people living with HIV and AIDS, it's not enough to know -- you also have to go for health care," said CDC Director Dr. Tom Frieden at a Tuesday news briefing.


"For health care systems, it's not enough to diagnose patients," he added. "You have to take accountability and responsibility for every patient diagnosed in your health center, to provide them with the most sensitive, effective, culturally appropriate care so that they will get onto treatment, stay into treatment, live longer, live healthier, stay out of the hospital and not infect others."


When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body, allowing people with HIV to live longer, healthier lives, Frieden said.


Viral suppression also reduces the likelihood that patients will transmit HIV to others. Treatment has been shown to reduce sexual transmission of HIV by 96 percent, the CDC said, and U.S. clinical guidelines recommend that everyone diagnosed with HIV receive treatment.


Among the nearly 840,000 people who had not achieved viral suppression, researchers found that:


The study did not find statistically significant differences in viral suppression by race, ethnicity or gender, which is "encouraging," said Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.


But researchers did find that young adults are at greater risk of uncontrolled HIV, with only 13 percent of people age 18 to 24 having achieved viral suppression. "More than any other group, our young people are not getting the care they need," said Mermin, also speaking at the news briefing.


This is largely because young adults are less likely to have been diagnosed with HIV. Only half of those 18 to 24 with HIV have been diagnosed, compared with more than 90 percent of people 45 and older, the report said.


"To close the age gap in viral suppression, we will need to expand efforts to reach young adults with HIV testing," Mermin said.


Mermin said that accessing HIV care can be difficult, particularly for people who are impoverished or suffering from substance abuse problems.


But even people of means can find it hard to maintain HIV treatment, Frieden said.


"Taking treatment for an infection that may have no symptoms and that you need to take for life is not easy," he said. "That's why it's so important that services for people living with HIV be sensitive, easy to access and without financial barriers."


The CDC hopes to improve HIV diagnosis and treatment through efforts launched in 2010 as part of the National HIV/AIDS Strategy, said Dr. Eugene McCray, director of the CDC's Division of HIV/AIDS Prevention, at the news briefing.


McCray said these efforts include innovative partnerships to make HIV testing simple, accessible and routine.


Additional efforts include programs to help health departments identify infected individuals who have fallen out of care. Public awareness campaigns about the importance of HIV testing and ongoing HIV treatment are also key, McCray said.


More information


For more on HIV, visit the U.S. National Institutes of Health.


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Full-Day Preschool Beats Part-Day for School Preparedness

By Dennis Thompson

HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Children who attend a full-day preschool program are better prepared for elementary school success than children who attend a part-day program, a new study has found.


Chicago preschoolers who went the whole day rather than a half-day had higher scores on measures of school readiness skills, including language, math, social development and physical health, researchers from the University of Minnesota reported.


"We found that about 80 percent of children with full-day preschool were at or above national norms in terms of school readiness, compared with 58 percent of children at a part-day program," said Arthur Reynolds, a professor at the University of Minnesota Institute of Child Development.


Full-day preschool gave kids a jump on nearly all skill sets equal to an additional three to four months of learning, the researchers found. "These are sizable benefits," Reynolds said.


The full-day preschoolers also had better attendance and fewer instances of chronic absence, the researchers reported in the Nov. 26 issue of the Journal of the American Medical Association.


The findings are good news for parents juggling heavy workloads, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park, N.Y.


"These findings are likely comforting and reassuring for households where the work commitments of the primary caregivers necessitate placing their child in a full-day preschool program," Adesman said. "Although the findings from this methodologically rigorous study need to be replicated, the results cannot be ignored until then."


Nationally, about half of children who enter kindergarten aren't properly prepared for K-12 school, Reynolds said.


Reynolds and his colleagues wanted to see whether attending a full day at a high-quality preschool program could better prepare children for K-12 than just going for half-days.


The study focused on nearly 1,000 predominantly low-income, ethnic minority children enrolled in the Midwest Child-Parent Center Education Program at 11 Chicago schools for the 2012-2013 school year. Of the children, 409 attended full-day preschool and 573 attended a part-day program.


At the end of preschool, researchers evaluated school readiness skills of the children. They found that full-day preschool participants had higher scores than part-day peers on a range of skills, and also had better school attendance. Scores for literacy and mental development were not significantly different.


"It's good to see that more exposure to a good thing does better than less exposure," said Lawrence Schweinhart, former president of the HighScope Educational Research Foundation in Ann Arbor, Mich.


A full day of preschool gives teachers a chance to engage with the kids on a variety of important subjects, Reynolds said.


"In a part-time program, we find most of that time is devoted to language development or reading," Reynolds said. "There isn't time in two-and-a-half or three hours to cover math, science, social-emotional learning and other skill sets that will help children prepare for school."


Parents also are more likely to encourage attendance with a full-day program, he added.


"If you're only there for a couple of hours, it's easy to miss a day," Reynolds said. "But in a seven-hour day there's a lot going on, so if you miss a day you miss a lot. It's a packed day, but a nurturing day. Parents see the value of a full day and they see their child growing at a higher level, and they don't want to miss that."


However, children likely will not reap these benefits if they go to a low-quality preschool that acts more like a day care center than an educational program, said Schweinhart, who wrote an editorial accompanying the study.


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Parents Need to Take Lead on Teen Concussion Prevention

By Robert Preidt, HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Parents need to take an active role in protecting their children from sports concussions, an expert warns.


Parents must make sure sports-playing teens have the right protective gear and undergo standard, Dr. David Dodick, chair of the American Migraine Foundation and a professor of medicine at the Mayo Clinic College of Medicine in Scottsdale, Ariz. in an American Migraine Foundation, said in a foundation news release.


Any coach involved with teens sports needs to have appropriate training. Teen sports teams need concussion sideline and after-injury protocol, said Dodick. He also advised that there should be either a health professional available at games to evaluate blows to the head, or a safety officer who can give simple tests to determine if an athlete has suffered a concussion.


It's also important to make sure that schools forbid students with concussions from playing and don't allow them to return to play until cleared by a concussion specialist, Dodick said.


Teens need to understand how serious a concussion can be. Parents should also make sure their teen knows the signs and symptoms of concussion, which include nausea and vomiting, dizziness, confusion, headache, slowed thinking, memory loss, insomnia or excessive sleeping, irritability/depression or mood swings, and sensitivity to light and/or noise.


If your child has any of these symptoms after a head injury, see a doctor immediately, said Dodick, who noted that symptoms can worsen over hours or days.


Another way to reduce children's risk of concussion is for them to play with others who are similar in height, weight, strength and level of training.


More information


The American Academy of Family Physicians has more about concussion.


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Infants With Eczema May Be More Prone to Peanut Allergy: Study

By Robert Preidt, HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Exposure to peanut protein in household dust may increase the risk of peanut allergy in infants with the skin condition eczema, a new study reveals.


About 2 percent of school-aged children in the United States are allergic to peanuts. And severe eczema in infants has been linked to food allergies, particularly peanut allergy, the researchers noted.


The new study included 359 infants aged 3 months to 15 months. The researchers examined the amount of peanut protein the children were exposed to in household dust. The children were at high risk for peanut allergy because they were allergic to cow's milk or eggs, or had moderate to severe eczema and were allergic to cow's milk or eggs.


The investigators found that exposure to peanut protein in household dust early in life doubled a child's risk of peanut allergy. The risk was highest among children with eczema, according to the study published online Nov. 18 in the Journal of Allergy and Clinical Immunology.


"This study adds to the growing body of evidence that exposure to peanut via a damaged skin barrier may increase the risk of peanut allergy," study first author Dr. Helen Brough, of the department of pediatric allergy at King's College London, said in a college news release.


"Previous studies have shown, for example, that infants with eczema treated with creams containing peanut oil in the first six months of life had a higher risk of developing peanut allergy later in life," Brough explained.


Study senior author Gideon Lack, also of King's College London, added, "This is further evidence for the dual-allergen-exposure theory, which suggests food allergies develop through exposure to allergens via the skin, likely through a disrupted skin barrier, whilst consumption of these food proteins early in life builds up tolerance in the body."


According to Lack, "Previous guidelines recommending that mothers should avoid peanuts during pregnancy and breast-feeding have now been withdrawn. It may be that the timing and balance of skin and oral exposure to a particular food early in life determines whether a child develops an allergy or tolerance to that food."


More information


The U.S. National Institute of Allergy and Infectious Diseases has more about food allergy.


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FDA Panel Mulls Worth of Steroid Shots For Back Pain

By Steven Reinberg

HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- An expert advisory panel of the U.S. Food and Drug Administration will decide Tuesday whether to recommend that doctors stop giving steroid injections for back pain.


These shots are commonly used to treat back pain, but they are not approved for this use and whether the risks outweigh the benefits is a matter of debate.


According to the FDA, serious but rare side effects with these shots can include death, spinal cord blockage, paralysis, blindness, stroke, seizures, nerve injury and brain swelling.


And experts are divided on whether steroid shots actually ease back pain.


A study published earlier this year in the New England Journal of Medicine found that people who have lower back pain caused by spinal stenosis -- a common condition among those over the age of 60 in which the open space in the spinal canal narrows from inflammation -- are unlikely to get relief from steroid shots.


Study author Dr. Janna Friedly, an assistant professor of rehabilitation medicine at the University of Washington in Seattle, said at the time that, "These steroid injections aren't helpful. There is no added benefit to the steroid itself, so if people are considering these injections, I would recommend that they consider an alternative."


However, Dr. Houman Danesh, a specialist in pain management and rehabilitation and physical medicine at Mount Sinai Hospital in New York City, said he believes these injections are both safe and effective.


"Steroid injections have been practiced longer than we have had a vaccine for polio, and after six decades the FDA has decided to review the safety and efficacy of these injections," he noted.


Danesh thinks the FDA's current interest is based on an incident in 2012, when more than 700 people contracted fungal meningitis and other infections that resulted in more than 60 deaths, all the result of a single compounding pharmacy distributing steroids contaminated with a fungus that caused these complications.


He added that effectiveness of steroid injections has been studied in multiple clinical trials in the past. "One of the first studies, in 1977, was a placebo-controlled, randomized study. This study showed up to 70 percent improvement in pain with steroid injections, compared with 43 percent with placebo," he said.


In 2008, studies showed as many as 91 percent of people getting these injections reported significant pain relief, Danesh said.


"Steroid injections are a safe and effective means of treating nerve irritation in the spine," he added.


Although the FDA is not required to follow the recommendations of its advisory panels, which is the Anesthetic and Analgesic Drug Products Advisory Committee in this case, it typically does.


More information


Visit the U.S. National Library of Medicine for more on steroid shots.


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Op-ed: Creating Patient Experience Programs in Hospitals Doesn't Have to Be Difficult

I’ll admit, during my time as a medical student, resident and even fellow, I never gave much thought to patient experience. There never seemed to be enough time to think about the role of compassionate care delivery or empathy. The concept of patient experience simply wasn’t discussed, so, patients stopped being people to us, and instead became synonymous with their conditions. But we were still saving lives, so didn’t that count for something? It wasn’t until I had a negative experience in a hospital with my dad that I began to give great thought to patients’ overall experience in medicine, especially within a hospital – and ultimately came back to the reason I went into medicine in the first place.


[SPECIAL REPORT: Hospital of Tomorrow]


In many hospitals today, patients simply aren’t seen in the same light as customers in any other industry. To be fair, it’s a unique situation: Patients don’t really choose to be in a hospital; it’s something that is necessary, so they aren’t exactly a willing consumer. But what some hospitals forget is that patients today have a voice more than any other time in history. There are ratings of hospitals readily available on the Internet based on patient feedback.


In addition, Medicare now requires patients to fill out a 27-question Hospital Consumer Assessment of Healthcare Providers and Systems survey that asks patients about such things as communication with doctors, communication with nurses, responsiveness of hospital staff and communication about medicines. And the results have financial implications: Nearly $1 billion of Medicare reimbursements are contingent upon the results of the survey, as well as data on the quality of care publicly available online.


[READ: Hospitals Focus On Patient Experience Through Design]


Yet so many hospitals still consider a patient experience program a “nice to have” element, but not a necessity. Changing that perception starts with clearing up a few major misconceptions. Patient experience isn’t simply about making patients happy. It’s first about the safety and quality of the care that is being delivered, then about making sure it is done in a patient and family-centered way. Those are the things that improve a hospital’s reputation, affect patient referrals and determine whether a patient will return in the future should the need arise.


Another misconception is the idea that establishing patient experience as a priority is an onerous task that only big medical institutions can do, but it doesn’t have to be that way. The level of investment can vary based on resources, but the process is still the same. When we at the Cleveland Clinic started our patient experience journey in 2009, there was no textbook or playbook telling us how to start. We overhauled our approach to patient care and we did it through trial and error. Today, health care facilities don’t have to do that same legwork; facilities of all sizes can implement scalable programs to improve patient-centeredness.


When I look at the health care landscape, one of the biggest deficits right now as far as patient experience is lack of communication – between doctors and nurses, doctors and patients, nurses and patients, patients and support staff. Poor communication leads to lack of coordination of care delivery, which jeopardizes patient safety, results in poor outcomes, and increases health care waste.


[OPINION: How the Group Practice Model Can Save U.S. Health Care (//www.usnews.com/health-news/hospital-of-tomorrow/articles/2014/09/12/op-ed-how-the-group-practice-model-can-save-us-health-care )]


The way to help correct that is to set patient experience as a strategic priority for the hospital – and this is something that must be done by senior leadership. Having the CEO at the helm of this effort is the only way it can be successful. Only the CEO can set the culture for the institution, and it’s one that must revolve around the patient experience concept.


Improving communication also starts with defining what patient experience means for your organization and establishing certain language around it. Certainly you want to take patients’ input into account, but it’s important to not let them define it, because each will have different opinions on what it actually means. Instead, hospitals should take the lead and be aspirational, yet realistic, in what they intend to do.


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Could Popular Heartburn Drugs Upset Your 'Good' Gut Bugs?

By Randy Dotinga

HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Heartburn drugs such as Prilosec and Nexium may disrupt the makeup of bacteria in the digestive system, potentially boosting the risk of infections and other problems, a small new study suggests.


The research doesn't confirm that these changes make it more likely users will become ill, and study authors aren't recommending that anyone stop taking the so-called proton pump inhibitors.


However, these antacids "should be used at the lowest dose that provides adequate relief of symptoms, and attempts to discontinue their use should be considered periodically," said study co-author Dr. John DiBaise, professor of medicine at the Mayo Clinic in Scottsdale, Ariz.


According to Harvard Medical School, billions of dollars are spent annually on antacid drugs in an attempt to combat heartburn, ulcers and gastroesophageal reflux disease, also known as GERD. Old standbys such as Maalox and Mylanta have been supplanted by more effective, more expensive drugs, including proton pump inhibitors. These include Prevacid (lansoprazole) and Protonix (pantoprazole) in addition to Prilosec (omeprazole) and Nexium (esomeprazole).


"Despite years of safe and effective use, in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use," DiBaise said.


Long-term use of proton pump inhibitors has been linked to infection with a germ called Clostridium difficile, which causes severe diarrhea, he said. Researchers have also connected the medications to vitamin deficiencies, bone fractures and pneumonia, among other conditions.


In the new study, researchers sought to understand what happens to the trillions of germs in the digestive system when people take omeprazole, the generic name for the drug best known as Prilosec.


Ten participants, aged 18 to 57, took 20 or 40 milligrams of the drug a day for 28 days. Researchers analyzed the study participants' stool samples to understand the germs in their guts.


"These microbes have evolved with us to participate in our normal development and metabolism, and perform certain functions that we would not be able to accomplish without their help," DiBaise said. Many scientists believe that people's risk of disease goes up when their normal germ makeup changes, he said.


The researchers found evidence that the medications disrupted the balance of bacteria in the digestive systems of the participants, and the changes lasted for at least a month after they discontinued the drug. It didn't seem to matter whether they took the higher or lower dose, DiBaise said.


DiBaise cautioned that the study doesn't prove that the drug causes users to become more vulnerable to C. difficile infections. However, it shows that the drug "creates a situation in the gut microbial environment that may increase an individual's susceptibility," he said.


The researchers suggest additional research is needed with a larger group of study participants.


What should users do for now? According to DiBaise, proton pump inhibitors are "the most effective medications to treat gastroesophageal reflux disease." If patients don't have the most severe symptoms, he said, other types of heartburn drugs might help. Also recommended: eating smaller portions, losing weight, not lying down for two hours after eating, and avoiding alcohol, cigarettes and "trigger" foods.


Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School, said patients shouldn't become alarmed about "the safest class of therapy I've used in the 34 years being a doctor."


The new research won't stop him from prescribing the drugs, Johnson said, adding he's "hesitant to make too much out of this." Even so, "the key message is that patients should talk to their care provider and discuss the need for these medications and justify their continued use."


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Daily Physical Activity May Help Lower Parkinson's Risk

By Robert Preidt, HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- A moderate amount of physical activity in your daily life may reduce your risk of Parkinson's disease, according to a new study.


"We found that a medium level of daily total physical activity is associated with a lower risk of Parkinson's disease," study author Karin Wirdefeldt, of the Karolinska Institute in Stockholm, said in a news release from the journal that published her study, Brain: A Journal of Neurology.


While the study found a link between exercise and a reduced risk of Parkinson's disease, it's important to note that it wasn't designed to prove that exercise was the definitive cause of this lower risk.


The research included more than 43,000 women and men in Sweden who were followed for an average of more than 12 years. None had Parkinson's disease when they enrolled. Nearly 300 had been diagnosed with the disorder by the end of the study.


Those who got more than six hours a week of physical activity through household tasks and commuting to work had a 43 percent lower risk of Parkinson's than those who got fewer than two hours a week of such activities, the researchers found.


The researchers also noted that men with a medium level of total physical activity were 45 percent less likely to develop Parkinson's than those with a low level of total physical activity.


Leisure time exercise alone was not associated with a lower risk of Parkinson's, according to the study.


More information


The Parkinson's Disease Foundation has more about Parkinson's disease.


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Early Puberty Linked to Increased Risk of Depression in Teens

By Robert Preidt, HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- Youngsters who enter puberty early are at increased risk for depression, a new study suggests.


Early puberty was linked with a number of factors associated with depression, such as poor self-image and high anxiety levels, according to the researchers. Early puberty was also linked to social problems, such as conflict with family and peers, and having friends who were prone to getting into trouble, the study found.


Although the study found an association between early puberty and these factors, it's important to note that the study wasn't designed to show that early puberty was the cause of these issues.


"Only some teens are vulnerable to the effects of early maturation, particularly those with more disruption in their families and less support in their peer relationships," study leader Karen Rudolph, a psychology professor at the University of Illinois, said in a university news release.


The study also found that early puberty was associated with an increased risk of depression in boys as well as girls.


"It is often believed that going through puberty earlier than peers only contributes to depression in girls," Rudolph said. "We found that early maturation can also be a risk for boys as they progress through adolescence, but the timing is different than in girls," she added.


"In girls, early maturation seems to trigger immediate psychological and environmental risks and consequent depression," Rudolph said. "Pubertal changes cause early maturing girls to feel badly about themselves, cope less effectively with social problems, affiliate with deviant peers, enter riskier and more stressful social contexts and experience disruption and conflict within their relationships."


Initially, boys who entered puberty early had much lower rates of depression than girls, but had similar rates by the end of the study's fourth year.


"While early maturation seemed to protect boys from the challenges of puberty initially, boys experienced an emerging cascade of personal and contextual risks -- negative self-image, anxiety, social problems and interpersonal stress -- that eventuated in depression as they moved through adolescence," Rudolph said.


The study followed 160 youth for four years. It was published online in the journal Development and Psychopathology.


More information


The American Academy of Family Physicians has more about depression in children and teens.


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ER Visits on the Rise, Study Reports

By Robert Preidt, HealthDay Reporter



TUESDAY, Nov. 25, 2014 (HealthDay News) -- The number of emergency department visits in the United States rose from about 130 million in 2010 to a record 136 million in 2011, according to the U.S. Centers for Disease Control and Prevention.


The findings also showed that fewer people were going to ERs with non-urgent medical needs: 96 percent of patients were identified as needing medical care within two hours of arriving at the ER. In 2010, that number was 92 percent, according to the research.


Sixty percent of patients arrived at the ER after normal business hours (after 5 p.m. on weekdays). One-third of visits were for patients on either end of the age spectrum -- younger than 15 or older than 65, the researchers found.


Almost 30 percent of visits were for injuries. The highest injury rates were among patients 75 and older, the study noted.


"The report also finds that there are large numbers of admitted patients who wait long times for inpatient beds," Dr. Michael Gerardi, president of the American College of Emergency Physicians (ACEP), said in an ACEP news release.


"Nearly two-thirds of patients waited two or more hours for beds in 2011, and nearly three-quarters of hospitals continued to board patients, even when the emergency department was critically overloaded. Hospitals must move admitted patients out of the emergency department faster to make room for the increasing number of people coming," he said.


It's believed that there will be about 140 million ER visits in 2014, according to the ACEP.


"The growth in patient demand aligns with what emergency physicians have been seeing and predicting: demand is going to increase," Gerardi said.


"Given that our nation's population is aging, and emergency departments have a critical role as the front line of responding to disasters and infectious disease outbreaks in America, such as what we saw with Ebola, we need to prepare for increased numbers of patients," he added.


Despite increasing use of ERs, most hospitals had not expanded their ERs as of 2011 and had no plans to expand them in the following two years, according to Gerardi.


"Emergency departments are essential to every community and must have adequate resources," he said. "They continue to be under severe stress and face soaring demands, despite the efficiency of caring for more than 136 million of the sickest patients each year using only 4 percent of the nation's health care dollar. This report is more evidence that we are going to need more resources, not less, in the future."


More information


The U.S. National Library of Medicine has more about emergency medical services.


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