octobre 2016

New Method for Performing Aortic Valve Replacement Proves Successful in High-Risk Patients

lundi 31 octobre 2016

News Release

Monday, October 31, 2016

Researchers at the National Institutes of Health have developed a new, less invasive way to perform transcatheter aortic valve replacement (TAVR), a procedure widely used to treat aortic valve stenosis, a lethal heart condition. The new approach, called transcaval access, will make TAVR more available to high risk patients, especially women, whose femoral arteries are too small or diseased to withstand the standard procedure. The Journal of the American College of Cardiology published the findings.

Aortic valve stenosis involves the narrowing of the heart’s aortic valve which reduces blood flow through the heart. For about 85 percent of patients with this condition, doctors typically perform TAVR through the femoral artery in the leg. But for the other 15 percent, doctors must find a different access route. The most common alternative routes are through the chest, which requires surgery and are associated with significantly more complications.

Transcaval access, which can be performed in awake patients, involves electrifying a small wire so that it crosses between neighboring blood vessels in the abdomen. The technique calls for making large holes in both the abdominal aorta and the inferior vena cava, which physicians previously considered dangerous because of the risk of fatal bleeding.

The new method was developed by researchers at the National, Heart, Lung and Blood Institute (NHLBI) and tested in a trial on 100 patients at 20 hospitals across the United States. Researchers said it proved successful in 99 of the patients.

“This is a seminal study,” said the lead author, cardiologist Adam B. Greenbaum, M.D., co-director of the Henry Ford Hospital Center for Structural Heart Disease, Detroit. “It challenged conventional wisdom, which objected to the idea of safe passage between the vena cava and the aorta. More important, it is the first of many non-surgical minimally-invasive tissue-crossing, or so-called transmural catheter procedures developed at NIH that can be applied to diverse fields of medicine.”

Robert J. Lederman, M.D., a senior investigator in NHLBI’s Division of Intramural Research who led the study, said researchers developed the method to address a specific clinical need, even though they knew it would be a challenging proposition for most surgeons and physicians to accept. The proposed and counterintuitive mechanism of action is that bleeding from the aorta spontaneously decompresses into a corresponding hole the physician makes in the vein, because the surrounding area behind the peritoneum has higher pressure than the vein.

The results of the research, which were independently confirmed by a committee of outside cardiologists, show the procedure not only has a high success rate, but also an acceptable rate of bleeding and vascular complications, particularly in the high risk patients studied. The study builds on the access technique that Lederman’s NHLBI team developed and first tested in animals in 2012 and first applied with Henry Ford physicians to help patients in 2013. NHLBI and its collaborators are now working to find ways to train more specialists to perform the procedure.

The study will also be presented on Monday, October 31 at the Transcatheter Cardiovascular Therapeutics conference in Washington, D.C. Co-authors include researchers from Henry Ford Hospital; Emory University, Atlanta; Oklahoma Heart Institute, Tulsa; Lexington Medical Center, West Columbia, South Carolina; and Oschner Medical Center, New Orleans.

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI, a part of the National Institutes of Health (NIH), plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at www.nhlbi.nih.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 www.nih.gov.

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New Method for Performing Aortic Valve Replacement Proves Successful in High-Risk Patients

Nearly Two-Thirds of Smokers Also Use E-Cigarettes: CDC

SUNDAY, Oct. 30, 2016 (HealthDay News) -- Many American adults who use electronic cigarettes also smoke tobacco cigarettes, a U.S. Centers for Disease Control and Prevention survey reveals.

The survey found that in 2015, 59 percent of all adult e-cigarette users were also current cigarette smokers. The survey also showed that 30 percent of e-cigarette users were former smokers and 11 percent using the devices had never smoked.

Among young adults ages 18 to 24, 40 percent of e-cigarette users were never smokers, 43 percent were current smokers and 17 percent were former smokers.

"If there is a public health benefit to the emergence of e-cigarettes, it will come only if they are effective at helping smokers stop using cigarettes completely, responsibly marketed to adult smokers and properly regulated to achieve these goals," said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

Altogether, 3.5 percent of all U.S. adults were e-cigarette users in 2015, down slightly from 3.7 percent in 2014, the CDC survey found.

Myers said these findings raise concerns that many adults using e-cigarettes are using the devices in addition to tobacco cigarettes, rather than in place of them.

Myers' organization also said the finding that 40 percent of young adults who use e-cigarettes have never been smokers raises concerns that e-cigarettes may be introducing young nonsmokers to tobacco use and nicotine addiction.

There has been a sharp increase in use of e-cigarettes by youth. In 2015, 24 percent of high school students were current users of e-cigarettes, compared to 11 percent who smoked cigarettes, a previous CDC survey found.

E-cigarettes "will not benefit public health if smokers use them in addition to cigarettes instead of quitting or if they re-glamorize tobacco use among young people and attract nonsmokers," Myers said in a Campaign for Tobacco-Free Kids statement.

Current evidence on whether e-cigarettes help smokers quit is limited and inconclusive, he said.

SOURCE: Campaign for Tobacco-Free Kids, statement from Matthew Myers, president, Oct. 27, 2016

News stories are provided by HealthDay and do not reflect the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, the U.S. Department of Health and Human Services, or federal policy.

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Alcohol, Drugs a Poor Halloween Mix

SATURDAY, Oct. 29, 2016 (HealthDay News) -- Alcohol, drugs and Halloween are a bad blend, an ER doctor warns.

"Injuries related to pumpkin carving are more common if persons are intoxicated or under the influence of mood-altering substances. Puncture-type injuries are quite common during Halloween -- especially injuries to the index finger," said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

Even when you're sober, it's important to take some safety precautions when carving your jack-o'-lantern. Glatter offers these tips:

Make sure your carving tools and hands are dry to prevent slipping.
Consider using specially designed pumpkin-carving tools found online and in specialty shops. "They may be more useful to carve rinds, poke through holes and scoop out the inside of the pumpkin, without being too sharp to cause injury," Glatter said in a hospital news release.
Carve the pumpkin fully before removing the top so you won't have to put your hand inside and cut near it.

"In general, it is safer to hold the top of the pumpkin and carve with the tip of the blade pointing down to the floor," Glatter said.

Some adults tend to drink to excess on Halloween, which increases their risk of injury, he said.

"The potential for injuries and falls as a result of loose-fitting costumes and special masks or hats which may hamper their ability to walk carefully and hinder their vision, coupled with mood-altering substances is a recipe for injury and harm," Glatter warned.

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Researchers: We Found Area of Brain That Responds to Placebo

FRIDAY, Oct. 28, 2016 (HealthDay News) -- Scientists say they've pinpointed the brain region linked to the placebo effect.

The placebo effect occurs when a fake therapy -- such as a sugar pill -- leads to a significant decrease in pain or other health-related improvement.

The finding could lead to improved treatment for the 100 million Americans who suffer from chronic pain, the study authors said.

Using a new type of MRI developed for the study, the investigators said they identified a region within the brain that responds to a placebo.

"The new technology will allow physicians to see what part of the brain is activated during an individual's pain and choose the specific drug to target this spot," said study co-author Vania Apkarian, a professor of physiology at Northwestern University's Feinberg School of Medicine, in Chicago.

"It also will provide more evidence-based measurements. Physicians will be able to measure how the patient's pain region is affected by the drug," he said in a Northwestern news release.

The researchers said the findings have the potential to advance personalized pain therapy that is based on how a patient's brain responds to a drug. Knowing how the brain reacts to a drug could also lead to more precise clinical trials for pain medications by identifying and excluding patients with high placebo response, the researchers added.

"Given the enormous societal toll of chronic pain, being able to predict placebo responders in a chronic pain population could both help the design of personalized medicine and enhance the success of clinical trials," said study co-author Marwan Baliki, an assistant professor of physical medicine and rehabilitation at Northwestern.

The study was published Oct. 27 in the journal PLoS Biology.

SOURCES: Northwestern University, news release, Oct. 27, 2016

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Poorer Heart Attack Victims, Especially Women, Fare Worse

vendredi 28 octobre 2016

THURSDAY, Oct. 27, 2016 (HealthDay News) -- Younger heart attack survivors who struggle to afford health care and medications have worse outcomes than those who don't, a new study finds.

"Our study emphasizes that patients need us to think about their social needs, not just their clinical symptoms," said study senior author Dr. Erica Spatz.

Spatz is an assistant professor of medicine at Yale School of Medicine in New Haven, Conn.

"We have not completed our job if we discharge patients from the hospital and recommend they use medications or services like cardiac rehab that they cannot afford," she added in a Yale news release.

In the study, the researchers surveyed more than 3,400 heart attack survivors aged 18 to 55 in the United States and Spain, one month and 12 months after their hospitalization.

Nearly one-third of the patients said they struggled to afford health care services and one-fifth had difficulty affording medications. These problems were more common among women than men.

Those who faced financial barriers reported worse quality of life, more symptoms of depression, and more stress, according to the researchers.

"We suspected women may experience greater challenges than men -- they often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young women have worse outcomes following a heart attack as compared with similarly aged men," said study first author Adam Beckman.

Beckman is a recent graduate of the Yale Global Health Scholars program.

The study was published recently in the Journal of the American Heart Association.

SOURCE: Yale University, news release, Oct. 18, 2016

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Stressful Jobs with Little Control/Shorter Life Spans?

THURSDAY, Oct. 27, 2016 (HealthDay News) -- It can be very frustrating to be in a high-demand job where your boss allows you little control, and a new study suggests such constant stress might even shorten your life.

"We found that individuals in highly stressful jobs with little control die at a younger age than workers who have more control in their jobs," said study lead author Erik Gonzalez-Mule. He's an assistant professor of organizational behavior and human resources at Indiana University's Kelley School of Business.

The researchers also found the reverse was true. People in high-demand jobs who had high control over their work seemed to decrease their chances of death during the study by 34 percent.

However, the study couldn't prove a cause-and-effect relationship between job control and death. It only showed an association between these factors.

Still, there are several ways a lack of on-the-job control might affect overall health and the risk of dying, Gonzalez-Mule explained.

"We know that workplaces do affect health," he said. "In particular, there's evidence showing that stressful jobs affect our satisfaction with our lives."

One example: "Workers who have less control over their stressful jobs are more likely to be overweight than those workers who can control their jobs," he said.

Gonzalez-Mule said he and co-author Bethany Cockburn from the University of Iowa launched the study to better understand how stress at work affects health. The researchers also wondered whether "high control can actually make stressful jobs beneficial," Gonzalez-Mule said.

The researchers looked at nearly 2,400 people who took part in a long-term study in Wisconsin. All of the study volunteers were 63 to 67 years old in 2004.

The researchers examined answers from the participants in 2004 about their jobs and then tracked their health to 2011. Half of the study participants were women.

The researchers defined low levels of control in jobs -- "an inability to set one's own goals, decide how to accomplish tasks and prioritize work," Gonzalez-Mule said.

"Examples of jobs that could are traditionally low-control include construction workers, auto mechanics, or nursing aides. Examples of jobs that are traditionally high-control include supervisors, craftsmen and construction inspectors," he noted.

The researchers then compared death rates among the participants and their jobs.

"Having low control over a stressful job was associated with a 15.4 percent increase in the likelihood of death compared to having low control over a low-stress job," Gonzalez-Mule said.

What do the researchers think is going on?

"Decades of health research has found that the effects of stress compounds over time, starting with psychological stress, which can eventually lead to physical problems like high blood pressure and even death," Gonzalez-Mule said.

"The idea is that people find ways to cope with stress, like engaging in unhealthy behaviors such as smoking, having a sedentary lifestyle or eating unhealthy foods," he said.

What could be done to help workers?

Gonzalez-Mule said gaining more control over work could translate to stress relief and even promote "good" stress --"like having pressure to work fast and to use intense concentration, which may result in feelings of accomplishment and mastery."

Clinical psychologist Joshua Klapow, an associate professor of public health at the University of Alabama at Birmingham, praised the study.

"As we look at job descriptions, work environment corporate culture, employee health and well-being, we cannot overlook the critical role of individual perception," he said.

"It's not always about what you are asking the individual to do, how much work they think they have, or how 'hard' their job is. Very often it's about giving them the feeling of control in their work environment that can buffer many challenges and prevent negative outcomes," Klapow said.

Nellie Brown is director of the Workplace Health and Safety Program at Cornell University's School of Industrial and Labor Relations. She suggested that employers do things such as allow workers to set their own schedules.

"When managers give people more control, it doesn't mean they give up authority," she said. "They [workers] feel less stressed, but the work gets done."

The study was published recently in Personnel Psychology.

SOURCES: Erik Gonzalez-Mule, Ph.D., assistant professor, organizational behavior and human resources, Indiana University's Kelley School of Business, Bloomington; Nellie Brown, M.S., director, Workplace Health and Safety Program, Cornell University School of Industrial and Labor Relations, Ithaca, N.Y.; Joshua Klapow, Ph.D., clinical psychologist and associate professor, Public Health, University of Alabama at Birmingham; Sept. 2, 2016, Personnel Psychology online

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Heart Group Advises Personalized Nutrition Counseling

THURSDAY, Oct. 27, 2016 (HealthDay News) -- Health care providers need to consider people's ethnic, cultural and personal preferences when offering healthy eating advice, a new American Heart Association scientific statement says.

Health care providers also need to use easy-to-understand language and food examples.

"It's one thing for professionals to summarize the data and develop guidelines. An entirely different strategy is required to translate those guidelines into daily behaviors embraced in real life, by real people," said Linda Van Horn, the statement writing group chair. She is a professor of preventive medicine (nutrition) at Northwestern University Feinberg School of Medicine in Chicago.

"To consumers, it's an apple, an orange, a pizza. It's not saturated fat, refined carbohydrates and potassium. That's nutrition jargon familiar among professionals, but not normal conversation for the average American," Van Horn said in an AHA news release.

Advice about healthy eating can be adapted to different cultural and personal preferences, as well as affordability.

Van Horn noted that some ethnic groups have higher rates of heart disease and stroke, so addressing certain eating habits in those groups may help lower those risks.

Some examples: Blacks report consuming more sugar-sweetened beverages and fewer fruits and vegetables than whites; and people of Chinese, Korean and Japanese heritage tend to have diets lower in saturated fats, but higher in salt content, the AHA said.

"Identifying optimal nutrition for preserving good health is an ongoing, dynamic science. But there are fundamental principles we know now about how some foods decrease risk of heart disease, while other foods increase risk. For example, I've yet to see a study reporting that fruits and vegetables are bad for you," Van Horn said.

The statement, published Oct. 27 in the journal Circulation, provides health care providers with practical ways to help patients make healthier food choices. For example, there are portion sizes for different types of vegetables, whole grains, meat, poultry, eggs and many other products.

"We translate the recommendations into real-life, buy-it-at-the-grocery store, order-it-on-the-menu type choices," Van Horn said.

"Counseling people about healthy eating is a process, but when someone becomes motivated to actually make dietary changes such as eating more fruits and vegetables, amazing things happen. In as little as three weeks, they develop a preference for those foods and even begin to miss them if they're not on the plate," she said.

SOURCE: American Heart Association, news release, Oct. 27, 2016

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Depression: FDA-Approved Medications May Help

jeudi 27 octobre 2016

Long-term Oxygen Treatment Does Not Benefit Some COPD Patients

News Release

Thursday, October 27, 2016

Study addresses long-standing question for those with moderately low blood oxygen levels.

“For the most part, this treatment did not improve or prolong life in study participants.”

—James P. Kiley, Ph.D., Director, NHLBI, Division of Lung Diseases

Newly published data from the Long-Term Oxygen Treatment Trial (LOTT) show that oxygen use is not beneficial for most people with chronic obstructive pulmonary disease (COPD) and moderately low levels of blood oxygen. It neither boosted their survival nor reduced hospital admissions for study participants. Previous research showed that long-term oxygen treatment improves survival in those with COPD and severely low levels of blood oxygen. However, a long-standing question remained whether a different group of COPD patients — those with moderately low levels of blood oxygen—also benefit. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) — a part of the National Institutes of Health—and the Centers for Medicare & Medicaid Services.

The study, the largest of its kind to evaluate the effectiveness of home oxygen in this group of patients, is published in the current online issue of the New England Journal of Medicine. The 738 patients enrolled in this study had COPD and moderately low levels of blood oxygen (in contrast to severely low blood oxygen levels) at rest or during exercise.

In the current study, patients with moderately low levels of blood oxygen are defined as those with a blood oxygen saturation (SpO₂) between 89 and 93 percent at rest (moderate resting hypoxemia), or a SpO₂ below 90 percent during the 6-minute walk test. Patients with severely low blood oxygen levels are defined as those with a SpO₂ equal to or less than 88 percent at rest. This latter group was excluded from the LOTT study because prior studies showed that they benefit from long-term oxygen treatment. Blood oxygen saturation or SpO₂ refers to the percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the blood and is measured through a pulse oximeter. A pulse oximeter is a special probe that indirectly measures oxygen levels in the blood, often by attachment to the finger.

“These results provide insight into a long-standing question about oxygen use in patients with COPD and moderately low levels of blood oxygen. For the most part, this treatment did not improve or prolong life in study participants,” said James P. Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases. “The findings also underscore the need for new treatments for COPD.”

Researchers say patients with any form of COPD should check with their doctors before making changes in their treatment plans. “We want to make it clear that LOTT was not designed to assess individual responses to oxygen treatment and that individual responses can vary. Each COPD patient should discuss their own personal situation with their healthcare provider,” said William C. Bailey, M.D., Professor Emeritus at the University of Alabama at Birmingham School of Medicine, and study Chair.

COPD, the third leading cause of death in the United States, is a progressive lung disease triggered primarily by cigarette smoking, although up to 20 percent of patients with COPD never smoked. Symptoms include shortness of breath, chronic coughing, and wheezing. The disease also causes low oxygen levels in the blood. About 15 million people have been diagnosed with COPD in the United States and another 10 million may be undiagnosed.

For decades, oxygen has been one of the main treatment tools for patients with COPD and low oxygen levels. It involves the use of metal tank cylinders containing oxygen or concentrators that extract oxygen from air; both systems deliver the gas through a nasal tube or mask.

The LOTT study is a randomized clinical trial to determine whether oxygen use could help COPD patients with moderately low levels of blood oxygen. The seven-year study, which included patients from 42 medical centers throughout the United States, began in 2009 and was completed in 2015.

In the study, half of the patients received long-term oxygen and the other half did not. The researchers found no significant differences between the two groups based on how long patients survived, and the amount of time leading to their first hospitalization. They also found no differences in other important benchmarks, such as the rates at which the patients were hospitalized or experienced worsening of COPD symptoms. Nor did researchers find statistically significant differences between the groups in quality of life, levels of depression or anxiety, lung function, or ability to walk for short periods.

Although no cure for COPD exists, there are a number of treatment options, including the use of bronchodilators and steroids, as well as pulmonary rehabilitation, surgery, and lung transplantation. Researchers worldwide are also studying new medications and exploring other approaches such as gene therapy. They continue to emphasize the importance of not smoking tobacco in preventing or slowing the progression of COPD.

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HIV May Hide in Tissues, Even After Treatment

WEDNESDAY, Oct. 26, 2016 (HealthDay News) -- HIV patients who've been treated with antiretroviral drugs still have the AIDS-causing virus in their tissues, a new study suggests.

Treatment with antiretrovirals eliminates detectable levels of HIV in the blood and controls the disease. But the new findings suggest that HIV in the tissues may not cause AIDS but could contribute to the development of unrelated conditions, such as cancer and heart disease, according to the University of California, San Francisco (UCSF) researchers.

"Looking in tissues of treated HIV patients, we found that HIV in some tissues did not appear to be affected by antiretrovirals," said study senior author Dr. Michael McGrath.

"Notably we saw no evidence of drug resistance, which we would have seen if the virus had been exposed to medications," said McGrath. He is UCSF professor of laboratory medicine at the AIDS and Cancer Specimen Resource, which is supported by the U.S. National Cancer Institute.

This finding is expected in untreated patients, but it was a surprise to see it in virally suppressed patients, he added.

"Our results suggest that HIV in varied tissue compartments can be untouched by the medications," McGrath said in a university news release.

The researchers analyzed autopsy tissue samples from five HIV patients who took antiretrovirals and found undetectable levels of the virus in their blood.

However, the virus had evolved and migrated to brain, kidney, spleen and other tissues similar to the way it does in HIV patients who don't take antiretroviral drugs, the study authors said.

The study appears in the October issue of the Journal of Virology.

It's possible that active, untreated virus in tissues could be driving diseases unrelated to AIDS "that are increasingly the cause of death for virally suppressed patients," McGrath said.

"In addition, our findings suggest that strategies to 'cure' HIV infection, which are centered on treatment of blood, must consider targeting tissue-based sites of HIV," he added.

SOURCE: University of California, San Francisco, news release, Oct. 20, 2016

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Oxygen Therapy Little Help for Those with Milder COPD

WEDNESDAY, Oct. 26, 2016 (HealthDay News) -- A new study says that oxygen therapy may not help people in the less severe stages of chronic obstructive pulmonary disease (COPD).

COPD is an umbrella term for the lung diseases chronic bronchitis and emphysema. The study findings could change clinical practice, the researchers added.

In 2014, close to 16 million Americans said they'd been diagnosed with COPD, according to the U.S. Centers for Disease Control and Prevention. The disease stands as the third-leading cause of death in the United States.

One common treatment for COPD is supplemental oxygen -- with both portable and at-home devices.

The therapy has been proven to prolong the lives of COPD patients with severe decreases in their blood oxygen levels, said study corresponding author Dr. Robert Wise.

What's been unclear, he said, is whether it benefits patients with moderately low oxygen levels -- either when they're at rest or when they exert themselves.

The study findings were published Oct. 27 in the New England Journal of Medicine.

"No one has really known," agreed Dr. Magnus Ekstrom, a respiratory medicine specialist at Lund University in Sweden. "During all this time, and despite the fact that we are talking about something as basic and common in everyday respiratory practice as supplemental oxygen."

Ekstrom, who wrote an editorial published with the new study, said the findings are something doctors and COPD patients should discuss.

For the study, Wise and his colleagues randomly assigned 738 COPD patients to receive supplemental oxygen or not. All of the patients had moderately low oxygen levels in their blood -- either persistently or when they were physically active.

Over the next six years, there was no evidence that the oxygen-therapy group fared any better.

It did not improve patients' quality of life, forestall hospitalization or lengthen their lives, the researchers found.

Why? It's not clear from this study, according to Wise, a professor of medicine at the Johns Hopkins University School of Medicine's Division of Pulmonary and Critical Care Medicine in Baltimore.

But, he said, it appears that the harmful effects of low blood oxygen may only arise at a certain threshold. So COPD patients with moderately low levels may not have much to gain from supplemental oxygen.

Still, Wise stressed that the results do not mean oxygen therapy is useless.

It does help patients with more severe oxygen deficits, he said -- and some people with moderately low levels may benefit, too.

"Certain patients with exercise-induced hypoxemia may feel better with supplemental oxygen," Wise said, referring to the medical term for low oxygen.

Patients like those, he said, should not feel compelled to stop, based on the new findings.

"But if you're not receiving symptomatic benefit, talk to your doctor," Wise suggested. "Doctors and patients now have this important new evidence to use in discussing the therapy."

Besides the lack of benefit for some patients, oxygen therapy also has downsides, Wise pointed out.

For the most part, it's safe, he said. But patients can trip over the equipment, which is especially dangerous for elderly, frail people. And because oxygen feeds combustion, it has the potential to contribute to fires.

In this trial, two patients had to be hospitalized after tripping over their oxygen equipment, and five patients reported fires or burns.

There's also the cost. In recent years, Medicare has paid more than $2 billion annually toward oxygen therapy, according to the U.S. Government Accountability Office. But patients still have to foot 20 percent of the payment.

Ekstrom agreed that doctors and patients have to talk about all the pros and cons of oxygen therapy.

And that, he said, can also apply to people who started oxygen because of severe hypoxemia.

Over time, Ekstrom said, some patients see their COPD improve -- especially if they began oxygen because of an infection or exacerbation of the disease.

"The benefit of oxygen [for them] could be evaluated through a walk test," Ekstrom said. The standard six-minute walk test measures how much distance a patient can walk in that time.

Both he and Wise stressed another point: There are other treatments for COPD -- including medications and pulmonary rehabilitation programs, which may include exercise, nutrition counseling and help with symptom management.

"This study does not imply there's nothing we can do," Wise said. "COPD is preventable and treatable."

SOURCES: Robert Wise, M.D., professor, medicine, Johns Hopkins University School of Medicine, Baltimore; Magnus Ekstrom, M.D., respiratory medicine and allergology, Lund University, Lund, Sweden; Oct. 27, 2016, New England Journal of Medicine

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Oxygen Therapy Little Help for Those with Milder COPD

Parent-Child Screening Urged for Inherited Heart Condition

WEDNESDAY, Oct. 26, 2016 (HealthDay News) -- Young children should be screened for a type of genetic heart disease that significantly increases their risk of a heart attack at a young age, a new British study suggests.

The screening could also identify parents with familial hypercholesterolemia. The condition, which causes high cholesterol levels, is the main inherited cause of early heart disease, the study authors said.

Without preventive medication, people with familial hypercholesterolemia have a 10-fold increased risk of heart attack before age 40, the study noted.

Researchers tested more than 10,000 children in England and found that one in 270 had familial hypercholesterolemia. That rate is nearly double the previously reported one in 500, the researchers said.

After a child with familial hypercholesterolemia was identified, their parents underwent screening. Overall, one in every 125 persons tested was found to be at high risk for a heart attack, the researchers said.

The researchers also concluded that with effective treatment, screening 1- to 2-year-olds for familial hypercholesterolemia when they receive routine vaccinations could prevent about 600 heart attacks in people younger than 40 in England and Wales.

The study was published in the New England Journal of Medicine.

"This is the first demonstration that child-parent screening works on a large scale. It's the only screening method that stands a reasonable chance of covering the whole population and identifying those at highest risk of an early heart attack," said lead researcher Dr. David Wald, a professor of cardiology at Queen Mary University of London.

"The next step is for public health agencies to consider offering this routinely at the time of childhood vaccination to test all children aged 1 to 2 years," he said in a university news release.

Steps to reduce the risk of heart attack include cholesterol-lowering statins and other medications in adults and teens, along with healthy eating and avoiding smoking.

"This is an example of an effective screening strategy being combined with routine vaccination, which has clear advantages," Wald said. "No extra clinic visits are needed and uptake is high because parents are already focused on the future health of their children and the family as a whole."

SOURCE: Queen Mary University of London, news release, Oct. 26, 2016

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Skin Patch to Treat Peanut Allergy Shows Benefit in Children

mercredi 26 octobre 2016

News Release

Wednesday, October 26, 2016

NIH-funded study suggests patch is safe, convenient mode of treatment.

A wearable patch that delivers small amounts of peanut protein through the skin shows promise for treating children and young adults with peanut allergy, with greater benefits for younger children, according to one-year results from an ongoing clinical trial. The treatment, called epicutaneous immunotherapy or EPIT, was safe and well-tolerated, and nearly all participants used the skin patch daily as directed.

The ongoing trial is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and conducted by the NIAID-funded Consortium of Food Allergy Research (CoFAR), which is led by Hugh Sampson, M.D., of Icahn School of Medicine at Mount Sinai in New York. Stacie Jones, M.D., of the University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, chairs the study. One-year outcomes are published online on October 26 in the Journal of Allergy and Clinical Immunology.

“To avoid potentially life-threatening allergic reactions, people with peanut allergy must be vigilant about the foods they eat and the environments they enter, which can be very stressful,” said NIAID Director Anthony S. Fauci, M.D. “One goal of experimental approaches such as epicutaneous immunotherapy is to reduce this burden by training the immune system to tolerate enough peanut to protect against accidental ingestion or exposure.”

CoFAR researchers at five study sites randomly assigned 74 peanut-allergic volunteers aged 4 to 25 years to treatment with either a high-dose (250 micrograms peanut protein), low-dose (100 micrograms peanut protein), or placebo patch. The investigators assessed peanut allergy at the beginning of the study with a supervised, oral food challenge with peanut-containing food. The patches were developed and provided by the biopharmaceutical company DBV Technologies under the trade name Viaskin. Each day, study participants applied a new patch to their arm or between their shoulder blades.

After one year, researchers assessed each participant’s ability to consume at least 10 times more peanut protein than he or she was able to consume before starting EPIT. The low-dose and high-dose regimens offered similar benefits, with 46 percent of the low-dose group and 48 percent of the high-dose group achieving treatment success, compared with 12 percent of the placebo group. In addition, the peanut patches induced immune responses similar to those seen with other investigational forms of immunotherapy for food allergy. Investigators observed greater treatment effects among children aged 4 to 11 years, with significantly less effect in participants aged 12 years and older.

“The clinical benefit seen in younger children highlights the promise of this innovative approach to treating peanut allergy,” said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation (DAIT). “Epicutaneous immunotherapy aims to engage the immune system in the skin to train the body to tolerate small amounts of allergen, whereas other recent advances have relied on an oral route that appears difficult for approximately 10 to 15 percent of children and adults to tolerate.”

Nearly all of the study participants followed the EPIT regimen as directed. None reported serious reactions to the patch, although most experienced mild skin reactions, such as itching or rash, at the site of patch application.

“The high adherence to the daily peanut patch regimen suggests that the patch is easy-to-use, convenient and safe,” said Marshall Plaut, chief of DAIT’s Food Allergy, Atopic Dermatitis and Allergic Mechanisms Section. “The results of this study support further investigation of epicutaneous immunotherapy as a novel approach for peanut allergy treatment.”

Additional studies in larger groups of children are needed before the therapy could be approved for wider use. The CoFAR study continues to assess the long-term safety and effectiveness of peanut EPIT. After the first year, all participants began receiving high-dose daily patches, and they will continue in the study for a total of two and a half years of EPIT.

The work was funded by NIAID, NIH, under award numbers U19AI066738 and U01AI066560. Additional support was provided by NIH’s National Center for Advancing Translational Sciences. The ClinicalTrials.gov identifier for the study Epicutaneous Immunotherapy for Peanut Allergy (CoFAR6) is NCT01904604. The CoFAR clinical sites involved in the trial are Arkansas Children's Hospital in Little Rock, National Jewish Health in Denver, The Johns Hopkins University in Baltimore, Icahn School of Medicine at Mount Sinai in New York and the University of North Carolina at Chapel Hill School of Medicine.

NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available at http://ift.tt/29Yl1bl.

NIH…Turning Discovery Into Health^®

Reference

SM Jones et al. Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults. Journal of Allergy and Clinical Immunology DOI: 10.1016/j.jaci.2016.08.017 (2016).

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Less Than Half of Older Hip Fracture Patients Fully Recover: Study

TUESDAY, Oct. 25, 2016 (HealthDay News) -- For older adults, a fractured hip is often life-changing: The majority will never return to their former levels of independence and physical activity, according to new research.

"We all hope for full recovery, but less than half recover to their previous function after a hip fracture," said Dr. Victoria Tang, lead author of the study.

The chances of recovery among hip-fracture patients older than 85 with dementia or other health problems are even lower, the study authors found.

"By being able to set realistic expectations of the likelihood of recovery, as family members, we can take steps to plan and prepare for future care needs of the patient," added Tang. She is medical director of the geriatric surgery wellness program at the University of California, San Francisco.

For older adults, the odds of suffering a hip fracture increase as bones tend to weaken. The U.S. Centers for Disease Control and Prevention reports that more than 300,000 people aged 65 and older are hospitalized for hip fractures each year.

Using the nationally representative Health and Retirement Study, Tang and her colleagues reviewed data on just over 730 adults aged 65 and older (average age nearly 85 years) who had sustained a hip fracture. The researchers assessed each patient's health and physical ability before and after the injury.

For instance, could they walk around the block or climb stairs without resting before their fracture? And afterwards, were they able to dress themselves and get to the bathroom on their own?

The researchers found that the likelihood of recovery to the prefracture level of function was less than 50 percent regardless of previous ability level.

About one in three returned to their prior daily functioning, according to the analysis. Just over one-third were able to move as before, and only four out of 10 regained their former ability to climb stairs. Even for those who were very physically active before their injury, outcomes were only slightly better, the findings showed.

The study authors also found that about one-third of patients returned to living independently without assistance.

"From my clinical experience, I see that those that do not recover back to living independently need more support at home with bathing, dressing, ambulating, etcetera," said Tang. "Some move into assisted-living and some move from a skilled nursing facility into a nursing home."

The findings suggest a distinctly lower recovery rate than previous studies, the researchers said. However, because this was an observational study, it could not prove cause-and-effect.

Dr. Maria Torroella Carney is chief of geriatric and palliative medicine at Northwell Health in New Hyde Park, N.Y. She called the study "important because it has the potential to educate patients and families about the realistic outcomes of a hip fracture in older adults.

"It is important to try to understand a patient's long-term care goals, such as whether or not the patient can or is able to undergo surgery," Carney said. Patients will also likely face "an intense rehabilitation process, which may be associated with increased pain and potential complications," she added.

Carney said older adults are at greater risk of a hip fracture because of gait disturbances, muscle weakness, and bone mass loss. Bone mass decreases with age, contributing to osteoporosis, a condition characterized by weak and brittle bones. This puts the hip bone at risk for fracture.

More than 95 percent of seniors' hip fractures are caused by falls, and three out of four hip fractures happen to women, the CDC reports.

To help prevent hip fractures, the CDC recommends that older adults ask their doctor or health-care provider to evaluate their risk for falling and talk with them about preventive measures. These might include taking vitamin D supplements, getting screened and possibly treated for osteoporosis, and reviewing any medicines that might make them sleepy or dizzy.

Doctors may also suggest exercises that strengthen the legs and improve balance, as well as taking steps to make the home safer. For starters, it's important to keep floors clear of tripping hazards. Also valuable: installing grab bars by the toilet and in the shower, and put railings on both sides of the stairs.

The report was published online recently in the Journal of General Internal Medicine.

SOURCES: Victoria Tang, M.D., medical director, Surgery Wellness Program, division of geriatrics, University of California, San Francisco; Maria Torroella Carney, M.D., chief, division of geriatric and palliative medicine, department of medicine, Northwell Health, New Hyde Park, N.Y.; Sept. 7, 2016, Journal of General Internal Medicine, online

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The Scoop about Healthy Poop

TUESDAY, Oct. 25, 2016 (HealthDay News) -- Your bowel movements can offer important clues about your health, a doctor says.

If bowel movements feel comfortable, then it's likely all is well, said Dr. Gabriel Neal, a family medicine doctor and clinical assistant professor at Texas A&M College of Medicine.

"Normal bowel movements are relatively soft but dense. They should be any shade of brown or green," Neal said in a college news release.

Viruses and bacteria in the intestinal tract can cause stool discoloration, diarrhea or blood in the stool. The color of the blood can help your doctor pinpoint the location of the infection.

"If an infection is in the lower intestines or colon, then the blood in your stool is going to be red. If you find black blood, then the blood has oxidized and is from higher up in your digestive tract, such as the stomach or upper intestines," Neal said.

People with gallbladder disease sometimes have white stools, so if you ever notice white bowel movements, contact your doctor, he said.

It's also important to pay attention to bowel movement frequency.

"If you're having bowel movements three times per week or less, then that is the common definition of constipation. On the other side, more than six times per day for adults is too much," Neal said.

Also, a sudden change in bowel movements could be a sign of underlying conditions.

"Don't ignore a significant change in bowel movement patterns -- in terms of frequency or their form," Neal said.

"If bowel movements hurt, are frequently strained or just look or feel different, then these problems should be addressed," Neal said. Your doctor can suggest dietary changes or perhaps recommend some medication to help, he added.

Talking about your bowel movements may be taboo in polite conversation, but don't hold back potentially vital information from your doctor, Neal noted.

"Bowel movements are natural and will happen throughout your entire life. It's important to have an open discussion with your physician to make sure your digestive system is working most efficiently," Neal concluded.

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3 in 4 Teens Think E-Cigarettes Safer Than Tobacco: Survey

TUESDAY, Oct. 25, 2016 (HealthDay News) -- Close to three-quarters of American teenagers believe e-cigarettes are less harmful or addictive than real cigarettes, a new study finds.

The same can't be said for their notions about the safety of cigars and smokeless tobacco. And the perception of the safety of these products is directly related to how popular they are, the researchers added.

"E-cigarettes are now the most commonly used tobacco product among U.S. youth, and the increases in e-cigarettes' perceived safety mirrors rapid increases observed in their use," said lead researcher Dr. Stephen Amrock, from the department of medicine at Oregon Health and Science University in Portland.

"Our research thus provides a missing descriptive link into the underpinnings between these products' rising popularity," he said.

E-cigarettes, powered by battery, heat up a liquid containing nicotine, flavorings and other chemicals. The vapor is then inhaled.

Children who use e-cigarettes are more likely than those who do not to go on to use traditional cigarettes, Amrock added.

"This is not a no-risk situation. The FDA has just recently begun to consider e-cigarettes as tobacco and regulate them accordingly. That is an important part of the process in getting these products out of the hands of children," he said.

Using data from the 2012 and 2014 National Youth Tobacco Survey, Amrock and his colleagues found that 73 percent of teens believed e-cigarettes were less harmful than cigarettes. This compares with 20 percent who thought smokeless tobacco was less harmful and 26 percent who thought cigars were less harmful.

In addition, 47 percent believed that e-cigarettes were less addictive than cigarettes, but only 14 percent thought smokeless tobacco was less addictive. And, 31.5 percent believed cigars were less addictive, Amrock's team found.

Teens who thought e-cigarettes were less harmful or addictive tended to be male, white or live with someone who used these products, Amrock said.

Between 2012 and 2014, increasing numbers of teens decided that e-cigarettes were less harmful than cigarettes, he added.

The findings were published online Oct. 25 in the journal Pediatrics.

"Concern exists that e-cigarettes are re-normalizing smoking," Amrock said. "Children and parents need to understand that these products contain nicotine and are potentially harmful, both now and because they have been linked to later cigarette use."

Stanton Glantz is a professor at the University of California, San Francisco's Center for Tobacco Control, Research and Education. He said the study adds to the evidence that e-cigarettes are expanding the tobacco epidemic.

The finding that teens think e-cigarettes are less addictive than conventional cigarettes is especially concerning "because e-cigarettes are designed to deliver nicotine, the same addictive drug as [in] cigarettes," he said.

"Indeed, the ideal e-cigarette will deliver as much or even more nicotine than a conventional cigarette," Glantz added.

Compounding the problem, according to Glantz: the Obama administration directed the FDA to drop the regulation of flavors from the recent rule taking over jurisdiction of e-cigarettes.

"The effect of this deletion will delay regulation of flavors in e-cigarettes, which appeal to kids, by years, leading more kids to get addicted to nicotine," he said.

Erika Sward, assistant vice president for national advocacy at the American Lung Association, said, "We know that kids are very attracted by the flavors of e-cigarettes, and we also know that there is likely to be much more use of these products."

A recent study found that "several flavorings impacted the toxicity of e-cigarettes, and strawberry was the most toxic of the ones they found," she said.

Some in Congress are trying to weaken the FDA's authority over e-cigarettes, Sward said, "to essentially grandfather in all of these products that are on the market, so FDA can't easily remove the ones that are most dangerous.

"It's critical that Congress push back against the attempts by some to give this sweetheart deal to the e-cigarette industry. It's quite appalling," she added.

"We are seeing a threat to all of the work we have done as a nation to reduce the deadly burden of tobacco use," Sward said.

SOURCES: Stephen Amrock, M.D., department of medicine, Oregon Health and Science University, Portland; Erika Sward, assistant vice president, national advocacy, American Lung Association; Stanton Glantz, Ph.D., professor, medicine, Center for Tobacco Control, Research and Education, University of California, San Francisco; Oct. 25, 2016, Pediatrics, online

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Women Reaching Equality in Dubious Habit: Drinking

mardi 25 octobre 2016

MONDAY, Oct. 24, 2016 (HealthDay News) -- Women have made major strides towards equality with men, but new research shows there's one way in which they are catching up that could be harmful: drinking.

Women are now nearly on par with men in alcohol consumption, and the ill effects drinking has on health, a worldwide review finds.

Historically, men have been far more likely than women to drink alcohol, and to drink so much it affects their health. Older studies suggested as much as a 12-fold difference between the sexes, the researchers said.

Recent data suggests that the gap has closed. Women across the globe are now nearly as likely as men to drink and to engage in excessive, harmful drinking, said lead researcher Tim Slade. He's an epidemiologist with the National Drug and Alcohol Research Center at the University of New South Wales in Australia.

"We can no longer think of alcohol use and alcohol-related harms as problems that just affect men," Slade said.

To track trends in drinking between the genders, Slade and his colleagues pooled data from more than 4 million people who were part of 68 international studies. These studies were published between 1980 and 2014. The studies included data collected between 1948 and 2014, representing people born as far back as 1891.

The researchers focused on three categories: any alcohol use, excessive use, and health and social problems related to drinking.

Men born between 1891 and 1910 were twice as likely as their female counterparts to drink alcohol. People born between 1991 and 2000 were about equally likely to drink, the researchers found.

At the same times, the gender gap for excessive drinking fell from 3 times higher for men to 1.2 times. The gender gap for harms associated with drinking fell from 3.6 times higher for men to 1.3 times, the researchers reported.

After accounting for potential bias, the researchers concluded that the gender gap for drinking fell by 3.2 percent with each successive five-year generation, but was steepest among those born from 1966 onward.

There's no single reason why more women are drinking, Slade said. It's likely that drinking has become more socially acceptable for women as they've joined the workforce, entered higher education in greater numbers, and have become more financially independent, he said.

Dr. Victor Karpyak, an alcohol researcher at the Mayo Clinic in Rochester, Minn., agreed that social evolution likely has played a role in this trend.

"This is something which is mostly influencing access to alcohol and decisions that women in different societies make about whether they can drink, whether they can drink in public, whether they can drink in the company of males, and whether it's acceptable for women to exhibit signs of intoxication," Karpyak said.

Paul Rinaldi, director of the Addiction Institute at Mount Sinai West in New York City, said women might also be tempted to drink to deal with the pressure placed on them to be a "superwoman" and manage both a career and family life.

"There is still a mandate for women in the workplace to do it all," Rinaldi said. "I think they really do feel the pressure to juggle things in a way that is different from men."

However, Rinaldi added that older statistics might underrepresent female drinking, since many women engaged in "hidden drinking" before it became socially acceptable.

With the rise in female drinking, public health officials need to step up alcohol interventions for young adult women, especially since there's such a wide variety of health problems associated with drinking, said Dr. Geetanjali Chander. Chander is an associate professor of medicine at Johns Hopkins Medicine in Baltimore.

Women in their 20s and 30s -- "peak childbearing age" -- are more likely to have a child affected by fetal alcohol disorder, and are more likely to develop liver disease and cancers associated with alcohol use, Chander said.

"Women experience the biological consequences of alcohol use at lower levels of use than men," Chander said, noting that guidelines limit women to no more than 7 standard drinks per week compared with 14 drinks a week for men.

The new study appears online Oct. 25 in the journal BMJ Open.

SOURCES: Tim Slade, Ph.D., epidemiologist, National Drug and Alcohol Research Center, University of New South Wales, Australia; Victor Karpyak, M.D., Ph.D., alcohol researcher, Mayo Clinic, Rochester, Minn.; Paul Rinaldi, Ph.D., director, Addiction Institute at Mount Sinai West; Geetanjali Chander, M.D., M.P.H., associate professor, medicine, Johns Hopkins University, Baltimore, Md.; Oct. 25, 2016, BMJ Open, online

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Old Blood as Good as New for Transfusions, Study Finds

MONDAY, Oct. 24, 2016 (HealthDay News) -- Using the freshest blood for transfusions does not appear to boost patient survival, a new Canadian study indicates.

"It's been a contentious issue, but our study finally puts an end to the question about whether stored blood could be harmful and fresher blood would be better," said lead author Nancy Heddle. She is a professor emeritus of medicine at McMaster University, in Hamilton, Ontario.

"Our study provides strong evidence that transfusion of fresh blood does not improve patient outcomes, and this should reassure clinicians that fresher is not better," added Heddle, who is also research director of the McMaster Centre for Transfusion Research.

In the study, the researchers examined data from nearly 31,500 patients at six hospitals in the United States, Canada, Israel and Australia who received blood transfusions.

The in-hospital death rate was 9.1 percent among those who received the freshest blood and 8.7 percent among those who received the oldest blood, the findings showed.

More than 40 previous studies failed to adequately answer the question about whether the freshest blood was best, said study co-author John Eikelboom, a professor of medicine at McMaster.

"Advances in blood storage now allow blood to be stored up to 42 days before transfusion, and the usual practice is to use up the blood that has been in storage the longest. But, because there are biochemical, structural and functional changes in the blood during storage, there had been concerns about the use of 'older' blood," Eikelboom explained in a university news release.

"This study reassures us that aging is not bad -- even for blood," he added.

The findings were published Oct. 24 in the New England Journal of Medicine.

SOURCE: McMaster University, news release, Oct. 24, 2016

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Polio Nearly Vanquished: CDC

MONDAY, Oct. 24, 2016 (HealthDay News) -- Polio is almost a thing of the past, but it still exists in small pockets on the planet, U.S. health officials reported Monday.

In 1988, a global effort to eradicate polio, a disease that has crippled millions of children worldwide, began. Since then, the number of cases dropped from 350,000 to just 27 this year, according to the U.S. Centers for Disease Control and Prevention.

"We are on the brink of the eradication of polio -- we are closer than ever," CDC Director Dr. Tom Frieden said during a media briefing.

"In this period [1988-2016], 2.5 billion children have been vaccinated against polio," he said. "If it were not for this effort, an estimated 15 million more children would be disabled. Every year polio eradication is delayed, the incremental cost is about $800 million."

The battle to eradicate the disease, however, continues in areas where it is still endemic, officials added.

"The new cases in Nigeria highlight the need to improve tracking of the disease," Frieden said. "We have to redouble our efforts to get over the finish line in Pakistan and Afghanistan. Despite big obstacles, both countries are making substantial progress."

Vaccinating children in some parts of the world, such as Pakistan, Afghanistan and Nigeria, can be a dangerous task. According to published reports, workers in these areas trying to vaccinate children have been killed by extremists who believe vaccinations sterilize children or that workers are Western spies.

The Global Polio Eradication Initiative is made up of five groups: the CDC, Rotary International, the World Health Organization (WHO), United Nations Children's Fund (UNICEF) and the Bill and Melinda Gates Foundation, Frieden said.

"We will get to a day when polio is history," Frieden said.

Finally eradicating polio is going to cost $1.5 billion, John Germ, president of Rotary International, said during the media briefing.

"If we don't get the funding, polio is going to spread again, and it's going to cost us billions of dollars and hundreds of thousands of lives a year for the children that we must protect against this virus," he said. "It can cost us a dream of a polio-free world."

No cure for polio exists -- it can only be prevented. The polio vaccine can protect a child for life, health officials said.

Despite the progress seen since 1988, "as long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease," according to WHO. The virus can easily be imported into a polio-free country and can spread rapidly among unvaccinated populations.

"Failure to eradicate polio could result in as many as 200,000 new cases every year, within 10 years, all over the world," WHO says.

"Polio is almost defeated," Reza Hossaini, director of polio eradication at UNICEF, said during the briefing. But, "the recent cases in Nigeria remind us that almost is not good enough."

SOURCES: Oct. 24, 2016, media briefing with Tom Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention; John Germ, 2016-2017 president, Rotary International; Reza Hossaini, director, polio eradication, United Nations Children's Fund

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Coffee's Impact a Matter of Genes?

lundi 24 octobre 2016

FRIDAY, Oct. 21, 2016 (HealthDay News) -- Why can some people enjoy a cup of coffee just before bed and sleep peacefully, while others lie awake for hours?

A new study suggests genes may hold the answer.

"Each of us could be potentially responding to caffeine differently, and it's possible that those differences can extend beyond that of caffeine," said study author Marilyn Cornelis. She is an assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

In earlier research, Cornelis linked variations in genes to patterns of coffee consumption. In the new study, she looked for connections between these gene variations and chemicals that appear in the blood after people consume caffeine.

She found that gene variants linked to lower levels of caffeine chemicals -- which suggest faster caffeine metabolism -- are the same variants previously linked to higher levels of coffee consumption.

Cornelis' team also came across something unusual: a gene that may be connected to both caffeine metabolism and the metabolism of glucose and lipids.

"How this gene relates to both caffeine metabolism and caffeine-seeking behavior is unclear but worthy of further study, given its link to several health outcomes," Cornelis said in a university news release.

In the big picture, she said, "the study further re-emphasizes the notion that not everyone responds to a single cup of coffee or other caffeinated beverage in the same way."

The study findings are based on an analysis of caffeine chemicals and genes in almost 10,000 people of European descent.

The study was published recently in the journal Human Molecular Genetics.

SOURCE: Northwestern University, press release, Oct. 17, 2016

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Many Adults Unaware That Using E-Cigarettes Can Hurt Kids

FRIDAY, Oct. 21, 2016 (HealthDay News) -- Many Americans don't know that indoor use of electronic cigarettes exposes children to nicotine and leaves nicotine deposits on surfaces, a new survey shows.

"E-cigarettes primarily emit a toxic aerosol, not harmless water vapor," said Robert McMillen, an associate professor of psychology at Mississippi State University, who was the author of the report.

"Unfortunately, many parents are unaware of the risk that exposure poses for their children and do not implement household rules to protect their children," McMillen said in a news release from the American Academy of Pediatrics.

In a survey of more than 3,000 adults in 2015, McMillen and his colleagues found: 68 percent did not allow e-cigarette use in their homes; more than three-quarters banned the battery-operated devices from the car; and over eight in 10 said e-cigarettes should not be allowed in places with smoking bans. About three-quarters also said it was unacceptable for parents to use e-cigarettes in front of children.

However, many adults were not clear about the potential dangers of e-cigarettes, the researchers also found.

Only 37 percent of the respondents knew that exhaled e-cigarette vapor contains nicotine or that using e-cigarettes indoors deposits nicotine on surfaces.

And almost half of the adults did not know that e-cigarette use around children exposes them to nicotine, according to the survey.

Who was less likely to forbid e-cigarette use at home or support restrictions on use of the devices?

Smokers, e-cigarette users, males, 18- to 24-year-olds with lower levels of education, and adults without children in the home, according to the survey.

Smokers, e-cigarette users and less-educated adults were also less likely to believe that e-cigarette use posed risks to children. Older adults and adults with kids in the household were more likely to be uncertain about potential harms.

McMillen said parents need to be educated about the risks that e-cigarette emissions pose to children and the need to ban tobacco use and e-cigarette use from their homes and cars.

The survey results are to be presented Saturday at the American Academy of Pediatrics' annual meeting, in San Francisco. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

SOURCE: American Academy of Pediatrics, news release, Oct. 21, 2016

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Tips for Keeping Halloween Safe and Fun

(*this news item will not be available after 01/19/2017)

By Mary Elizabeth Dallas

Friday, October 21, 2016

FRIDAY, Oct. 21, 2016 (HealthDay News) -- Trick-or-treating, bobbing for apples and costume parties are just a few things kids love about Halloween, but holiday fun can put them at risk, health experts warn.

The U.S. Department of Health and Human Services offers parents these tips to help keep Halloween safe and fun:

Beware of sugar overload. Don't trick-or-treat on an empty stomach. Make sure your children have a light meal or healthy snack before heading out.
Keep an eye out for candy tampering. Always check kids' candy before letting them eat it. Discard anything that looks discolored or odd, has pinholes or torn wrappers.
Avoid allergy triggers. Teach kids with allergies to search for allergens on the ingredients list of any treats they receive. They should never eat home-baked goods.
Remove choking hazards. Very young children should not be allowed to have treats that could cause choking, such as gum, peanuts, hard candies or small toys.
Guard against foodborne illnesses. If apples or raw fruit are on your party menu, wash them thoroughly under running water and scrub with a produce brush before serving. Remember that unpasteurized juice or cider as well as raw cookie dough or batter can contain harmful bacteria. Chill all perishable foods until serving time and don't leave them out at room temperature for more than two hours.
Put a new spin on bobbing for apples. It's a Halloween party tradition, but it can expose kids to harmful bacteria. Consider alternatives such as cutting apples out of construction paper, writing fun activities on them and putting a paperclip on each one. Kids can "fish" for an apple with a magnet tied to a string.

SOURCE: U.S. Department of Health and Human Services, news release

HealthDay

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Cartilage from Nose Used to Repair Bum Knees

vendredi 21 octobre 2016

THURSDAY, Oct. 20, 2016 (HealthDay News) -- Using cells from the cartilage in patients' noses, Swiss doctors have successfully made patches to treat 10 adults whose knee cartilage was damaged by injury.

Two years after the transplants, most of the patients grew new cartilage in their knees and reported improvements in pain, knee function and quality of life.

"We have developed a new, promising approach to the treatment of articular cartilage injuries," said lead researcher Ivan Martin, a professor of tissue engineering at the University of Basel. The articular cartilage is the tissue that covers and protects the ends of the knee bones, and injuries to it can lead to degenerative joint conditions like osteoarthritis.

Although the results of this preliminary trial are encouraging, more research is needed before this technique could become widely available, Martin stressed.

"Before this can be offered to patients as a standard treatment, obviously it needs to be tested in a larger number of patients and in randomized trials with long-term assessment of clinical outcomes," Martin said.

The report was published Oct. 22 in The Lancet.

One joint repair expert welcomed the new approach.

"Treatment of cartilage injuries remains a significant clinical problem, and there is no gold standard treatment and no optimal treatment available," said Dr. Nicole Rotter, vice chair of the department of otorhinolaryngology at Ulm University in Germany.

Using cells from the nose for joint repair is completely new, added Rotter, who co-wrote an editorial accompanying the study. "Nasal cartilage might be a great source for cartilage repair; however, further clinical studies are required," she said.

For the study, Martin and colleagues took a small sample of cartilage cells from the patient's nose bone, then grew more cells by exposing them to growth hormone for two weeks. All the cells were then placed in a membrane of collagen and cultured for two more weeks.

The engineered graft was cut into the right shape and used to replace damaged cartilage after it was surgically removed from the patient's knee.

With the procedure, only a small sample of cells is taken from the nose, using a local anesthetic. After the knee is repaired, the patient is on crutches for six to eight weeks. It typically takes several months for a full recovery, the researchers said.

Two years after the procedure, MRI scans revealed that new tissue had developed that was similar to normal knee cartilage. In addition, nine patients reported improvements in the use of their knee and less pain. One patient was excluded because of several new sports injuries.

No bad reactions were reported, but two serious adverse events unrelated to the procedure occurred -- an independent injury in the untreated knee and new cartilage damage in other areas of the treated knee, the researchers said.

Dr. Matthew Hepinstall, an orthopaedic surgeon at Lenox Hill Hospital Center for Joint Preservation and Reconstruction in New York City, welcomed the new findings.

Even small articular cartilage injuries can cause pain, limit walking and running, and restrict joint motion, Hepinstall said. "Over time, surrounding healthy cartilage can deteriorate -- resulting in arthritis," he added.

A variety of surgical procedures have been developed to fill "potholes" in articular cartilage, with varying success, he said.

For the last two decades, surgeons have been able to take cartilage cells from the knee, grow them in a lab, and put them back into a patient's knee, Hepinstall said.

But that procedure requires two operations, Hepinstall noted.

This new study demonstrates the plausibility of taking cartilage cells from the nose in a less invasive procedure that only requires a local anesthetic, he said.

"If the study results can be duplicated and extended to a larger number of patients, this is a step forward in articular cartilage restoration, and I applaud the research efforts," Hepinstall said.

SOURCES: Ivan Martin, Ph.D., professor, tissue engineering, University of Basel, Switzerland; Nicole Rotter, M.D., vice chair, department of otorhinolaryngology, Ulm University, Germany; Matthew Hepinstall, M.D., orthopaedic surgeon, Lenox Hill Hospital Center for Joint Preservation and Reconstruction, New York City; Oct. 22, 2016, The Lancet

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Is It Really True That Chocolate May Be Good for You?

THURSDAY, Oct. 20, 2016 (HealthDay News) -- A new analysis of existing studies provides more support for the idea that cocoa in chocolate may actually be good for you.

But be cautious if you're tempted to raid the candy aisle: While it seems to be beneficial, the impact of chocolate on day-to-day health isn't clear.

And the researchers aren't ready to offer recommendations about exactly how much chocolate -- and what type -- provides benefits that outweigh its unhealthy effects.

Whatever the case, "when balancing the benefits and risks," said study lead author Xiaochen Lin, users "shouldn't ignore the calories and sugar that may come with chocolate." Lin is a graduate student at Brown University in Providence, R.I.

At issue: What do we know overall about the health effects of flavanols -- a component of the cocoa in chocolate -- on cardiovascular and metabolic systems? To gain more perspective, Lin and her colleagues reviewed 19 controlled trials that involved a total of 1,131 participants eating cocoa flavanols or a placebo.

The participants assigned to consume the flavanols either ate or drank as little as 166 milligrams a day or as much as 2,110 milligrams. They consumed the foods for as little as two weeks or as long as a year.

The amount of flavanols is not standard among chocolate products. A 2011 study in the Journal of Agricultural and Food Chemistry found that flavanol levels varied widely among popular dark chocolate candy products, although there were more than in milk or white chocolate.

With funding from the U.S. National Institutes of Health and the Mars candy company as well as the American Heart Association and drug maker Pfizer, the researchers found that those who ate the cocoa flavanol foods had lower levels of triglycerides, potentially boosting cardiovascular health. Also, tests suggested their bodies were doing a better job of controlling inflammation and blood sugar.

And "good" cholesterol levels also rose slightly in those who ate the cocoa flavanol foods, the analysis showed.

According to Lin, these differences were "small-to-modest" but still significant from a statistical perspective. The studies also suggest that the effects are the same regardless of whether people are overweight or have certain other health problems.

At this point, Lin said, there's no way to know whether the apparent beneficial effect of chocolate will actually affect people's health in a significant way. The authors of the analysis are calling for more research to gain insight into how the "short-term" apparent benefits revealed by the studies may affect people over the long term.

For now, Lin and her colleagues don't know what to tell people about the best levels of chocolate consumption. However, the researchers do note that most of the studies looked at dark chocolate (also known as "bittersweet" or "semisweet" chocolate) specifically.

According to the University of Michigan, dark chocolate has high levels (more than 60 percent) of cocoa and little or no added sugar.

"The findings from the current study apparently shouldn't be generalized to different sorts of chocolate candies or white chocolates" since they could have different levels of sugar and fat, said study co-author Dr. Simin Liu. He is director of the Center for Global Cardiometabolic Health at Brown University.

Why might chocolate be good for you?

John Finley, an adjunct professor of nutrition and food sciences at Louisiana State University, said cocoa flavanols may be beneficial because they fight off inflammation, which is linked to diabetes and heart disease.

Cocoa "is likely to be beneficial along with other approaches to improving health," he said. But, he added, "cocoa is frequently combined with high-sugar products, which would be likely to cancel any benefits."

Finley, who was not involved with the study, recommends taking cocoa flavanols through cocoa supplements -- they are available in sugar-free forms -- or as an addition to otherwise beneficial foods.

"I actually add it to oatmeal every day," he said, sprinkling on 25 grams of cocoa -- roughly 2 rounded tablespoons.

"I also suggest the extra-dark cocoa. It tastes better and may have more benefits," Finley said.

The report was published recently in The Journal of Nutrition.

SOURCES: Xiaochen Lin, graduate student, and Simin Liu, M.D., Sc.D., director, Center for Global Cardiometabolic Health, Brown University, Providence, R.I.; John Finley, Ph.D., adjunct professor, Nutrition and Food Sciences, Louisiana State University, Baton Rouge; Sept. 28, 2016, The Journal of Nutrition

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Is It Really True That Chocolate May Be Good for You?

Mediterranean Diet, Caffeine May Be Good for Your Eyes

THURSDAY, Oct. 20, 2016 (HealthDay News) -- Eating a Mediterranean diet and consuming caffeine may lower your chances of developing age-related macular degeneration (AMD), a leading cause of blindness, according to a new study.

Previous research has shown that a Mediterranean diet -- high in fruits, vegetables, whole grains, nuts, healthy fats and fish -- benefits the heart and lowers cancer risk. But there has been little research on whether it helps protect against eye diseases such as AMD, the researchers noted.

Using questionnaires, the researchers assessed the diets of 883 people, aged 55 and older, in Portugal. Of those, 449 had early stage AMD and 434 did not have the eye disease.

Closely following a Mediterranean diet was associated with a 35 percent lower risk of AMD, and eating lots of fruit was especially beneficial.

The researchers also found that people who consumed high levels of caffeine seemed to have a lower risk of AMD. Among those who consumed high levels of caffeine (about 78 milligrams a day, or the equivalent of one shot of espresso) 54 percent did not have AMD and 45 percent had the eye disease.

The researchers said they looked at caffeine consumption because it's an antioxidant known to protect against other health problems, such as Alzheimer's disease.

However, the study did not prove that consuming coffee and following a Mediterranean diet caused the risk of AMD to drop.

The findings were to be presented this week at the annual meeting of the American Academy of Ophthalmology (AAO), in Chicago.

"This research adds to the evidence that a healthy, fruit-rich diet is important to health, including helping to protect against macular degeneration," lead author Dr. Rufino Silva, a professor of ophthalmology at the University of Coimbra, in Portugal, said in an AAO news release.

"We also think this work is a stepping stone towards effective preventive medicine in AMD," Silva added.

Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

SOURCE: American Academy of Ophthalmology, news release, Oct. 16, 2016

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'Fake Pills' May Help Ease Back Pain

jeudi 20 octobre 2016

WEDNESDAY, Oct. 19, 2016 (HealthDay News) -- Even if they know the pills are fake, chronic back pain sufferers may get relief from placebo drugs, a new study indicates.

Researchers found that patients who knowingly took a placebo pill while undergoing traditional treatment for lower back pain had less pain and disability than those who received traditional treatment alone.

"These findings turn our understanding of the placebo effect on its head," said Ted Kaptchuk, a joint senior author of the study and director of the Program in Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center in Boston.

"This new research demonstrates that the placebo effect is not necessarily elicited by patients' conscious expectation that they are getting an active medicine, as long thought," Kaptchuk added in a hospital news release. "Taking a pill in the context of a patient-clinician relationship -- even if you know it's a placebo -- is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms."

Kaptchuk's team gave 97 patients with chronic low back pain a 15-minute explanation of the placebo effect. Most were already taking medications for their pain, including non-steroidal anti-inflammatories (NSAIDS). None was taking strong prescription painkillers known as opioids.

The patients were divided into two groups: those who only received traditional treatment and those who used traditional treatment along with a placebo pill. The dummy pills were provided in a bottle labeled "placebo pills," so it was clear they were a sham medication.

After three weeks, the placebo group experienced a 30 percent reduction in their usual and maximum pain levels. The traditional treatment group reported a 9 percent drop in their usual amount of pain and a 16 percent reduction in their maximum pain, the researchers said

Pain-related disability was essentially unchanged among those who only received the traditional treatment, while those who took the placebo pill experienced a 29 percent drop in disability.

"It's the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our health care system," Kaptchuk said in the news release. "The body responds to that."

The study authors said people with other conditions that cause pain, fatigue, common digestive or urinary symptoms or depression may benefit from knowingly taking placebo pills.

"You're never going to shrink a tumor or unclog an artery with placebo intervention," Kaptchuk said. "It's not a cure-all, but it makes people feel better, for sure."

The researchers noted, however, that the effectiveness of placebo pills also hinges on a strong doctor-patient relationship.

"Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered," said study lead author Claudia Carvalho of the Instituto Superior de Psicologia Aplicada (ISPA) in Lisbon, Portugal. "Taking placebo pills to relieve symptoms without a warm and empathic relationship with a health-care provider probably would not work."

The study results were published Oct. 13 in the journal Pain.

SOURCE: Beth Israel Deaconess Medical Center, news release, Oct. 13, 2016

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