jueves, 31 de mayo de 2012

They're Cute, But Baby Chicks Can Harbor Salmonella: MedlinePlus

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They're Cute, But Baby Chicks Can Harbor Salmonella

CDC traces multistate outbreak, says children under 5 shouldn't handle live young poultry

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125720.html

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WEDNESDAY, May 30 (HealthDay News) -- Few things are harder for a youngster to resist touching than a cuddly baby chick. But a new U.S. government study has bad news for parents -- those adorable little chicks may harbor salmonella bacteria.
The study found that 316 people, primarily young children, from 43 U.S. states had been infected with salmonella after handling young live poultry.
"This was an eight-year investigation into an outbreak of Salmonella Montevideo that was linked primarily to one mail-order hatchery in the U.S.," said study co-author Casey Barton Behravesh, a veterinary epidemiologist with the U.S. Centers for Disease Control and Prevention. "We were able to work with the hatchery, and after the intervention, the number of human infections declined. This is a success story," she added.
The study's findings are published in the May 31 issue of the New England Journal of Medicine.
Salmonella causes more than 42,000 reported infections each year, according to the CDC. But, because many people never report milder infections with the bacteria, the CDC estimates that the actual number of infections may be as much as 29 times higher than that. About 370 people die each year because of salmonella, according to background information in the study.
Children, especially those younger than 5 years, are at greatest risk of salmonella infection. The elderly, pregnant women and those with compromised immune systems also have a higher risk of getting sick from salmonella, according to the CDC.
Diarrhea, fever and abdominal cramping are common signs of salmonella infection. Most people get better on their own, but some people develop a more serious infection and need to be hospitalized.
Live poultry infected with salmonella generally appear healthy, but can still spread the bacteria to their offspring. About 50 million live poultry (chicks, goslings and ducks) are sold through mail order in the United States each year. These animals can usually be purchased for $5 or less at agricultural feed stores or through the mail.
Barton Behravesh said people who keep chickens in their yards at home can be exposed when collecting eggs or cleaning up the chicken coop. Children in schools that hatch baby chicks as part of their curriculum may also be exposed.
The CDC was alerted to this outbreak in 2005 by the state of Colorado. It had three infections with the same unusual strain of salmonella, called Salmonella Montevideo. All three reported exposure to baby chicks and ducks.
The CDC eventually found a total of 316 people -- half of them under 4 years old -- who had been infected with this particular strain. Twenty-three percent of those the CDC was able to interview were hospitalized. No deaths were reported.
Seventy-seven percent reported they'd had contact with live young poultry in the week before the illness. The researchers then traced the poultry back to their source, which turned out to be a single mail-order hatchery for most of those infected.
The owners of the hatchery implicated in many of the infections voluntarily replaced old equipment and implemented new cleaning and vaccination procedures, and began testing for salmonella. After initial success, Barton Behravesh said a lapse in the new procedures led to increased salmonella at the hatchery. But, she said, the hatchery is now back on track.
Because this wasn't the only hatchery linked to salmonella outbreaks in the nation, the CDC recommends that children under 5 not handle live poultry.
Dr. Lorry Rubin, director of pediatric infectious diseases at Cohen Children's Medical Center of New York, in New Hyde Park, agreed with that recommendation. "The younger the child, the more difficult it is to ensure compliance with hand-washing," Rubin said. "It's reasonable to have a prohibition on handling live poultry in children under 5 or 6. Older children and adults should be educated in proper hand-washing hygiene."
Small turtles are also known to harbor salmonella, and their sale was banned three decades ago in the United States, but some people still have them as pets. In February, the CDC reported on a multistate salmonella outbreak involving turtles in 2010-2011.
Dwarf frogs, iguanas and other reptiles can carry salmonella, too.
"It's important for parents to be aware of the risks. There is so much education and enrichment that comes from interacting with animals. But animals can carry germs that can make children sick," said Barton Behravesh.
Both experts said if you or your children do touch animals or reptiles, wash your hands thoroughly after doing so. If you can't get to a sink, use an alcohol-based sanitizer until you have an opportunity to wash your hands.

SOURCES: Casey Barton Behravesh, D.V.M., Dr.P.H., veterinary epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta, Ga.; Lorry Rubin, M.D., director, pediatric infectious diseases, Cohen Children's Medical Center of New York, New Hyde Park, N.Y.; May 31, 2012, New England Journal of Medicine

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Pre-op Treatments Boost Survival for Esophageal Cancer Patients: Study: MedlinePlus

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Pre-op Treatments Boost Survival for Esophageal Cancer Patients: Study

Experts say adding chemo, radiation before surgery is now standard treatment for most with the disease

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125721.html
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WEDNESDAY, May 30 (HealthDay News) -- Patients with esophageal cancer who receive chemotherapy and radiation before surgery have better outcomes, Dutch researchers report.
"We think that patients with esophageal cancer have the best chance to survive this cancer when they are treated with preoperative chemo-radiotherapy followed by surgery," said lead researcher Dr. Ate van der Gaast, from the medical oncology department at Erasmus University Hospital in Rotterdam. "By giving preoperative chemo-radiotherapy, more patients are cured than with surgery alone."
In the United States, more than 17,000 people will be diagnosed with esophageal cancer and more than 15,000 will die from it this year, according to the American Cancer Society.
For the study, published in the May 31 issue of the New England Journal of Medicine, the Dutch team randomly assigned nearly 400 people with esophageal cancer either to surgery alone or chemotherapy and radiation before surgery.
The researchers found patients who received chemotherapy before surgery lived an average of four years, while those who went straight to surgery lived an average of two years. More patients in the chemotherapy group had a complete response to treatment and had more of the cancer removed during surgery than those who had surgery alone, the team also noted.
Complications after surgery were similar in both groups, and 4 percent of patients in each group died in the hospital after the procedure, the researchers added.
Dr. Raja Flores, chief of thoracic surgery at Mount Sinai Hospital in New York City, said "these findings were what everyone expected, but not to the degree it came out."
With esophageal cancer, removing the cancer from the area around the tumor is key to treatment. Chemotherapy and radiation is performed before surgery to help contain the cancer so more of it can be removed during the operation, Flores explained.
This approach is becoming standard therapy, he said, "but this study gives the proof positive that that's the way it should go."
Flores said although the treatment adds initial cost, it can save money. "If it leads to more cures, it's going to save money," he said.
Patients need to make sure this approach is discussed with them "so they just don't run straight to surgery," Flores said.
Dr. Harvey Mamon is clinical director of the department of radiation oncology at Brigham and Women's Hospital and Dana Farber Cancer Institute in Boston. He said: "This is an important and well-done study that will influence practice patterns. For all intents and purposes, the standard of care for locally advanced esophageal cancer was already preoperative chemo-radiation followed by surgery."
The significant improvement in the chemo-radiation portion in this trial confirms this current standard of care, he said. "I don't think we're likely to see further trials of surgery alone versus surgery following chemo-radiation."

SOURCES: Ate van der Gaast, M.D., Ph.D., medical oncology, Erasmus University Hospital, the Netherlands; Raja Flores, M.D., chief of thoracic surgery, Mount Sinai Hospital, New York City; Harvey Mamon M.D., Ph.D., clinical director, department of radiation oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, associate professor, radiation oncology, Harvard Medical School, Boston; May 31, 2012, New England Journal of Medicine

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More Families Seek Kidney Donations on Facebook: MedlinePlus

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More Families Seek Kidney Donations on Facebook

Researchers unsure if social media is a safe, effective route to finding donors

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125719.html
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By Robert Preidt

Wednesday, May 30, 2012

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WEDNESDAY, May 30 (HealthDay News) -- More patients and families are using Facebook to seek kidney donations, but it's not clear if doing do improves the chances of obtaining a donor organ, a new study finds.

Researchers from Loyola University Medical Center in Maywood, Ill., examined 91 Facebook pages that were seeking kidney donations for patients aged 2 to 69 and found that 12 percent of the pages reported receiving a kidney transplant and 30 percent reported that potential donors had come forward to be tested for compatibility.

One page reported that more than 600 people had been tested as potential donors for a child, according to the study recently presented at a meeting of the National Kidney Foundation.

On kidney solicitation pages where identities could be determined, the researchers found that 37 percent of the pages were created by patients, 31 percent by patient's children, and 32 percent by other family members or friends of patients.

There was wide variation in the amount of personal information revealed on the pages. Some pages simply asked people to donate, without providing any other information. Other patients offered extensive details about patients who needed kidneys, including medical history, family photos and emotional stories about hospital stays, emergency room visits, financial problems and the difficulties of living on dialysis.

White patients and those with more than 50 posts by other people were most likely to succeed in having people agree to be tested to determine if they were compatible to donate a kidney, said kidney specialist Dr. Alexander Chang, a nephrology fellow at Loyola University Chicago Stritch School of Medicine, and colleagues.

They noted a number of ethical concerns. Three percent of the pages received offers to sell kidneys, mostly from people in Third World countries. Would-be donors typically asked for $30,000 to $40,000. Selling organs is illegal.

Only 5 percent of the pages seeking donations mentioned the risks of kidney donations, and only 11 percent mentioned the associated costs.

"Use of social media could be an effective way to solicit kidney donation, but more study is needed to determine how to do this safely and with enough knowledge to make informed decisions," Chang said in a Loyola news release.

SOURCE: Loyola University Medical Center, news release, May 28, 2012

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Obesity May Raise Odds for Painful Leg Condition: MedlinePlus

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Obesity May Raise Odds for Painful Leg Condition

Excess weight can lead to fluid backup called lymphedema

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125723.html
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Wednesday, May 30, 2012

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WEDNESDAY, May 30 (HealthDay News) -- The health risks associated with being overweight and obese are well publicized, but new research may add another condition to this list: leg lymphedema, pain and swelling due to blockage of the lymph nodes in the groin area.
Lymphedema in the arms traditionally is associated with breast cancer surgery that involves removal of or damage to the lymph nodes. A blockage in the lymphatic system can prevent proper drainage of lymph fluid. As fluid builds up, pain and swelling can occur.
In a letter published in the May 31 issue of the New England Journal of Medicine, Dr. Arin Greene and colleagues at Children's Hospital Boston reported on 15 obese individuals with swelling in both legs. They diagnosed five of these individuals with leg lymphedema, and the cause of the condition was obesity.
"We now believe that obesity is a risk factor for lymphedema if the body-mass index becomes greater than 60," Greene said. "It only seems to affect the legs, but we have not investigated the arms."
Individuals in the study who had a body-mass index (BMI) lower than 54 had normal lymphatic function. The average BMI of the patients with lymphedema was 70; BMI of 30 or greater is considered obese. BMI is a measure of body fat based on an individual's height and weight.
Other risk factors for leg lymphedema include injury to the lymph nodes in the groin because of infection, surgery or radiation. In addition, people can be born with the condition. Regardless of the cause, leg lymphedema can cause pain, swelling and infections.
Although there is no cure for lymphedema, compression and significant weight loss may help relieve the pain and swelling, Greene said.
Lymphedema in the legs manifests itself as swelling, pain, discomfort, tightness in the skin, decreased flexibility and difficulty walking, said Cathy Kleinman-Barnett, a lymphedema specialist at the Lymphedema/Edema Management Program at Northwest Medical Center in Margate, Fla.
"Obesity causes lymphedema because the sheer additional weight puts too much pressure on the lymph nodes in the groin area, compromising the system," she said. "This causes a fluid backup like a clogged drain. Skin can thicken, harden and become red, dry and warm to touch."
It's important to treat the condition, she added, because "it can really interfere with a person's quality of life in a physical and a psychosocial way as people may be less inclined to go out and interact with others."
Kleinman-Barnett said lymphedema therapists can prescribe a program of manual lymphatic drainage, which helps direct lymph flow out of the congested areas. Recommendations on skin care, compression bandaging and exercises also can help, she said.
More than 35 percent of U.S. adults are obese, according to the Centers for Disease Control and Prevention. Obesity already is known to increase the risk of heart disease, diabetes, arthritis and certain types of cancer.

SOURCES: Cathy Kleinman-Barnett, lymphedema specialist, Lymphedema/Edema Management Program, Northwest Medical Center, Margate, Fla.; Arin Greene, M.D., Children's Hospital, Boston; May 31, 2012, New England Journal of Medicine

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Humans Can Sniff Out Old Age in Others, Study Shows: MedlinePlus

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Humans Can Sniff Out Old Age in Others, Study Shows

And coming from the healthy elderly, the odor isn't unsettling, participants said

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125724.html
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Wednesday, May 30, 2012

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Taste and Smell Disorders

WEDNESDAY, May 30 (HealthDay News) -- How old do you think you smell? A new study suggests that humans possess the ability to judge whether a person has reached their senior years just by sniffing their body odor.
People in the study correctly gauged whether the former wearer of an underarm pad was elderly or not just by sniffing it. And for the record, most didn't think "old-people smell" was off-putting at all.
The finding "shows that there's yet another signal hidden in the body odor that we are somehow able to extract and make use of," said study co-author Johan Lundstrom, an assistant professor at the Monell Chemical Senses Center, in Philadelphia.
As for the notion that "old-people smell" doesn't leave people as disgusted as you might expect, Lundstrom said the odor's power -- or lack thereof -- appears to have a lot to do with whether the elderly are actually physically present. "Lacking a context, the negativity of the body odors disappear," he said.
The study authors launched their research as part of an effort to better understand the chemical signals that people detect in body odor. Previous research had suggested that we can pick up signs of sickness in other people's body odor and even get a sense of whether someone is related to us, Lundstrom said.
Animals appear to be able to detect age through body odor, he said, although it's not clear why it might matter to them. One theory is that the signal could let other animals know that an animal is older and thus more likely to produce offspring because it's managed to stay alive so long, he said.
In the new study, 56 people -- 20 young (20 to 30 years old), 20 middle-aged (45 to 55), and 16 elderly (75 to 95) -- wore clean T-shirts and underarm pads while sleeping. The pads soaked up a sample of each individual's body odor.
The researchers then asked 41 young people to smell the resulting odors -- from pads kept in glass jars -- and try to tell them apart.
Participants were generally able to discriminate between the age groups, but they weren't much better at it than chance, Lundstrom said. However, they were able to do a better job of grouping together body odors from older people and identifying them as coming from the elderly.
"The old-age body odor sticks out," Lundstrom said, but it didn't do so in a negative way. In fact, the subjects tended to think the old age body odors were more pleasant and less intense than those of other age groups.
One factor might explain that: Older men smell more like women, possibly because they've lost testosterone, Lundstrom said.
He also noted that the people who provided their body odor for the study were healthy. That means the older people did not suffer from problems that can occur among seniors that might affect their body odors, such as incontinence.
The "popular prejudice" against the odor of the elderly probably reflects people's distaste for odors in geriatric wards and nursing homes, noted one expert, Tim Jacob, a professor of biosciences at Cardiff University, in England, who studies smell and is familiar with the new study's findings.
"This is obviously an unfair association," he said. "But if people know where the smell originates [that is, in an older person], they may be unconsciously or consciously prejudiced. In this study they did not know where the smell originated."
So how might people be able to detect old age through smell? It's not clear, Lundstrom said. One possibility is that we're not detecting old age specifically, but instead a signal that "piggybacks" on chemical signs of disease in the elderly, he said.
In the big picture, "given the research showing the importance of the olfactory -- smell -- system among other animal species, it is likely that humans possess similar capabilities that we don't yet fully understand, yet influence our behavior more than we realize," said Elizabeth Krusemark, a smell researcher and postdoctoral fellow at the University of Wisconsin Madison's Cognitive and Affective Neuroscience Lab.

The study appears in the May issue of PLoS One.

SOURCES: Johan Lundstrom, Ph.D, assistant professor, Monell Chemical Senses Center, Philadelphia; Tim Jacob, Ph.D., professor, School of Biosciences, Cardiff University, U.K.; Elizabeth Krusemark, Ph.D., postdoctoral fellow, Cognitive and Affective Neuroscience Lab, University of Wisconsin at Madison. May 2012 PLoS ONE

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Once-Obese Women Still Face Stigma, Study Finds: MedlinePlus

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Once-Obese Women Still Face Stigma, Study Finds

'Fat bias' may linger even after weight loss

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125709.html
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Wednesday, May 30, 2012

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WEDNESDAY, May 30 (HealthDay News) -- Even after they shed their excess pounds, formerly obese women still have to contend with "anti-fat prejudice," according to a new study.
Researchers asked young women and men to read about women who had either lost 70 pounds of excess weight or had stayed the same weight (weight-stable), and who were either currently obese or currently thin.
The participants were then asked about some of the women's attributes, including their attractiveness.
"We were surprised to find that currently thin women were viewed differently depending on their weight history," study leader Janet Latner, of the University of Hawaii at Manoa, said in a news release from the University of Manchester, in England. "Those who had been obese in the past were perceived as less attractive than those who had always been thin, despite having identical height and weight."
The participants also showed greater bias against obese people after they had read about women who had lost weight, compared to after reading about weight-stable women -- regardless of whether the weight-stable women were thin or obese.
The findings, published May 29 in the journal Obesity, suggest that the stigma of obesity is so powerful that it can continue even after an obese person has lost weight.
The researchers said they were particularly troubled by the finding that participants' negative attitudes towards obese people increased when they were falsely told that body weight is easily controlled.
"The message we often hear from society is that weight is highly controllable, but the best science in the obesity field at the moment suggests that one's physiology and genetics, as well as the food environment, are the really big players in one's weight status and weight loss," study co-author Kerry O'Brien, from the University of Manchester School of Psychological Sciences and Monash University in Melbourne, in Australia, noted in the news release.
"Weight status actually appears rather uncontrollable, regardless of one's willpower, knowledge and dedication. Yet many people who are perceived as 'fat' are struggling in vain to lose weight in order to escape this painful social stigma. We need to rethink our approaches to, and views of, weight and obesity," O'Brien noted.

SOURCE: University of Manchester, news release, May 29, 2012

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Infant 'Smarts' Similar With Different Types of Formula: Study: MedlinePlus

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Infant 'Smarts' Similar With Different Types of Formula: Study

But breast-fed babies score slightly higher than those on soy or cow's milk formulas

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125710.html
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WEDNESDAY, May 30 (HealthDay News) -- Babies who are fed soy formula do as well as babies drinking cow's milk formula on tests of mental ability in the first year of life, a new study finds. But breast-fed babies score slightly higher than infants on either type of formula, the researchers say.
About 20 percent of formula-fed babies in the United States are on soy formula, often because their mothers cannot breast-feed and they are allergic to cow's milk formula.
"Our study is very important because it shows that the growth and development of children in the U.S. who are fed soy formula is the same as children who are fed milk formulas," said Thomas Badger, professor of pediatrics at the University of Arkansas for Medical Sciences and lead investigator of the study.
Badger and his colleagues have looked at the effects of soy components in animal studies and found negative and positive effects, such as less weight gain. In particular, they were concerned that one of the chemicals in soy that can act like estrogen could alter brain development and function in babies.
The researchers did find a difference in brain development between breast-fed babies and those on cow's milk or soy formula, but it was so small that it will probably not affect long-term ability, Badger said. "I don't think parents should be worried at all if their kids are on formula."
Another expert agreed.
"This study should be a great relief to people who have been using soy formula," said Dr. Ruth Lawrence, medical director of the Breastfeeding and Human Lactation Study Center at the University of Rochester Medical Center, who was not involved in the study.
"[But] you really have to see what the babies do when they have to learn to read and do social things," Lawrence said. Badger and his colleagues will test the babies in the study when they are 6 years old to see if there are differences in test scores or behavior later in life.
"I would expect that at 6 years you will see a wider spread between human milk and formula [groups]," Lawrence said. Previous research has found that people who were breast-fed do better all the way up through high school than those who were fed cow's milk formulas, she added.
The benefit of mother's milk probably comes both from nutritional differences as well as the act of breast-feeding, Lawrence said. "There are a lot of items in human milk, and the formula companies take all these synthetic chemicals and dump them into [cow's] milk and it is not the same," she said.
The study, published online May 28, appears in the June print issue of the journal Pediatrics.
Another study published in the same issue found that supplementing cow's milk formula with one of the nutrients found in mother's milk -- long-chain fatty acids -- was not associated with better mental scores in babies.
For that study, researchers at Yale University analyzed 12 previous studies involving about 1,800 infants that looked at the effects of supplementation with the fatty acids DHA (docosahexaenoic acid) and arachidonic acid, which are important for brain development. Cow's milk normally contains a different profile of fatty acids than human milk, Lawrence said.
The fact that this analysis did not find a benefit of fatty acid supplementation on mental development "poses an interesting question of whether formula companies should stop adding it, because it costs money," Lawrence said.
"We know it is probably nutritionally good," Lawrence said. Similar to the findings of Badger's study, there might be a difference in mental ability associated with supplementation in babies after 6 or 12 years, she added.
The study by Badger and his colleagues involved 131 breast-fed babies, 131 babies on cow's milk formula and 129 babies on soy formula.
Of the breast-fed babies, about half got only breast milk for their first year, along with solid food starting at about 6 months, and the other half were fed cow's milk formula, either exclusively or along with breast milk and solid food, after they were 6 months old. Most of the babies in the formula groups were fed breast milk for some of their first two months.
The researchers tested the babies' mental and motor skills and language ability at 3, 6, 9 and 12 months of age.
The researchers found that the breast-fed babies scored better than babies who were fed cow's milk formula at 9 and 12 months and better than babies on soy milk at 6, 9 and 12 months. When the researchers divided the babies into groups based on their mental test scores, they found that breast-fed babies were more likely to be in the top 20th percentile and formula-fed infants were more likely to be in the bottom 20th percentile.
"[However], all these kids are in the top half of the normal range," Badger said. "I think this is such a small component, and genetics and environment will make the big difference."
He added that the solid food some of the babies started eating at around 6 months could also have affected their scores, but the group has not taken into account this aspect of their diet yet. The group did adjust for factors including mother's age, IQ and economic status.
The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months followed by a combination of breast-feeding and solid foods until at least 1 year of age.
A mom who cannot breast-feed might achieve some of the benefits by holding her baby close to her chest when she is bottle-feeding so the infant can make eye contact with her and hear her heartbeat, Lawrence said.
Badger is on the Science Advisory Board of the Soy Nutrition Institute and has given input to the U.S. National Institutes of Health committee on soy formula. The Soy Nutrition Institute did not contribute to the current study.

SOURCES: Thomas Badger, Ph.D., professor, pediatrics, physiology/biophysics, director, Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Ark.; Ruth Lawrence, M.D., professor, pediatrics, obstetrics and gynecology, medical director, Breastfeeding and Human Lactation Study Center, University of Rochester School of Medicine, Rochester, N.Y.; June 2012, Pediatrics

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Could Bloodletting Ease Heart Risks for the Obese?: MedlinePlus

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Could Bloodletting Ease Heart Risks for the Obese?

Small study backs long-abandoned practice, but one cardiologist says there are far better, modern treatments

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125708.html
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By Robert Preidt

Wednesday, May 30, 2012

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WEDNESDAY, May 30 (HealthDay News) -- The ancient medical practice of bloodletting may benefit obese people with metabolic syndrome, a small new study suggests.
Metabolic syndrome is a group of conditions -- including abdominal obesity, high triglycerides (a type of fat found in the blood), high fasting blood sugar levels and high blood pressure -- that increase the risk of diabetes and heart disease.
Bloodletting was common throughout history but was abandoned in the 19th century when it was determined that it had little or no effect on most diseases. But this study by German researchers found that two sessions of blood donation improved blood pressure and markers of cardiovascular disease in obese patients with metabolic syndrome.
In the study, 64 patients were divided into two groups. One group donated 300 milliliters (ml) of blood at the start of the study and between 250 and 500 ml four weeks later. One group didn't donate blood.
Six weeks after the second blood donation -- which allowed sufficient time for the body to generate new blood and return blood volume to normal -- systolic blood pressure (the top number in a reading) among those who donated fell from an average of 148 mmHg to 130 mmHg.
They also had reductions in blood sugar levels and heart rate, and an improvement in cholesterol levels.
The study is in the May 30 issue of the journal BMC Medicine.
Blood donation is known to reduce levels of iron stores in the body. Prior research has found that an accumulation of iron in the body is associated with high blood pressure and diabetes, according to researchers.
"Blood donation may prevent not just diabetes but also cardiovascular disease for the obese," study leader Professor Andreas Michalsen from the Charité-University Medical Centre, in Berlin, said in a journal news release.
But another expert isn't convinced the findings support a bloodletting Renaissance. It's true that excessive iron can worsen high blood pressure and diabetes, so it's a good idea for anyone with those conditions to make sure they're not unnecessarily boosting their levels by taking an iron supplement or multivitamin containing iron, said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City.
"With the advent of diet and exercise and medications, we should probably leave this practice of bloodletting to the 19th century, at which time the practice was abandoned," Steinbaum said. "Clearly there are alternative ways to manage these issues."

SOURCE: Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City; BMC Medicine, news release, May 30, 2012

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Digital records show no effect on diabetes care: MedlinePlus

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Digital records show no effect on diabetes care

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125739.html
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Wednesday, May 30, 2012

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By Amy Norton
NEW YORK (Reuters Health) - Electronic health records have been held up as a way to improve medical care, but a new study suggests they are not necessarily making a difference in diabetes treatment.

The study, of 42 physician practices in two U.S. states, found offices that used electronic records actually gave lower-quality diabetes care than those that stuck with old-fashioned paper records.

On the bright side, diabetes management actually improved across all the practices over the course of the study period. But offices using electronic records lagged.

The findings highlight the fact that switching from paper to e-records, alone, is not enough, according to lead researcher Jesse C. Crosson, an assistant professor at the UMDNJ-Robert Wood Johnson Medical School in Somerset, New Jersey.

"Just having these records doesn't mean they're being used in a meaningful way," Crosson said in an interview.

More needs to be done, he said, to help medical practices translate electronic records into better care.
The study, which appears in the Annals of Family Medicine, adds to others showing that digital records do not magically improve medical care on their own.

Electronic records have been part of a push to improve healthcare quality and cut costs. That's because digital records can, among other things, allow doctors, hospitals and other providers to communicate more easily -- with the goal of preventing errors and making sure patients get the tests and treatments they need.

Some electronic systems also have "decision support" software that gives doctors tips on how to best treat individual patients.

The U.S. Congress authorized up to $27 billion in government incentives to get doctors and hospitals to switch to "meaningful use" of health information technology. And by 2015, providers will face penalties if they don't switch.

"Meaningful use" means steps like having up-to-date medication lists for each patient, electronically prescribing drugs, and giving patients electronic copies of their health records if they request.
But so far, studies on the impact of electronic records have been mixed.

There's some evidence that going digital may help cut down on unnecessary tests -- but that benefit may be limited to larger doctor-hospital networks using the most-advanced electronic systems.

And it's not clear how much of an effect e-records have had on overall quality of care.

For the new study, Crosson's team focused on diabetes care at 42 medical practices in Pennsylvania and New Jersey, 16 of which had switched to electronic records.

They measured patients' quality of care by looking at how many were getting recommended tests, including regular blood sugar, blood pressure and cholesterol checks -- and, if necessary, medication to rein in high numbers.

Over a total of three years, the study found, quality of care generally improved.

At the outset, 44 percent of all patients were meeting treatment guidelines, for example. That had improved to 52 percent at the two-year mark.

But offices using paper records actually did a little better. In those practices, 61 percent of diabetes patients were getting recommended tests two years into the study. That figure was 51 percent among practices using electronic records.

It's not clear why the gap existed, according to Crosson.

He said they had no information on the specific features of the electronic systems offices were using. So it's not possible to say whether certain systems or software features are more effective than others.

But Crosson also pointed to the human element: doctors and their staffs need to shift their mindsets, as well as their records systems. "There needs to be a change in the way doctors think about the delivery of care," Crosson said.

That might include having someone on staff who calls patients with chronic conditions, like diabetes, to "check in to see how they are doing," he said.

The study does have limitations, Crosson's team points out. One is that the data were collected between 2004 and 2006 -- and the systems used right now in many doctors' offices may be different.

Electronic records are not the only quality-improvement measure that researchers and policymakers are considering. Information from patients' e-records can also be used in so-called "pay-for-performance" plans.

Those plans offer financial incentives to doctors who achieve certain goals that are known to improve patients' health, reduce errors or save money.

Some governments, in Canada and the UK, for example, have tested pay-for-performance plans -- as have some doctor-hospital networks in the U.S.

But a study published last month found that an Ontario program seemed to have made no impact on diabetes patients' quality of care.

Another new study, also in the Annals of Family Medicine, points to similar results in the UK. Looking at 29 family practices in London, researchers found that pay-for-performance incentives have had little impact on long-standing racial disparities in diabetes care.

According to the researchers, that all suggests broad policy shifts are, by themselves, insufficient. More "targeted" steps also seem necessary, they say.

For now, Crosson said, people with diabetes -- or other chronic conditions -- should not assume they are getting top-notch care simply because their doctor's office has gone digital.

"Even if they are using electronic records, things may still be falling through the cracks," Crosson said.
He suggested that people find out what types of tests and treatments are guideline-recommended for their particular health problem. If you have diabetes, one source would be the American Diabetes Association, he said.

Another good source, Crosson noted, is the U.S. Preventive Services Task Force -- an expert panel that makes testing recommendations on a variety of health conditions.

SOURCE: http://bit.ly/LsQquX and http://bit.ly/KtMBss Annals of Family Medicine, May/June 2012.

Reuters Health

More Health News on:: Diabetes; Personal Health Records

Stress and Memory Problems in Breast Cancer Patients

Article date: May 30, 2012

By Stacy Simon
Breast cancer survivors – and other cancer survivors, too – have long known that one of the side effects of chemotherapy seems to be a mental cloudiness that interferes with the ability to think clearly, remember details, and pay attention. There is even a nickname, “chemo brain,” that some doctors and patients use to refer to this condition. But chemo is not the only thing that can cause problems with thinking and memory for people with cancer. Researchers at the University of Missouri have found evidence that stress also plays a role in cognitive problems in breast cancer patients.
The researchers examined 36 women who had undergone surgery for breast cancer, but had not yet received other treatments that could contribute to chemo brain, like chemotherapy or hormone therapy. The women completed tests of their cognitive function and questionnaires about their coping styles and levels of stress. The patients who reported higher symptoms of stress and had ineffective coping strategies, including denial, disengagement, and helplessness, were more likely to experience cognitive problems. Depending on the task, from 14% to 17% of the women had problems with the memory tests. From 11% to 27% had problems with the word and language tests.
The study was published in the Journal for Clinical Psychology in Medical Settings.

The role of stress

The researchers discussed two theories of the relationship between stress and cognitive functioning. One theory speculates that people have only a limited amount of energy to spend on behaviors requiring self-control, such as making decisions, paying attention, and controlling emotions. According to this theory, using too much energy for one task, such as coping with a cancer diagnosis, leaves less energy for other tasks or behaviors.
The other theory focuses on physiological changes in the body in response to stress. It says the body responds to stress by releasing hormones such as cortisol. In the brain, cortisol interferes with the function of neurotransmitters, the chemicals that brain cells use to communicate with each other. Excessive stress hormone levels can make it difficult to think or retrieve long-term memories.
Lead researcher Stephanie Reid-Arndt, PhD, ABPP, said often, women receive a breast cancer diagnosis and immediately begin treatment without having much time to emotionally prepare. She said health care providers should identify patients who are experiencing psychological stress and offer effective ways to manage it.
Reid-Arndt said, "Teaching patients proactive ways to deal with stress can help them improve their quality of life as well as maintain their cognitive function."

Ways to cope

Reid-Arndt said it’s also up to women themselves to bring their symptoms to the attention of their health care team. But she said often the women may not know what to think about the cognitive changes they’re experiencing and may not realize they should report it.
She said there are many different possibilities for women to effectively cope with stress, so each person can be encouraged to find what works best for her. Often she encourages people to think back to other stressful times in their lives to see if they can identify coping strategies that worked previously. Some of the strategies that have worked for her patients include:

Regular exercise (including walking, joining a fitness club or group)
“Alternative” therapies (including Tai Chi, yoga, mindfulness-based stress reduction)
Regularly engaging in enjoyable activities (e.g., time with family, friends)
Joining a support group and/or getting involved with others who have also dealt with cancer
Participating in individual psychotherapy

The American Cancer Society’s online support networks include WhatNext , Cancer Survivors Network, and Circle Of Sharing. WhatNext emphasizes the treatment journey, while Cancer Survivors Network is more focused on emotional support. Circle Of Sharing customizes cancer information that users can share and creates a Personal Health Record.
For people with memory problems, the American Cancer Society offers tips that include keeping lists, exercising your brain with puzzles and games, getting physical exercise, eating lots of fruits and vegetables, sleeping and resting, and asking for help from family, friends, and your medical team.
Reid-Arndt said, “As a result of advances in screening procedures and in treatment, women diagnosed with breast cancer are living longer than ever before. This has allowed us to turn our attention to the goal of improving quality of life following cancer diagnosis and treatment. In addition to other consequences of treatment that are known to affect quality of life (e.g., fatigue, body image issues, lymphedema), our research has suggested that cognitive deficits also negatively influence quality of life among persons with a history of breast cancer. To help us minimize the occurrence of these difficulties, and to determine possible interventions, more information on potential causes is needed.”
Reviewed by: Members of the ACS Medical Content Staff

Odds of quitting smoking affected by genetics, May 30, 2012 News Release - National Institutes of Health (NIH)

National Institute on Drug Abuse (NIDA)

For Immediate Release
Wednesday, May 30, 2012

Contact:
NIDA Press Office
301-443-6245

Odds of quitting smoking affected by genetics

NIH-funded research shows genetics can predict success of smoking cessation and need for medications

Genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success, according to research published in today's American Journal of Psychiatry. Researchers say the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.
The study was supported by multiple components of the National Institutes of Health, including the National Institute on Drug Abuse (NIDA), the National Human Genome Research Institute, the National Cancer Institute, and the Clinical and Translational Science Awards program, administered by the National Center for Advancing Translational Sciences.
“This study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly,” said NIDA Director Nora D. Volkow, M.D. “It also highlights the potential value of genetic screening in helping to identify individuals early on and reduce their risk for tobacco addiction and its related negative health consequences.”
Researchers focused on specific variations in a cluster of nicotinic receptor genes, CHRNA5-CHRNA3-CHRNB4, which prior studies have shown contribute to nicotine dependence and heavy smoking. Using data obtained from a previous study supported by the National Heart Lung and Blood Institute, researchers showed that individuals carrying the high-risk form of this gene cluster reported a 2-year delay in the median quit age compared to those with the low-risk genes. This delay was attributable to a pattern of heavier smoking among those with the high risk gene cluster. The researchers then conducted a clinical trial, which confirmed that persons with the high-risk genes were more likely to fail in their quit attempts compared to those with the low-risk genes when treated with placebo. However, medications approved for nicotine cessation (such as nicotine replacement therapies or bupropion) increased the likelihood of abstinence in the high risk groups. Those with the highest risk had a three-fold increase in their odds of being abstinent at the end of active treatment compared to placebo, indicating that these medications may be particularly beneficial for this population.
“We found that the effects of smoking cessation medications depend on a person’s genes,” said first author Li-Shiun Chen, M.D., of the Washington University School of Medicine, St. Louis. “If smokers have the risk genes, they don't quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.”
According to the Centers for Disease Control and Prevention, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Smoking or exposure to secondhand smoke results in more than 440,000 preventable deaths each year — about 1 in 5 U.S. deaths overall. Another 8.6 million live with a serious illness caused by smoking. Despite these well-documented health costs, over 46 million U.S. adults continue to smoke cigarettes.
The study can be found at: http://ajp.psychiatryonline.org/article.aspx?articleID=1169679. For information on tobacco addiction, go to: www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine. For more information on tools and resources to help quit smoking, go to: www.smokefree.gov/.
This work was partially funded by NIDA under grant numbers DA19706, DA026911, DA021237 and DA030398.
The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at http://www.drugabuse.gov/, which is now compatible with your smartphone, iPad or tablet. To order publications in English or Spanish, call NIDA’s DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at http://drugpubs.drugabuse.gov/. NIDA’s media guide can be found at http://drugabuse.gov/mediaguide/, and its new easy-to-read website can be found at http://www.easyread.drugabuse.gov/.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.

NIH...Turning Discovery Into Health

Medical Groups OK Lung Cancer Screening for Heavy Smokers

Article date: May 23, 2012

By Stacy Simon
Two medical groups have new lung screening advice for heavy smokers. The American College of Chest Physicians (ACCP) and the American Society of Clinical Oncology (ASCO) recommend that patients at greatest risk of developing lung cancer be screened with low-dose CT scans. They base the new guidelines on a review of studies that looked at low-dose CT screening.
The American Cancer Society is among the organizations that reviewed the studies, and is developing a full lung cancer screening guideline of its own. In the meantime, ACS guidance says people who think they may be at increased risk should speak with their doctors about the risks and benefits of using low-dose CT scans for the early detection of lung cancer.
The review was published online May 20, 2012 in the Journal of the American Medical Association. Researchers analyzed 21 studies of low-dose CT screening. The most significant was the National Lung Screening Trial. This study included more than 50,000 people aged 55 to 74 who were current or former smokers with at least a 30 pack-year history of smoking (equal to smoking a pack a day for 30 years, or 2 packs a day for 15 years). The study found that people who got low-dose CT had a 20% lower chance of dying from lung cancer than those who got chest x-rays. However, other trials found no benefit from screening.
The screening in the studies was done at large teaching hospitals with access to a lot of medical specialists and comprehensive follow-up care. Most were National Cancer Institute cancer centers.

Weighing risks and benefits

The idea of screening for lung cancer is appealing, because it has the potential of finding the cancer earlier, when it’s easier to treat. Symptoms don’t usually appear until the cancer is already advanced and not able to be cured. But screening carries risks that may outweigh the benefits for everyone except those at higher than average risk for lung cancer, often heavy smokers. Age is also a risk factor.
One drawback of a low-dose CT scan is that it finds a lot of abnormalities that turn out not to be cancer but that still need to be assessed to be sure. (About 1 out of 4 people in the NLST had such a finding.) This may lead to additional scans or even more-invasive tests such as needle biopsies or even surgery to remove a portion of lung in some people. A small number of people who do not have cancer or have very early stage cancer have died from these tests. There is also a risk that comes with increased exposure to radiation.
The ACCP and ASCO say annual low-dose CT scanning should be offered to people like those in the National Lung Screening Trial: smokers and former smokers who are 55 to 74 years old, and have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years. They say the screening should be done at centers or hospitals that can provide the comprehensive care received by the people in the NLST.
They are not recommending CT scanning in people who are less heavy smokers, who are younger than 55 or older than 74, or who have other serious diseases that limit their life expectancy.

Quitting is still best

The ACCP and ASCO recommendations emphasize that screening for lung cancer is not a substitute for quitting smoking. The most important thing anyone can do to prevent lung cancer is not smoke.
Besides lung cancer, tobacco use also increases the risk for cancers of the mouth, lips, nose and sinuses, voice box, throat, esophagus, stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, ovary, and acute myeloid leukemia. In the United States, tobacco use is responsible for nearly 1 in 5 deaths; this equals about 443,000 early deaths each year.
If you smoke and want help quitting, see the American Cancer Society Guide to Quitting Smoking or call us at 1-800-227-2345.
Reviewed by: Members of the ACS Medical Content Staff

Sleepy, drunken drivers equally dangerous: study

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125738.html
(*this news item will not be available after 08/28/2012)

Wednesday, May 30, 2012

Related MedlinePlus Pages

By Andrew M. Seaman
NEW YORK (Reuters Health) - Being sleepy behind the wheel is almost as bad as drinking and driving, suggests a new study from France.
The study, published as a letter in the Archives of Internal Medicine, found that drivers who were either drunk or sleepy were at least twice as likely to be responsible for a vehicle accident compared to their well-rested or sober counterparts.
Christopher Drake, an associate scientist at the Henry Ford Hospital Sleep Disorders and Research Center in Detroit, said the findings do not change what was already known, but the study is still "interesting."
"We know from experimental studies that just four hours of sleep loss will produce as much impairment as a six pack. If you have a whole night of sleep loss, that's equivalent to having a blood alcohol content of 0.19," Drake, who was not involved with the new research, told Reuters Health.
Under the direction of Dr. Nicholas Moore at the Centre Hospitalo-Universitaire de Bordeaux in France, researchers analyzed information from 679 drivers who were admitted to a hospital in southwest France for more than 24 hours because of a serious accident between 2007 and 2009.
The researchers used information from driver questionnaires and police reports to determine what may have contributed to the accidents. Drivers reported what medications they were on, their alcohol use and how sleepy they had been before the crash. Patient files provided information on blood alcohol levels.
The majority of the injured drivers were under 55 years old and men. Over half were on a motorcycle, about one-third of the drivers were in a car and 10 percent were peddling a bicycle at the time of the accident.
The police determined 355 of the drivers were responsible for their respective crash. From that, Moore and his colleagues found that being between the ages of 18 and 29 years old, driving a car, drinking alcohol and being sleepy were all tied to an increased risk of causing an accident.
Surprisingly, taking medications that carry warnings about affecting a driver's abilities -- one of the researchers' main focuses -- was tied to a lower risk of causing an accident.
Moore told Reuters Health that may be because people taking those medications are more aware of their side effects.
"Medicinal drugs might be an issue to keep an eye on and warn people about, but it's not the main issue," he said.
‘NO SUBSTITUTE FOR SLEEP'
One way for people to reduce their accident risk is to take a nap before they hit the road, according to Moore.
"Don't hesitate if you're tired to take a short nap or drink a few cups of coffee. And if you drink coffee, it will take some time to take effect," he said.
Drake added, however, that coffee's effectiveness can wear off over time.
"Anytime you're feeling sleepy behind the wheel is a danger sign," he said.
The standard techniques of turning on the air conditioner or blasting the radio only mask the signs of sleepiness -- they don't make it go away. "They're good to get you to the next exit, but it's not going to get you home," Drake said.
There are some laws in the U.S. to punish sleepy drivers, but Drake told Reuters Health they are hard to enforce unless someone gets into an accident.
"It's very difficult. There is no breathalyzer for sleepiness," he said.
The study did have some limitations. Some of the questions are based on the patients' own reports, which may be subjective. Also, there is no way to know how many accidents sleepiness actually caused.
Overall, Moore said the best advice is, "don't drink and please sleep."
"There is no substitute for sleep," said Drake.
SOURCE: http://bit.ly/KapyWp Archives of Internal Medicine, May 2012.

Reuters Health

More Health News on:: Motor Vehicle Safety; Sleep Disorders

High Blood Sugar May Make Pneumonia Deadlier: MedlinePlus

A service of the U.S. National Library of Medicine
From the National Institutes of Health

National Institutes of Health

High Blood Sugar May Make Pneumonia Deadlier

Patients with community-acquired infection plus high glucose levels need monitoring, study finds

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_125713.html
(*this news item will not be available after 08/28/2012)

By Robert Preidt

Wednesday, May 30, 2012

Related MedlinePlus Pages

WEDNESDAY, May 30 (HealthDay News) -- Elevated blood sugar levels may help predict death in pneumonia patients, researchers say.

The new study included nearly 6,900 patients, average age 60, with community-acquired pneumonia who were admitted to hospitals and private practices in Austria, Germany and Switzerland between 2003 and 2009.

Community-acquired pneumonia, one of the leading infectious diseases in industrialized nations, is a major cause of illness and death, according to background information in the study published online May 29 in the journal BMJ.

Compared to patients with normal glucose levels at admission, those with elevated levels had a higher risk of death within 28 and 90 days. The higher a patient's glucose levels, the greater the risk of death, the investigators said in a journal news release.

The death rate within 90 days was 3 percent for patients without diabetes and normal glucose levels, 10 percent for those without diabetes but with elevated glucose levels, and 14 percent for patients with diabetes, regardless of their glucose levels on admission, the study revealed.

The findings show the necessity of glucose testing and close glucose monitoring after patients with community-acquired pneumonia are discharged from hospital, in order to diagnose diabetes and to prevent further complications, concluded Dr. Philipp Lepper, of the University Hospital of Saarland in Germany, and colleagues.

SOURCE: BMJ, news release, May 29, 2012

HealthDay