Hispanic Women's Upbeat Outlook May Boost Heart Health: MedlinePlus

Hispanic Women's Upbeat Outlook May Boost Heart Health: MedlinePlus

Hispanic Women's Upbeat Outlook May Boost Heart Health

Study finds they worry less about weight, diet than whites, and have better cardiac profiles

     

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- Hispanic women tend to exercise less and fret less about their weight than white women, and their heart disease risks are also lower, a new study suggests.

Examining data from female employees of a Miami-based health system, researchers theorized that a more upbeat attitude among Hispanic women might contribute to their better cardiovascular health.

Hispanic women logged more favorable results in 10 of 12 heart conditions and risk factors -- such as high blood pressure or cholesterol -- than non-Hispanic women, according to the research, published April 29 in the journal Circulation: Cardiovascular Quality and Outcomes.

"Obviously, this group has something that is set apart," said study author Emir Veledar, a biostatistician at Baptist Health South Florida in Miami.

"There is no difference among all these women in knowledge, but in positive attitude," he added. "Hispanic women are more satisfied with their jobs and their lives. They don't think they need to get more exercise; they have good or excellent health, and they're happy with their weight."

This so-called "Hispanic paradox," Veledar said, extends to the significant gap in average life expectancies between Hispanic and white women. Female Hispanics in the United States are expected to live for 87 years, about six years longer than white females.

Heart disease is the leading cause of death for adults of both genders and all races, according to the U.S. Department of Health and Human Services. Nearly 422,000 American women die of heart disease each year.

Veledar and his colleagues studied annual health-fair and test results gathered from nearly 7,700 female employees at Baptist Health South Florida. Of those, more than half were Hispanic.

Nearly two dozen measures of cardiovascular health were examined, including blood pressure, blood sugar levels and body mass index (BMI), a ratio of weight to height. The women's knowledge of cardiovascular risk factors was assessed and they were also asked about their attitudes about their job, weight and desire for more exercise.

With equal access to health care and benefits because of their shared employment situation, the women had notably different cardiovascular risk factors. Not only did Hispanics have lower rates of type 1 diabetes, high blood pressure and high cholesterol, they reported job and life satisfaction in greater numbers, the investigators found.

More than half of both Hispanic and non-Hispanic women wished to lose weight, but that number was about 54 percent among Hispanics and nearly 60 percent among non-Hispanics. Fewer Hispanics wished to get more exercise -- less than 33 percent compared to over 37 percent, the findings showed.

Veledar said there's no way to know if a more upbeat attitude among Hispanic women has any direct relationship to their better cardiovascular risk profile, but he said all ethnicities could benefit from a "balance in attitude."

Dr. Miguel Quinones, chairman of cardiology at Houston Methodist DeBakey Heart and Vascular Center, said research has long linked lower stress levels -- which can be influenced by a positive attitude -- with lower heart disease risks.

"There's no question that stress is one of the factors that modifies whether someone who is at risk for heart disease presents with heart disease," said Quinones, who wasn't involved with the new research. "For Hispanic women, if they have a less stressful environment because their family and cultural life is better, that may potentially be good."

Quinones explained that female Hispanics' lower heart risks likely have little to do with shared genetics, since Hispanics' roots may be, among others, Mexican, Cuban, Puerto Rican, African or European.

"Ethnicity does not equal race," he said.

Quinones also noted that the association between an upbeat attitude and improved cardiovascular health does not mean the former caused the latter.

SOURCES: Emir Veledar, Ph.D., biostatistician, Baptist Health South Florida, Miami; Miguel Quinones, M.D., chairman, cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston; April 29, 2015, Circulation: Cardiovascular Quality and Outcomes

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Put Car Seat on Your Summer-Travel Checklist: MedlinePlus

Put Car Seat on Your Summer-Travel Checklist: MedlinePlus

Put Car Seat on Your Summer-Travel Checklist

Expert clarifies age and size requirements

     

By Randy Dotinga

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- As you plan summer car trips with your young children, you should also consider car seat safety.

Car seats reduce the risk of death in infants and children by up to 71 percent, the U.S. Centers for Disease Control and Prevention says. But CDC research suggests 72 percent of car and booster seats are used improperly, which reduces their effectiveness.

Using a seat belt instead of a car seat for young children can be dangerous. "No matter how short the trip, if your child is in the car, he or she should be in a child safety seat," said Dr. Bridget Boyd, assistant professor of pediatrics at Loyola University Chicago Stritch School of Medicine.

"If your child is shorter than 57 inches, a seat belt will lay across the child's neck and belly," Boyd noted in a Loyola news release. "In the event of an accident, this puts pressure on sensitive areas with the potential for serious injuries, including spinal cord and abdominal injuries, or even death."

Boyd said recent changes to improve safety can be confusing for parents. Here, she offers tips:

• Keep your child's age, height and weight in mind when you choose a car seat. From birth to 2 years, a rear-facing car seat in the back seat is appropriate. From ages 2 to 5, or until a child has reached the upper height and weight limit for a seat, the child belongs in a forward-facing seat with a harness (a "convertible car seat") in the back seat.
• A booster seat is appropriate when children are too big for the forward-facing harness seat but not ready for a seat belt because it doesn't fit properly. Seat belts fit when the lap belt goes across the upper thigh, not the stomach, and the shoulder belt goes across the chest, not the neck. In general, seat belts properly fit people taller than 57 inches (4 feet 9 inches).
• For the highest level of safety, children who don't need a booster seat belong in the back seat until they're 13.
• Visit seatcheck.org to find a location near you -- often a police or fire station -- that will check and install a car seat for you.
• Don't use car seats more than 6 years old.

"Car seats and seat belts really could mean the difference between life and death for kids and parents," Boyd said. "Many of us remember running to the car yelling 'first' to nab the front seat, but it's safest to not even let the front seat be an option for kids, even if they are older."

Be a good role model, she added. "Talk about safety with your kids. It can make a world of difference," she said.

SOURCE: Loyola University Health System, news release, April 15, 2015

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C-Section Rates Drop Slightly With Hospital Review Program: MedlinePlus

C-Section Rates Drop Slightly With Hospital Review Program: MedlinePlus

C-Section Rates Drop Slightly With Hospital Review Program

Newborn complications also decreased, Canadian study reports

     

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- Fewer pregnant women had cesarean section births in Canadian hospitals that took part in a C-section review program, a new study reports.

The intervention program included onsite training in best-practice guidelines for C-sections, audits by a committee, and feedback for doctors.

"The benefit was driven by the effect of the intervention in low-risk pregnancies," said lead author Nils Chaillet, an associate professor of obstetrics and gynecology at the University of Sherbrooke in Quebec, Canada.

In hospitals with the program, fewer serious complications occurred in newborns, too, "suggesting that the reduction in the cesarean section rate is safe and that the program could improve the health of children," Chaillet added.

"The results suggested that by improving our knowledge about prenatal care programs and effectiveness, we can help reduce the rate of cesarean sections and not-medically-necessary procedures, thereby improving the quality of care and the health of mothers and their children," Chaillet said.

The findings were published in the April 30 issue of the New England Journal of Medicine.

C-section rates have climbed in many developed countries, including Canada and the United States, in recent decades, according to background information in the study.

Reasons for this increase include hospital factors, legal concerns, training resources, socioeconomic issues, health changes over time among mothers, insurance programs and information provided to mothers, among others, Chaillet said. But C-sections should only be considered for medical reasons, he said.

One medical reason for a C-section is labor problems, such as a baby not dropping down into the pelvis or the cervix not dilating appropriately, said Dr. Sheryl Ross, an obstetrician and gynecologist at Providence Saint John's Health Center in Santa Monica, Calif. Other reasons may include a baby positioned feet first (breech), a previous C-section, a baby over 9.5 pounds, twins or triplets, or a concerning fetal heart rate.

The current study aimed to reduce the rate of C-sections, and involved 32 hospitals throughout Quebec, Canada, and lasting one and a half years.

In the hospitals randomly assigned to use the program, a collaborating team of doctors, nurses and midwives reviewed the reasons for each C-section. Then health professionals received feedback, and the hospitals put in place best practices for when to perform C-sections.

More than 50,000 women delivered each year in the years before and after the intervention. In the year following the program, the rate of C-sections was slightly lower -- about 1.8 percent less -- in the hospitals with the program.

"This study suggested that joint decision-making from a group of health care professionals involved in a patient's pregnancy and delivery may actually lower the overall cesarean section rate," Ross said. "I suspect that other areas of medicine and patients would also benefit from this multifaceted intervention style of practicing medicine."

There wasn't a statistically significant change in the C-section rate for high-risk pregnancies, according to the study. But the C-section rate was reduced 1.7 percent for low-risk pregnancies in hospitals with the intervention.

In addition, slightly fewer minor and major complications for the newborns occurred in intervention hospitals compared to those without the program.

"Although the decrease in the rate of cesarean sections was small, it was significant and had the added benefit of improved neonatal outcomes," said Dr. Mitchell Maiman, chairman of the department of obstetrics and gynecology at Staten Island University Hospital in New York.

"Hospitals in the U.S. with even higher cesarean section rates are likely to reap even greater benefit," Maiman said.

Nothing on this scale has been done in the United States, according to Dr. Kevin Ault, a professor of obstetrics and gynecology at the University of Kansas Medical Center in Kansas City. "It is very challenging to get 32 hospitals together and agree to standardized clinical care," he said.

But in many hospitals throughout the United States, less formal versions of this kind of intervention have been implemented due to the influence of credentialing committees, insurance companies and hospital regulatory agencies, said Dr. Andre Hall, an obstetrician and gynecologist at Birth and Women's Care in Fayetteville, N.C.

"Specifically, indications that have been delineated by the American Congress of Obstetrics and Gynecology, such as no elective C-sections prior to 39 weeks for social reasons, have led to a small but statistically significant decrease in the rate of C-sections," Hall said.

One take-home message of this study, Hall added, is that patients should develop good relationships with their doctors and discuss labor and delivery plans ahead of time so that decisions can be made collectively.

SOURCES: Nils Chaillet, Ph.D., associate professor, department of obstetrics and gynecology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada; Sheryl Ross, M.D., obstetrician and gynecologist, Providence Saint John's Health Center, Santa Monica, Calif.; Mitchell Maiman, M.D., chairman, department of obstetrics and gynecology, Staten Island University Hospital, Staten Island, N.Y.; Kevin Ault, M.D., professor, department of obstetrics and gynecology, University of Kansas Medical Center, Kansas City, Kan.; Andre Hall, M.D., obstetrician and gynecologist, Birth and Women's Care, Fayetteville, N.C.; April 30, 2015, New England Journal of Medicine

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Better Diabetes Blood Sugar Management Leads to Fewer Eye Surgeries: MedlinePlus

Better Diabetes Blood Sugar Management Leads to Fewer Eye Surgeries: MedlinePlus

Better Diabetes Blood Sugar Management Leads to Fewer Eye Surgeries

Intensive therapy cut risk of needing a procedure in half, researchers report

     

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- Intensive management of type 1 diabetes can reduce the risk of having a diabetes-related eye surgery by nearly 50 percent, according to a new report.

But even for people who couldn't meet the very stringent blood sugar targets set for the study participants, just a 10 percent improvement in hemoglobin A1C -- a two- to three-month estimate of average blood sugar levels -- led to a 35 percent reduction in the risk of diabetes-related eye surgery, the study found.

"We're showing how a modest period of tight blood sugar control can lower the need for eye surgery, even way downstream," said the study's senior author, Dr. David Nathan, director of the Massachusetts General Hospital Diabetes Center and Clinical Research Center in Boston.

In general, the A1C goal for people with type 1 diabetes -- an autoimmune disease that destroys the body's ability to produce the hormone insulin -- is under 7 percent, according to JDRF (formerly the Juvenile Diabetes Research Foundation).

"So, a drop from 7.7 to 7 -- or from 8.5 to 7.7 -- would lead to a 35 percent reduction in diabetes-related eye procedures. A lower A1C is better, as long as you're doing it as safely as possible," Nathan said.

Lowering blood sugar levels too much can be dangerous, while elevated blood sugar can lead to long-term health consequences, including diabetic eye disease.

How does diabetes damage eyes? In several ways, according to Nathan. "The eyeball is tiny in relation to the rest of the body, but the eyes have enormous blood flow through very fine, small-caliber vessels," he explained.

"Diabetes can cause abnormalities to develop in these vessels. The vessels can break down, which causes leakage of blood. Or, the vessels try to repair [themselves] by developing new vessels, but these new vessels are thin and can bleed or leak fluid," Nathan said.

These problems can lead to conditions called macular edema and diabetic retinopathy. People with diabetes are also more likely to get cataracts earlier in life. "The development of cataracts is advanced by a decade or more in people with diabetes," Nathan noted.

The new research included two studies and about 1,400 people with type 1 diabetes. The first study from the early 1980s had two groups of people -- one that received intensive diabetes management, while the other group received standard care. That study lasted about 10 years. The second study followed most of the people from the initial study over the long term, though the intensive management stopped.

"In the initial study, the goal was to get the A1C to 6.05, which is the upper limit of normal for nondiabetics," Nathan said, adding that the average A1C ended up being 7 percent.

During the 23-year follow-up, 63 people out of 711 receiving intensive management ended up having diabetes-related eye surgery. Ninety-eight of the 730 people in the conventional therapy group had diabetes-related eye surgery.

For the intensive therapy group, the risk of needing cataract surgery was 48 percent lower. The risk of a procedure called vitrectomy, or retinal-detachment surgery -- or both surgeries -- was reduced 45 percent in the intensive management group, according to the study.

The costs of diabetes-related eye surgeries were 32 percent less for the group that received intensive management -- $429,000 versus $635,000, the study authors said.

"Interventions to control glucose [blood sugar] levels can improve outcomes, preserve life and prevent disabilities," said Helen Nickerson, director of translational development for JDRF.

"But it's also important to capture the economics of an intervention. This intervention cut the number of ocular [eye] surgeries by half -- you can put a cost on that and save health care resources," she added.

The study authors noted that cataract surgery is the top surgical expense for Medicare. Charges topped $2 billion during 2009 to 2010, the study said. And although cataracts aren't specific to people with diabetes, cataracts do occur more frequently in people with diabetes, the researchers noted.

"Given that the worldwide prevalence of type 1 diabetes is approaching 38 million persons, the potential benefits of intensive therapy to reduce morbidity and health care costs are substantial," the study authors wrote.

The study didn't include people with type 2 diabetes, so it's not clear if these benefits would be similar for them. The number of people with type 2 diabetes is estimated to be 10 to 20 times higher than those with type 1 diabetes, according to the study.

However, Nickerson said previous research has shown that people with type 1 diabetes are slightly more likely to have eye disease.

Results of the study are published in the April 30 issue of the New England Journal of Medicine.

SOURCES: David Nathan, M.D., director, Massachusetts General Hospital Diabetes Center and Clinical Research Center, and professor of medicine, Harvard Medical School, Boston, Mass.; Helen Nickerson, Ph.D., director, translational medicine, JDRF; April 30, 2015, New England Journal of Medicine

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Surge in Pollen May Spur Many Cases of Dry Eye: MedlinePlus

Surge in Pollen May Spur Many Cases of Dry Eye: MedlinePlus

Surge in Pollen May Spur Many Cases of Dry Eye

Both are at their worst this time of year, study says

     

By Robert Preidt

Wednesday, April 29, 2015

WEDNESDAY, April 29, 2015 (HealthDay News) -- High pollen levels in the spring are linked to dry eye, a new study suggests.

"Finding this correlation between dry eye and different seasons is one step toward helping physicians and patients treat the symptoms of dry eye even more effectively based on the time of year," said lead researcher Dr. Anat Galor, an associate professor of clinical ophthalmology at the University of Miami.

Dry eye causes burning, irritation and blurred vision. It costs the U.S. health system nearly $4 billion a year, Galor's team said in background information with the study.

The researchers analyzed 3.4 million visits to Veterans Affairs eye clinics nationwide between 2006 and 2011. During that time, nearly 607,000 cases of dry eye were diagnosed.

April had the highest rate of patients diagnosed with dry eye, nearly 21 percent. April is also when pollen levels usually peak each year.

In terms of seasons, there was a spike in spring when 18.5 percent of patients were diagnosed with dry eye, and another spike in winter. Rates were lowest in summer, at just over 15 percent, according to the study published online recently in the journal Ophthalmology.

The increase in dry eye cases in winter may be due to low indoor humidity associated with heating, according to the study authors. (Humidifiers can offset this, they suggested.)

"For the first time, we've found what appears to be a connection between spring allergens like pollen and dry eye, but also saw that cases rose in winter," Galor said in a journal news release.

The evidence linking pollen and dry eye suggests people with dry eye may benefit from allergy prevention in addition to treatments such as artificial tears, the researchers said. They recommended wearing goggles outside for yard work and using air filters indoors.

SOURCE: Ophthalmology, news release, April 23, 2015

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FDA MedWatch - Mammograms at Coastal Diagnostic Center in Pismo Beach, California: FDA Safety Communication - Quality Problems

Mammograms at Coastal Diagnostic Center in Pismo Beach, California: FDA Safety Communication - Quality Problems

AUDIENCE: Patient, Radiology, Oncology, OBGYN, Family Practice

ISSUE: The FDA is alerting patients who had mammograms at Coastal Diagnostic Center located in Pismo Beach, California anytime on or after February 24, 2013, about possible problems with the quality of their mammograms. The American College of Radiology (ACR), conducted a clinical image review of mammograms performed by Coastal Diagnostic Center between February 24, 2013 and February 24, 2015. The review was conducted after deficiencies were noted in the clinical cases that were submitted with the facility’s accreditation renewal application. The ACR revoked the facility’s accreditation effective April 10, 2015.

This does not mean that the results of the mammograms were inaccurate, but it does mean that the patients should consider having their mammograms re-evaluated at a Mammography Quality Standards Act (MQSA)-certified facility to determine if the patients need a repeat mammogram or additional medical follow-up. Patients have the right to request their mammogram and copies of their medical reports from Coastal Diagnostic Center.

On April 24, 2015, the FDA required the facility to notify all patients who received mammograms at Coastal Diagnostic Center any time on or after February 24, 2013, and their referring health care providers, about the problems with the mammography quality at the facility.

BACKGROUND: Under the Mammography Quality Standards Act of 1992, the FDA requires that all mammography facilities meet certain baseline quality standards and be certified to legally operate in the United States. This facility did not meet standards for mammography quality under the Act. The facility may no longer legally perform mammography at this time due to the revocation of its accreditation by the ACR and its MQSA certification being no longer in effect.

RECOMMENDATION: The FDA recommends the following for patients who had a mammogram at Coastal Diagnostic Center any time on or after February 24, 2013:

• If you have had a more recent mammogram at a MQSA-certified facility since then, you should follow the recommendations from that facility.
• If you have not had a mammogram at an MQSA-certified facility since then, follow these guidelines:
  • Talk with your health care provider as soon as possible about the need for a follow-up exam
  • If your health care provider recommends a repeat mammogram, it should be done at an MQSA-certified facility to ensure quality and accuracy. A database of MQSA-certified facilities in your area is available online or by calling the National Cancer Institute’s (NCI) information number at 1-800-422-6237.
  • If you need a repeat mammogram and your health insurance will not pay for it, you can call the National Cancer Institute’s (NCI) information number at 1-800-422-6237 for a listing of MQSA-certified facilities near you that will provide free or low- cost mammograms.

Read the MedWatch safety alert, including a link to the FDA Safety Communication, at:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm445181.htm

Opportunity for Public Comment - US Preventive Services Task Force

Opportunity for Public Comment - US Preventive Services Task Force



Public Comment on Draft Research Plan: Serologic Screening for Genital Herpes

The U.S. Preventive Services Task Force posted today a draft research plan on serologic screening for genital herpes. The draft research plan is available for review and public comment from April 30 through May 27, 2015. To review the draft research plan and submit comments, go to http://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment.