novembre 2016

Having Trouble Hearing? Maybe It's Not Your Ears

mercredi 30 novembre 2016

TUESDAY, Nov. 29, 2016 (HealthDay News) -- Seniors who struggle to make out what people are saying around the dinner table or on a noisy street may have perfectly "normal" hearing. The problem could actually be in the brain, a new study suggests.

Trouble processing conversations in a loud setting may indicate that the brain's ability to quickly and easily process speech is diminished.

The findings demonstrate that "separately from any typical hearing loss that might occur as we age, our brains also get worse at processing the sound of talking when there are other sounds at the same time," said study co-author Jonathan Simon. He's an associate professor at the University of Maryland's Institute for Systems Research.

"The background noise may not even be considered especially loud by younger listeners," he noted.

But "the implication is that typical older adults need to exert more effort, and take more time, in order to understand what someone is saying to them when there's also noise, even only moderate noise, around them," Simon explained.

About one in three Americans aged 65 to 74 has some degree of hearing loss, according to the U.S. National Institute on Deafness and Other Communication Disorders. For those 75 or older, half have difficulty hearing.

The new study included 17 young adults (aged 18 to 27) and 15 older adults (aged 61 to 73). All had normal hearing and were dementia-free.

All had a series of hearing tests, some of which included background noise. All also underwent brain scans focused on two regions of the brain: the midbrain, which controls basic sound processing; and the cortex, which is critical to speech comprehension.

Younger adults performed significantly better than seniors in both quiet and noisy settings. But the researchers found that noisy settings were more challenging for seniors.

The scans suggested why.

Midbrain scans revealed that neurological signaling related to hearing was weaker among the older study participants. And cortex scans suggested that auditory information took longer to process among seniors than young adults.

Why? The study authors theorized that the problem could trace back to normal age-related nerve impairment that undermines signaling and communication between nerve cells in the brain.

Regardless, the bottom line was clear: seniors often have to expend more effort to hear, and often end up with worse results.

"Typical seniors who have difficulty understanding what someone is saying in a noisy room will have both kinds of degradation," said Simon, referring to loss of actual hearing function as well as brain-processing problems.

And that means that while hearing aids "may be an important part of any solution to general problems with hearing," they don't solve the whole problem, Simon said.

The solution, he added, could be a kind of physical therapy for hearing and speech recognition.

"There is -- in theory, not yet in practice -- a real possibility of restoring enough of the youthful aspects of the brain to help with this problem," Simon said.

Robert Frisina directs the University of South Florida's Global Center for Hearing and Speech Research, in Tampa. Though he was not involved with the new research, he called "the Maryland study a good advance in this area."

"Now, it is pretty well accepted that neurodegenerative changes in the parts of the brain used for hearing play a significant role in age-linked hearing loss and speech perception problems, particularly in background noise," he said.

"As the aging brain is understood more and more at molecular levels, these molecular changes become the prospective targets for drug or medication interventions," Frisina added.

Future interventions may ultimately involve a combination of both hearing therapy and cutting-edge medicine, Frisina said.

The study was published recently in the Journal of Neurophysiology.

SOURCES: Jonathan Z. Simon, Ph.D., associate professor, department of electrical and computer engineering, department of biology, and Institute for Systems Research, University of Maryland, College Park, Md.; Robert D. Frisina Ph.D., professor of chemical and biomedical engineering and communication sciences and disorders, and director, Global Center for Hearing and Speech Research, University of South Florida, Tampa; Nov. 15, 2016, Journal of Neurophysiology

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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Having Trouble Hearing? Maybe It's Not Your Ears

Scientists Spot 'Teetotaler' Gene

TUESDAY, Nov. 29, 2016 (HealthDay News) -- Scientists say they've identified a gene variant that dampens the desire to drink alcohol.

They said their discovery might lead to the development of drugs that could control alcohol consumption, possibly even among problem drinkers.

This variation of the beta-Klotho gene was pinpointed through genetic research involving more than 105,000 light and heavy social drinkers. Alcoholics were not included in the research, the study authors said.

Participants provided genetic samples and answered questionnaires on their weekly drinking habits.

Heavy drinking was defined as more than 21 drinks per week for men and more than 14 drinks per week for women. Light drinking was considered to be 14 drinks or less per week for men and seven drinks or less per week for women. A "drink" was the equivalent of a small glass of wine, or a half pint of beer.

"The study identified a variation in the [beta]-Klotho gene linked to the regulation of social alcohol consumption. The less frequent variant -- seen in approximately 40 percent of the people in this study -- is associated with a decreased desire to drink alcohol," said study co-corresponding author David Mangelsdorf. He is chair of pharmacology at University of Texas Southwestern Medical Center in Dallas.

"Excessive alcohol consumption is a major public health problem worldwide, causing more than 3 million deaths per year," said study co-corresponding author Steven Kliewer, a professor of molecular biology and pharmacology at UT Southwestern.

"Much of the research on alcohol consumption has focused on addiction. However, the overall burden of alcohol-associated disease reflects the total amount of alcohol consumed, not just addiction," he said in a university news release.

Having people shift from heavy to moderate social drinking could have significant public health benefits, such as reduced heart disease risk, the researchers said.

Heavy drinking is linked to two heart disease risk factors in particular, high blood pressure and obesity, according to the American Heart Association.

The study was published online Nov. 28 in the Proceedings of the National Academy of Sciences.

SOURCE: University of Texas Southwestern Medical Center, news release, Nov. 28, 2016

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Smoking Raises Heart Attack Risk 8-Fold in People Under 50

TUESDAY, Nov. 29, 2016 (HealthDay News) -- All smokers face a higher risk of heart attack, but the threat is particularly high among those under 50, a new study finds.

Compared to former smokers and nonsmokers in their age group, heart attack risk was nearly 8.5 times higher for smokers younger than 50, British researchers found.

One expert in smoking and health who reviewed the report said the findings underline the importance of keeping youth and cigarettes apart.

"Through comprehensive tobacco-control programs that include environmental smoking bans, high taxes on cigarettes, and anti-tobacco media campaigns, we can decrease the rates of smoking/tobacco use, heart disease and many other health conditions," said Patricia Folan. She directs the Center for Tobacco Control at Northwell Health in Great Neck, N.Y.

The study found that smokers at older ages faced higher heart risks, as well. Compared to former smokers and nonsmokers in their age group, smokers aged 50 to 65 were at five times higher risk of heart attack, and smokers over 65 had a three times higher risk, the findings showed.

"All the patients who smoke tell us they wish they had quit sooner, before their health was compromised, but they just didn't know how to do it," Folan noted.

For the study, researchers led by Dr. Ever Grech, of Northern General Hospital in Sheffield, England, analyzed data from more than 1,700 adult heart attack patients in northern England.

The researchers found that 48.5 percent were current smokers, about 27 percent were former smokers and 24 percent were nonsmokers.

Current smokers tended to be a decade younger than former smokers or nonsmokers when they suffered their heart attack, the data showed.

Compared to nonsmokers, current and former smokers were two times more likely to have a previous history of heart disease, and three times more likely to have peripheral artery disease, in which clogged blood vessels restrict blood flow to the legs, according to the report.

Overall, smokers had a more than tripled risk of heart attack than former smokers or nonsmokers combined, Grech's group found.

Younger smokers tended not to have other heart attack risk factors seen in older smokers, such as high blood pressure, high cholesterol and diabetes. This suggests that smoking may be the most important risk factor for heart attack in younger smokers, the researchers said. Also, other research has shown that the fatty deposits in the arteries of smokers are more likely to rupture.

Folan said the findings "highlight the need for more intense treatment of younger smokers, as well as preventive measures targeting adolescents and young adults."

The bottom line, she said, is that "it is never too early or too late to start talking to patients about quitting smoking."

The study was published online Nov. 29 in the journal Heart.

SOURCES: Patricia Folan, D.N.P., director, Center for Tobacco Control, Northwell Health, Great Neck, N.Y.; Heart, news release, Nov. 29, 2016

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Smoking Raises Heart Attack Risk 8-Fold in People Under 50

Fast-Food Calorie Labeling Not Working, Study Finds

mardi 29 novembre 2016

MONDAY, Nov. 28, 2016 (HealthDay News) -- Does it help to know that a double quarter-pounder with cheese delivers 740 calories? Probably not, a new study suggests.

Starting next May, fast-food chains with more than 20 locations in the United States must display calorie counts on menus. But this study questions whether the well-intended regulations will actually steer customers to less-fattening foods.

Research in Philadelphia, where such rules already exist, indicate as few as 8 percent of fast-food eaters make healthy choices based on menu calorie counts, the study found.

"I believe menu labeling has been an important policy effort to combat a public health problem for which we have few solutions," said study author Andrew Breck.

"The success of such a calorie-labeling campaign, however, requires that target consumers simultaneously see the calorie labels, are motivated to eat healthfully, and understand how many calories they should be eating," said Breck. He is a doctoral candidate at NYU Wagner Graduate School of Public Service in New York City.

Simply presenting calorie information is not enough, he and his colleagues stressed.

To be effective, nutrition labeling must be clearer and larger. It must also reach regular fast-food eaters -- people who expressed more concern with cost and convenience than nutrition, Breck and his colleagues found.

The trend toward nutrition labeling on fast-food menus began in response to the U.S. obesity epidemic. About 38 percent of adults and 17 percent of teenagers are obese, according to the U.S. Centers for Disease Control and Prevention. Obesity has been linked to a greater risk of high blood pressure, stroke, diabetes, cancer, and other health issues.

Philadelphia in 2010 required fast-food restaurants to post the caloric, fat and sodium content of meals. New York City and Seattle already had similar rules.

But based on interviews with 1,400 people in Philadelphia, Breck's team concluded that significant labeling improvements are needed for such laws to have an impact.

The researchers analyzed responses from about 700 customers at 15 fast-food eateries in Philadelphia and another 700 people interviewed by phone.

Nutrition postings went unnoticed by nearly two-thirds surveyed at the restaurants and one-third questioned by phone, the investigators found.

To increase visibility of calorie content, the study authors recommended increasing the type size or color contrast of calorie information on menus and menu boards.

Making these numbers more apparent could have another effect as well, the researchers suggested.

"We are hopeful that highly visible posting of calorie content on menus may also cause some restaurants to add new, more healthful options to their menus," Breck said.

But customers must first know what their recommended caloric intake should be -- and many don't, the study found.

Less than half of those surveyed at the restaurants correctly estimated the number of calories they should consume daily, Breck said.

To put calorie content into perspective, Breck would like to see statements like this on fast-food menu boards: "2,000 calories a day is used for general nutrition advice, but calorie needs vary."

"Traffic-light or stop-sign type labeling indicating the healthfulness of food items is another example of a policy that has proven successful in laboratory settings in improving consumer choice," Breck said. But whether it would work in real-world settings isn't yet known.

Finally, Breck said, successful nutrition labeling must provide information that differs from consumers' expectations of how many calories foods contain.

Connie Diekman, director of university nutrition at Washington University in St. Louis, said calorie posts are just a start in improving the nation's eating behaviors.

"Awareness is the first step in the change process, so if consumers begin to see the numbers, eventual change is possible," Diekman said.

Motivation is also critical, she said, "and achieving that requires time, education, a desire to change, and an environment that supports the changed behaviors."

As a society, Diekman added, "we have a ways to go to provide an environment that encourages and supports healthy eating."

The study was published online recently in the Journal of Public Policy & Marketing.

SOURCES: Andrew Breck, Ph.D. candidate, Wagner Graduate School of Public Service, New York University, New York City; Connie Diekman, M.Ed, R.D., director of university nutrition, Washington University in St. Louis; October 2016, Journal of Public Policy & Marketing, online

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Fast-Food Calorie Labeling Not Working, Study Finds

Texas Reports 1st Likely Case of Local Zika Infection

MONDAY, Nov. 28, 2016 (HealthDay News) -- Texas reported its first possible case of locally transmitted Zika infection on Monday. If confirmed, Texas would join Florida as the only states with local transmissions of the mosquito-borne illness linked to birth defects.

The case involves a woman who lives in Brownsville, near Mexico, and she had no travel-related risk factors for Zika infection, the U.S. Centers for Disease Control and Prevention said. The virus is typically spread through the bite of the Aedes aegypti mosquito, although it can also be transmitted through sexual contact.

"Even though it is late in the mosquito season, mosquitoes can spread Zika in some areas of the country," CDC Director Dr. Tom Frieden said in an agency news release. "Texas is doing the right thing by increasing local surveillance and trapping and testing mosquitoes in the Brownsville area."

As of Nov. 23, an estimated 182 of more than 4,400 reported cases of Zika infection in the United States were spread by mosquitoes, according to the CDC. Most of the infections reported in the United States occurred in areas of Latin America and the Caribbean, where Zika cases have been at epidemic proportions.

Thirty-six of the cases in the United States were believed to be sexually transmitted and one was the result of a laboratory exposure. Those numbers do not include the Texas case, the CDC said.

Most adults who are infected with Zika experience mild symptoms. But, the babies of women who are infected while pregnant can experience devastating birth defects, the most common of which has been microcephaly, where the brain is underdeveloped and the head is abnormally small.

And surprising new research released last week reported that fetuses exposed to the Zika virus can look normal at birth but later show signs of microcephaly and other brain abnormalities.

In that study, scientists found that 13 infants in Brazil who were exposed to the virus in the womb had normal head size as newborns, but subsequently experienced slower head growth.

Eleven of these babies were diagnosed with microcephaly and other neurologic complications associated with Zika syndrome, the researchers reported.

"Among infants of mothers exposed to Zika virus during pregnancy, the absence of microcephaly at birth does not rule out congenital Zika virus infection or the presence of Zika-related brain abnormalities," the CDC said in a news release.

The findings from last week, released by U.S. and Brazilian researchers, underscore the need for continuing evaluation of newborns with possible exposure to Zika in the womb, the CDC said.

The findings also highlight the "importance of early neuroimaging for infants who were exposed to Zika virus prenatally," the agency added.

Although these babies all tested positive for Zika exposure in the womb, abnormal head growth wasn't detected until at least 5 months of age, according to the report.

The CDC urges residents -- especially pregnant women -- to take steps to protect themselves from mosquito bites. They should use an insect repellent registered by the Environmental Protection Agency containing one of the following ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus or para-menthane-diol, or 2-undecanone. They should also wear long-sleeved shirts and long pants, use or repair screens on windows and doors, use air conditioning when available, and remove standing water inside and outside where mosquitoes can lay eggs.

The CDC also says:

Zika is spread to people primarily through the bite of infected Aedes species mosquitoes, which are found in Brownsville.
A pregnant woman can pass Zika virus to her fetus during pregnancy or during birth.
A person infected with Zika virus can pass it to sex partners.
No vaccines or treatments are currently available to treat or prevent Zika infections.

SOURCES: Nov. 28, 2016, news release, U.S. Centers for Disease Control and Prevention; CDC's Morbidity and Mortality Weekly Report, Nov. 22, 2016

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Pesticide Exposures May Alter Mouth Bacteria

MONDAY, Nov. 28, 2016 (HealthDay News) -- Pesticide exposure may change the makeup of bacteria in the mouths of farm workers, a new study finds.

Researchers at the University of Washington analyzed swabs taken from the mouths of 65 adult farm workers and 52 adults who didn't work on farms. All lived in Washington's Yakima Valley.

The farm workers had higher blood levels of pesticides, and greater changes in their mouth bacteria than non-farm workers, the study found.

The most significant finding was in farm workers who had the organophosphate pesticide Azinphos-methyl in their blood.

In this group, researchers found significantly reduced quantities of seven common groups of oral bacteria. Among those was Streptococcus, which first author Ian Stanaway called "one of the most common normal microbiota in the mouth." He's a doctoral candidate in environmental toxicology.

Stanaway noted that previous studies have found that "changes in species and strains of Streptococcus have been associated with changes in oral health."

The changes noted in this new study persisted into the winter, long after the growing season when pesticide use is highest, the researchers said.

The study doesn't establish a direct cause-and-effect relationship, however.

The results were published recently in the journal Applied and Environmental Microbiology.

With this discovery, "the challenge becomes, what does this mean? We don't know," principal investigator Elaine Faustman said in a journal news release. Faustman is a professor in the university's Department of Environmental and Occupational Health Sciences.

"We depend on the microbiome for many metabolic processes," she said.

SOURCE: Applied and Environmental Microbiology, news release, Nov. 11, 2016

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How to Prevent Spread of The Skin Infection Impetigo

lundi 28 novembre 2016

SUNDAY, Nov. 27, 2016 (HealthDay News) -- Impetigo is a contagious skin infection that's preventable and can be treated with antibiotics, the U.S. Food and Drug Administration says.

It's common among kids, but adults can get impetigo, too. The telltale signs are blisters or sores, usually on the face, neck, hands and diaper area.

Impetigo can strike anytime but is more common during warm weather months. More than 3 million cases a year occur in the United States.

It's caused by two types of bacteria that are usually harmless. They can trigger infection when someone suffers a minor cut, scrape or insect bite.

"We typically see impetigo with kids 2 to 6 years old, probably because they get more cuts and scrapes and scratch more. And that spreads the bacteria," FDA pediatrician Dr. Thomas Smith said in an agency news release.

Symptoms include itchy rash; itchy red sores that fill with fluid and then burst, forming a yellow crust; and fluid-filled blisters. The condition is usually treated with topical or oral antibiotics.

Left alone, impetigo often clears up on its own after a few days or weeks, Smith said. It's important to keep the infected area clean and avoid scratching. The problem with leaving it untreated is that it could spread to other areas of the body and to other people.

"To spread impetigo, you need fairly close contact -- not casual contact -- with the infected person or the objects they touched," Smith said.

To prevent the spread of impetigo, he recommended cleaning infected areas with soap and water; loosely cover scabs and sores until they heal; gently remove crusty scabs; and wash hands thoroughly after touching infected areas or persons.

Smith also recommended not touching items used by a person with impetigo, such as utensils, clothing, towels, sheets and toys. If you have impetigo, he suggested not scratching and keeping fingernails short so the bacteria can't live under your nails.

SOURCE: U.S. Food and Drug Administration, news release

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Hitting the Slopes? Keep These Safety Tips in Mind

(*this news item will not be available after 02/24/2017)

By Mary Elizabeth Dallas

Saturday, November 26, 2016

SATURDAY, Nov. 26, 2016 (HealthDay News) -- Multi-passenger gondolas and high-speed chairlifts let skiers and snowboarders tackle more trails than ever before, but those who are tired are more apt to lose control and put themselves or others at risk, according to the National Ski Areas Association (NSAA).

Before you hit the slopes, the group urges you to get into shape. Once on the mountain, stop and rest when necessary.

These added steps will help you stay injury-free:

Have the right equipment. Get ski or snowboard bindings properly adjusted at a ski shop. Good equipment can also be rented at resorts.
Wear the right clothes. Choose garments made with high-quality water- and wind-resistant fabric. Look for design features to keep cold air out, including fabric flaps over zippers, fitted cuffs at wrists and ankles, collars that can be cinched up to the chin and adjustable drawstrings.
Dress in layers. Wearing multiple layers allows you to add or remove items if you are too cold or too hot. Choose a bottom layer that dries quickly and absorbs sweat to stay warm. Wear a turtleneck, sweater and jacket on top.
Expect fickle weather. Carry a hat or headband. Wear gloves or mittens. Be aware of changing conditions. Skiers and snowboarders may speed up on hard or icy slopes.
Use sunscreen. The sun reflects off the snow. It's important to protect your skin from harmful UV rays -- even on cloudy days.
Protect your eyes. Use sunglasses or goggles so you can see potential hazards.
Take a class. Qualified instructors can help you perfect your technique and become a more controlled skier or snowboarder.
Stay focused. It's important to stay in control mentally as well as physically on the slopes.
Play it safe. If you end up on a trail that is beyond your ability, remove your skis or snowboard and sidestep down the slope.

The NSAA says it's also important to warm up on easy trails before tackling more advanced runs and to drink plenty of water throughout the day. Remember: Winter sports, alcohol and drugs don't mix. Stay sober on the trails.

SOURCE: National Ski Areas Association

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Elder Abuse Often Missed in ER

FRIDAY, Nov. 25, 2016 (HealthDay News) -- About 10 percent of American seniors suffer elder abuse, yet the problem is often missed in hospital emergency departments, a new study finds.

Researchers reviewed national data and found that emergency doctors make a formal diagnosis of such cases in only 1 of 7,700 visits by seniors.

"These findings indicate that the vast majority of victims of elder abuse pass through the emergency department without the problem being identified," study senior author Dr. Timothy Platts-Mills, an assistant professor of emergency medicine at the University of North Carolina's School of Medicine, said in a school news release.

"Emergency physicians strive to make sure that for each patient who comes through the door, all serious and life-threatening conditions are identified and addressed. For elder abuse, EDs across the country are falling short," he added. Platts-Mills is also co-director of the division of geriatric emergency medicine at the university.

The authors of the study noted that victims of elder abuse typically don't receive routine care from a primary care doctor and often depend on the emergency department.

Each year in the United States, seniors make more than 23 million emergency department visits. That means emergency departments can play an important role in identifying elder abuse and taking steps to ensure the safety of these patients and fulfill their unmet health care needs, according to the researchers.

Identifying elder abuse can be difficult. Seniors who are physically frail or have mental impairment are prone to injury and may have difficulty caring for themselves, Platts-Mills explained.

"It can be very difficult distinguishing whether a bruise is from a fall or physical abuse, or whether poor hygiene is a result of a patient asking to be left alone or the result of overt neglect on the part of a care provider," he said.

"But those difficulties don't change the reality that elder abuse is common, takes a tremendous toll on its victims, and is frequently missed," Platts-Mills concluded.

The study was published recently in the Journal of the American Geriatrics Society.

SOURCE: University of North Carolina, news release, Oct. 18, 2016

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Consider Eye Safety When Choosing Kids' Toys

vendredi 25 novembre 2016

(*this news item will not be available after 02/22/2017)

By Robert Preidt

Thursday, November 24, 2016

THURSDAY, Nov. 24, 2016 (HealthDay News) -- Are you planning to shop on Black Friday for holiday gifts for the kids? Experts urge you to keep an eye on eye safety when making your choices.

U.S. emergency rooms treated 251,800 toy-related injuries in 2014, according to a report last year from the U.S. Consumer Product Safety Commission. Forty-four percent of those injuries were to the head and face area.

And a recent study in the journal JAMA Ophthalmology said basketball, baseball and air guns caused nearly half of all primary sports-related eye injuries.

"When giving the gift of sports equipment, Prevent Blindness strongly urges also providing sports eye protection," Hugh Parry, president and CEO of Prevent Blindness, said in a news release from the group.

"An eyecare professional can provide guidance for the best protection for each sport and athlete," he added.

Prevent Blindness also offers these toy safety tips:

Don't buy toys that shoot or include parts that fly off, or toys with sharp or rigid points, spikes, rods or edges.
Choose toys that will withstand impact and not break into dangerous pieces, and be sure toys are suitable for a child's ability and age.
Don't give toys with small parts to young children, because they tend to put things in their mouths. And avoid toys with long strings or cords, especially for babies and very young children.
Dispose of uninflated or broken balloons immediately.
Read all warnings and instructions on the package, and always supervise children and show them how to use their toys safely.
Look for the letters "ASTM." This designation means the product meets the national safety standards set by the American Society for Testing and Materials (ASTM).

SOURCES: Prevent Blindness, news release, Nov. 17, 2016

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A Little Alcohol Each Day May Cut Your Risk of Stroke

THURSDAY, Nov. 24, 2016 (HealthDay News) -- Light or moderate drinking may reduce the risk of one type of stroke but not another, while heavy drinking increases the risk of both types, a new study suggests.

A research team from England and Sweden reviewed 25 studies as well as national data from Sweden. The investigators reported that consumption of up to two drinks a day was associated with a lower risk of ischemic stroke (blocked blood flow to the brain), but appeared to have no effect on the risk of bleeding (hemorrhagic) stroke.

According to the American Stroke Association, about 87 percent of strokes are ischemic strokes, while the other 13 percent are hemorrhagic.

High-to-heavy drinking (two to more than four drinks a day) was associated with an added risk of both types of stroke, according to the findings published online Nov. 23 in the journal BMC Medicine.

"Our results showed that heavy drinkers were about 1.6 times more likely to suffer from intracerebral hemorrhage and 1.8 times more likely to suffer from subarachnoid hemorrhage. The association between heavy alcohol consumption and these two types of stroke was stronger than that for ischemic stroke," lead author Susanna Larsson said in a journal news release. She is an associate professor of epidemiology at Karolinska Institute in Sweden.

The differences between alcohol consumption and type of stroke may be due to the way alcohol affects the body, the study authors noted.

"Previous research has found an association between alcohol consumption and lower levels of fibrinogen -- a protein in the body which helps the formation of blood clots," Larsson said.

"While this may explain the association between light-to-moderate alcohol consumption and lower ischemic stroke risk, the adverse effect of alcohol consumption on blood pressure -- a major risk factor for stroke -- may increase the risk of hemorrhagic stroke and outweigh any potential benefit," she added.

Although the researchers found an association between alcohol and stroke risk, the study does not prove cause and effect. The researchers said factors other than alcohol use may have affected the results.

SOURCE: BMC Medicine, news release, Nov. 23, 2016

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A Little Alcohol Each Day May Cut Your Risk of Stroke

Strokes Decline in Older Americans, Rise in Young

WEDNESDAY, Nov. 23, 2016 (HealthDay News) -- There's a new generation gap in the United States -- strokes are increasingly striking young people, and at the same time, stroke rates are dropping in those 55 and older, a new study reports.

"People born during what I call the 'Golden Generation,' 1945 to 1954, had lower rates of stroke than those born 20 years before them and also in the 20 years after them," said lead researcher Joel Swerdel. He is a Ph.D. candidate at the Rutgers University School of Public Health in New Jersey.

People born during "Generation X" -- between 1965 and 1974 -- have a 43 percent higher rate of stroke than those born in the Golden Generation, researchers discovered.

Strokes primarily occur when a blood clot blocks a blood vessel or artery in the brain, starving the brain of oxygen and killing off brain cells in the affected area. It's the fifth-leading cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention.

Swerdel and his colleagues compared stroke and heart attack rates between generations using a unique database that includes nearly all hospitalizations for heart disease and stroke in New Jersey.

The investigators compared stroke rates for people at the same ages between generations, based on more than 225,000 records of stroke data between 1995 and 2014.

For example, the researchers looked at how many people aged 35 to 39 suffered a stroke between 1995 and 1999, and then stood that up against the number of stroke victims aged 35 to 39 between 2010 and 2014.

The results revealed an ever-increasing rate of stroke in younger generations. When comparing strokes that occurred in 1995-1999 against those in 2010-2014:

Stroke rates more than doubled in people 35 to 39 (a nearly 2.5-fold increase).
Stroke rates doubled in people aged 40 to 44.
Stroke rates increased by about 68 percent in people aged 45 to 54.
Strokes declined in all age groups 55 and older between 1995 and 2014, Swerdel said.

The so-called Golden Generation appears to be benefiting from blood pressure medication and cholesterol-lowering drugs that were unavailable to those who came before them, Swerdel suggested.

Baby boomers also dodged the twin epidemics of obesity and type 2 diabetes, which have hammered the health of younger generations, he said.

"If we look back at U.S. history, there was a big push towards adding a lot of sugar to food," Swerdel said. "For instance, sugared cereals didn't become popular until the early 1960s. The rates of obesity and diabetes in these younger groups may be a function of that."

Daniel Lackland is a professor and director of translational neuroscience and population studies at the Medical University of South Carolina in Charleston. He pointed out that younger people also have not had the dangers of high blood pressure ("hypertension") sufficiently impressed upon them.

"The campaign against hypertension really began in the 1970s, where everybody should know their blood pressure and get their blood pressure under control," Lackland said. "We think those programs had very, very high impact. These younger folks have not been exposed as diligently to that message."

Doctors need to start reviewing people as early as their teenage years for signs of high blood pressure, said Lackland, a spokesman for the American Heart Association.

"Today, we have a significant number of pediatricians who come asking, 'How do I diagnose and treat adult hypertension, because that's what I'm seeing in my pediatric patients,'" Lackland said. "Everybody should have their blood pressure measured, and everybody should know their blood pressure."

Both Swerdel and Lackland see these results as an early warning signal, rather than evidence of a hopeless situation.

"It sends up another alert that this isn't going away," Lackland said. "This is the pattern we're going to continue to see if we don't make some adjustments. On the good side, there are plenty of things we can do to make a significant difference."

For example, public programs to reduce added sugars in foods and deter consumption of sugary drinks can help tremendously, Swerdel said. Campaigns emphasizing a healthy diet and physical activity also can contribute to positive change.

"In young people, it's easy to change all this," Lackland said. "Alter your diet, lose some weight and don't eat as much salt."

The study was released online Nov. 23 in the Journal of the American Heart Association.

SOURCES: Joel Swerdel, Ph.D. candidate, Rutgers University School of Public Health, New Brunswick, N.J.; Daniel Lackland, Dr.PH., professor and director, translational neuroscience and population studies, Medical University of South Carolina, Charleston, S.C.; Nov. 23, 2016, Journal of the American Heart Association, online

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Strokes Decline in Older Americans, Rise in Young

Tobacco Flavors Draw in Young Folks

mercredi 23 novembre 2016

TUESDAY, Nov. 22, 2016 (HealthDay News) -- Flavored tobacco products attract young people who also consider them less harmful, researchers say.

The University of North Carolina team reviewed 40 studies conducted in the United States and other countries to assess people's attitudes about non-menthol tobacco flavors such as cherry, cotton candy and coffee.

"We found that flavors for most tobacco products have a universal and rather strong appeal to youth and young adults, and that they were perceived as less harmful among younger people," said review first author Li-Ling Huang in a university news release. She is a research collaborator at UNC Lineberger Comprehensive Cancer Center.

For example, some of the studies found that cigarette packs without flavor descriptions were less appealing to girls and young women. And a study from the United Kingdom found that teens believed that e-cigarettes with cherry and candy flavors were less harmful than tobacco-flavored e-cigarettes.

Other studies showed that flavors were a common reason why people -- especially teens -- experimented with, progressed to and regularly used tobacco products. The studies showed that users of all ages preferred flavored tobacco products.

The U.S. Food and Drug Administration banned flavored tobacco cigarettes, with the exception of menthol-and-tobacco-flavored cigarettes, in 2009. But there's currently no ban on flavored cigarillos, cigars, hookahs or e-cigarettes in the United States, other than a restriction on the sale of these products to minors.

Banning non-menthol flavors like fruit and candy could reduce use of most tobacco products worldwide, especially among young people, according to the authors of the review that was published in the journal Tobacco Control.

"This review shows that non-menthol flavors in most tobacco products appear to play a vital role in how users and even nonusers perceive, use and continue using tobacco products," said senior author Dr. Adam Goldstein, a professor at the university's School of Medicine Department of Family Medicine.

"Increasingly, countries around the world are interested in -- and some have started -- regulating or banning non-menthol flavors as a way to cut tobacco consumption. This research supports expansion and acceleration of that movement," he added.

SOURCE: University of North Carolina, news release, Nov. 21, 2016

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Tobacco Flavors Draw in Young Folks

Food Allergies Among Kids Vary by Race: Study

TUESDAY, Nov. 22, 2016 (HealthDay News) -- Black and Hispanic children are much more likely to have corn, shellfish and fish allergies than white children, according to a U.S. study.

The study also found that compared to whites, black children have much higher rates of asthma, eczema and allergies to wheat and soy.

The results, from the study of 817 children who were diagnosed with food allergies from birth to age 18, show that race and ethnicity are important factors in how people are affected by food allergies, according to the researchers.

"Food allergy is a prevalent condition in the U.S., but little is known about its characteristics and severity in racial minority groups," said study lead author Dr. Mahboobeh Mahdavinia, an allergy and immunology expert at Rush University in Chicago.

"Our goal was to characterize the food allergy-related outcomes in these children and to identify any disparities in health care usage among African-American, Latino and white children with food allergy," she said in a university news release.

Food allergies affect 8 percent of children in the United States, at an estimated annual cost of $24.8 billion.

Peanut was the most common food allergen among all three racial groups. The only food allergy more common among white children than black and Hispanic children was to tree nuts, which include almonds, Brazil nuts, cashews and pecans. Tree nut allergies are distinct from peanut allergy.

"A major concern is that African-American and Hispanic children had significantly higher rates of food-induced anaphylaxis [severe allergic reaction] than white children. Furthermore, African-American and Hispanic children also had higher odds of emergency room visits for food allergy-related reactions compared to white children," Mahdavinia said.

"We need to conduct further research to identify food allergy and food sensitivities among all races and ethnicities so we can develop culturally sensitive and effective educational programs to improve food allergy outcomes for all children," she added.

The study was published Nov. 21 in the Journal of Allergy and Clinical Immunology.

SOURCE: Rush University, news release, Nov. 21, 2016

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Food Allergies Among Kids Vary by Race: Study

2 Doses of HPV Vaccine Effective for Younger Teens

TUESDAY, Nov. 22, 2016 (HealthDay News) -- New global research confirms that two doses of the vaccine for HPV, rather than three, can protect younger teens against the sexually transmitted virus.

Based on this study and others, U.S. government health officials revised their guidelines last month to recommend a two-dose regimen for teens younger than 15. Prior to that revised guideline, three doses were recommended for adolescents and young adults up through 26 years of age.

The vaccine protects against infection by HPV (human papillomavirus), which is the cause of 90 percent of cervical cancers, according to the U.S. National Cancer Institute.

The new review included more than 1,500 young people, aged 9 to 26, who were vaccinated against HPV at 52 sites in 15 countries.

For the study, the researchers gave two doses of HPV vaccine to teens aged 9 to 14, and three doses of the vaccine to older teens and young women.

Girls and boys in the younger age group achieved the same immunity by getting two doses six to 12 months apart as older teens and young women did on a three-dose regimen over six months, the investigators found.

"With a simplified schedule and lower cost, it can be assumed [there would be] both higher coverage and improved compliance," said the study's lead researcher, Dr. Ole-Erik Iversen, from the University of Bergen in Norway.

The study, published online Nov. 21 in the Journal of the American Medical Association, was one of a number evaluated by the U.S. Centers for Disease Control and Prevention earlier this year, which led to the CDC's revised guidelines in October.

"HPV vaccines are very effective," said Dr. Lauri Markowitz, a medical epidemiologist with the CDC, who co-authored an editorial accompanying the study.

"With data from the trial reported in JAMA, evidence now supports a two-dose schedule in adolescents (aged 9 to 14) for all three licensed HPV vaccines," Markowitz and her colleagues wrote in the editorial.

According to the new CDC recommendation, three doses are still advised for older teens and young adults aged 15 to 26.

The new study was funded by Merck & Co., which makes the two Gardasil vaccines. The third vaccine, Cervarix, was withdrawn from the U.S. market in October by the maker, GlaxoSmithKline.

HPV infections are very common, with nearly everyone contracting at least one of many strains of the sexually transmitted virus at some point. About 79 million Americans are currently infected with HPV, the CDC estimates.

In addition to causing cervical cancers, HPV can lead to cancer of the penis, throat and anus, as well as pre-cancers and genital warts. The vaccines are close to 100 percent effective against pre-cancers and genital warts, the CDC noted.

While more teens and young adults are getting vaccinated against HPV, the rates still lag behind other vaccines, such as tetanus, diphtheria and pertussis, the CDC said.

In 2015, 42 percent of girls and 28 percent of boys aged 13 to 17 got three doses of HPV vaccine, Markowitz said, while 63 percent of girls and nearly 50 percent of boys got at least one dose.

The vaccines are typically covered in the United States with no copay, Markowitz said. The Vaccines for Children program helps families of eligible children who might not otherwise have access, according to the CDC.

SOURCES: Lauri Markowitz, M.D., medical epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Ole-Erik Iversen, M.D., Ph.D., researcher, University of Bergen, Bergen, Norway; Nov. 21, 2016, Journal of the American Medical Association, online

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2 Doses of HPV Vaccine Effective for Younger Teens

Can Occupational Therapy Slow Alzheimer's Decline?

mardi 22 novembre 2016

MONDAY, Nov. 21, 2016 (HealthDay News) -- Home-based occupational therapy may not slow down the physical decline that comes with Alzheimer's disease, a new clinical trial suggests.

The study looked at whether home visits from occupational therapists could put the brakes on Alzheimer's patients' "functional decline."

As the brain disorder progresses, it's not only memory that fades, but also day-to-day functioning. People gradually lose their ability to perform routine tasks -- such as making meals, using household items and bathing and dressing.

The goal of occupational therapy is to help family caregivers manage those difficulties. Sessions might address safe bathing or helping a loved one in and out of a car, for instance.

In the two-year study, the hope was that weaving occupational therapy into Alzheimer's patients' primary care would slow down their functional decline.

But that did not happen, said lead researcher Dr. Christopher Callahan, founding director of Indiana University's Center for Aging Research.

He called the findings "disappointing," but also said that occupational therapy can still be useful in managing Alzheimer's.

"There is still a role for occupational therapy in helping with specific impairments," Callahan said.

And others said the study did not fully measure all of the ways the therapy could benefit patients and family caregivers -- like boosting their quality of life.

Past studies have found that getting "home support" can improve caregivers' well-being, for instance, said Susan Stark, an assistant professor of occupational therapy, neurology and social work at Washington University in St. Louis.

According to Stark, the measurements used in this study may not have been "subtle enough" to capture certain benefits.

Plus, she said, the number of sessions may have fallen short: Families typically had 18 home visits over two years.

"It makes me wonder if there was a dose issue," Stark said.

In the real world, occupational therapy is not an automatic part of Alzheimer's care. But doctors may prescribe it on a case-by-case basis, Stark said.

Typically, an occupational therapist goes to the patient's home and recommends changes that can make daily living easier and safer. They may help the family remove fall risks, or use equipment to make bathrooms safer and more accessible, for example, Stark said.

Beyond that, therapists often use exercise to improve patients' strength and balance. They can also help caregivers learn to manage difficult behavior, or adapt activities that their loved one once enjoyed, such as gardening, to give them some mental stimulation.

Results of the new study were published Nov. 21 in the Annals of Internal Medicine.

For the study, Callahan's team recruited 180 Alzheimer's patients and their caregivers. All were given so-called "collaborative care," whereby an advanced practice nurse coordinated each patient's overall care.

In an earlier study, the researchers found that the collaborative approach helped reduce patients' behavioral problems and ease their caregivers' stress.

"In that first study, we wanted to see if we could help families with behavioral issues like wandering, agitation, or asking the same questions over and over again," Callahan explained.

"We noticed that while behavioral symptoms improved, patients' physical decline continued," he said.

So in this study, half of the families were randomly assigned to receive occupational therapy in addition to collaborative care.

But after two years, the researchers found, there was no evidence that the extra therapy had slowed patients' functional decline.

Still, the findings are based on one relatively small study, said Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association.

"It's difficult to draw conclusions from a single study," Fargo said. "I don't think this means that it's 'case closed' on occupational therapy for Alzheimer's."

He also agreed that it's important to better understand the impact on patients' and caregivers' quality of life.

For now, these specialists agreed occupational therapy can be useful to Alzheimer's patients' families.

"The underlying biology of the disease will continue. Occupational therapy can't change that," Stark said. "But having more environmental support may help patients stay safe and independent at home for a longer time."

To Callahan, his team's findings highlight the challenges family caregivers face. He said "more intensive" efforts will be needed to help them deal with the functional decline that comes with Alzheimer's.

That, Callahan said, might mean more extensive home modifications, better assistive devices and more community services.

SOURCES: Christopher Callahan, M.D., founding director, Indiana University Center for Aging Research, Indianapolis; Keith Fargo, Ph.D., director, scientific programs & outreach, Alzheimer's Association, Chicago; Susan Stark, PhD, OTR/L, assistant professor, occupational therapy, neurology and social work, Washington University in St. Louis; Nov. 21, 2016, Annals of Internal Medicine online

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Troubled Preschoolers Not Getting Effective Treatment

MONDAY, Nov. 21, 2016 (HealthDay News) -- Most preschoolers with mood, behavior and social disorders would benefit from non-drug therapies, but few receive this type of help, a leading group of U.S. pediatricians reports.

As many as one in 10 kids younger than 5 years old experiences these kinds of mental health problems, the American Academy of Pediatrics said in a new report.

Current evidence supports the use of "family-focused" therapies -- often including parent training -- as a first-line treatment for these children, the AAP reported. Yet mental health stigma, shortages of trained providers and insurance barriers limit access to evidence-based treatment, it said.

"Young children's mental health needs have long been overlooked," said Dr. Mary Margaret Gleason, lead author of the report.

"We don't want to leave children without treatment because these are real disorders that deserve treatment, and their suffering is real," said Gleason, an associate professor of psychiatry and behavioral sciences at Tulane University School of Medicine in New Orleans.

Doctors can distinguish mental disorders from a growing child's typical emotions and behaviors by assessing signs and symptoms, family history and level of impairment, the pediatrics group explained.

A child may have difficulty bonding with a parent or caregiver, for example, or exhibit sleep or appetite problems. Some may engage in disruptive behaviors or suffer from attention deficit hyperactivity disorder (ADHD). Others may be diagnosed with post-traumatic stress disorder.

These problems also may cause significant distress for families, added Gleason.

"If a 3-year-old isn't sleeping, it's not just the 3-year-old who's not sleeping," she said.

Young children exposed to trauma, abuse or neglect are especially vulnerable, according to the AAP.

Such early adversities affect their physical safety, school readiness and ability to interact with others, the group said. And the adverse effects can persist into adulthood.

Parents, policymakers and sometimes even care providers fail to recognize that young children are affected by the things that happen around them, Gleason explained.

The group's proposals for closing the treatment gap are included in a policy statement published online Nov. 21 in the journal Pediatrics.

The American Academy of Child and Adolescent Psychiatry and the nonprofit advocacy group Zero to Three have endorsed the statement, the AAP said.

"Any work that we can do to build resilience, that ability to bounce back, in young children is going to be with them for the rest of their lives," said Cindy Oser, director of infant-early childhood mental health strategy at Zero to Three.

In 2015, AAP published a report encouraging pediatricians to screen children for behavioral and emotional problems.

The new report focuses on proven treatments for young kids who have these mental health disorders. It notes that the effects of non-drug treatments can last for years, unlike the effects of medication.

Pediatricians are usually the primary care providers to children with emotional and behavioral problems, and therefore have a role to play in improving their well-being, according to the AAP.

The report outlines specific family-focused therapies with strong evidence of their effectiveness.

Some of these treatments empower the parent to act as the vehicle for change, Gleason explained, while others involve the parent but focus on the child.

However, connecting children and families with those resources remains a challenge, the AAP explained.

Geetha Gopalan, an assistant professor in the University of Maryland School of Social Work, said children of poverty "are most at risk of developing emotional-behavioral disorders."

But they have the "least access to effective mental health treatments," she added.

That's partly due to a shortage of qualified providers, said Gopalan.

The AAP calls for greater funding of programs to expand the mental health workforce and training opportunities for pediatricians.

The recommendations also focus on insurance rules and reimbursement practices that impede treatment.

Due to insurance rules, pediatricians often cannot get paid to care for a child with a mental health diagnosis. And many times they can't make a referral because of a shortage of trained specialists, the AAP explained.

While much needs to be done, Gleason is encouraged by early signs of progress. Some pediatricians now screen children for emotional and behavioral problems as part of well-child visits, for example.

There are many reasons that children have difficulty organizing their behaviors or feelings, Gleason added.

"What we'd really like parents to think about is, 'How do I help my child be as healthy as possible?' in the same way that we would if they were having trouble breathing," she said.

SOURCES: Mary Margaret Gleason, M.D., associate professor, psychiatry and behavioral sciences, Tulane University School of Medicine, New Orleans; Cindy Oser, R.N., director, infant-early childhood mental health strategy, Zero to Three, Washington, D.C.; Geetha Gopalan, L.C.S.W., Ph.D., assistant professor, University of Maryland School of Social Work, Baltimore; Nov. 21, 2016, online, Pediatrics

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What to Ask Your Doctor Before Taking Opioids

lundi 21 novembre 2016

Choose the Healthy Foods Options This Holiday Season

SUNDAY, Nov. 20, 2016 (HealthDay News) -- Even the best intentions to make healthy food choices during the holidays can be derailed, the American Heart Association cautions.

Eating a diet consisting of fruits, vegetables, lean protein and healthy grains is one of the most important ways to reduce the risk for heart disease and stroke, the association points out.

Fortunately, there are ways to avoid moments of weakness when dining out or going to gatherings, said Rachel Johnson. She is a nutrition professor at the University of Vermont and past chair of the association's nutrition committee.

When dining at a restaurant, the first step is to look at the menu with blinders on.

"Don't even let yourself look at that [unhealthy] section of the menu," Johnson said in an association news release. It's a lot easier to order a salad when menu options loaded with fat and calories aren't up for consideration, she added.

At home, it's also important to anticipate unhealthy cravings. Many people make unwise snack choices when they are relaxing after dinner, said Johnson. Instead of giving in to those cravings, take a walk or call a friend on the phone, she suggested.

It's also a good idea to plan ahead and anticipate food temptations. To increase the chances of making healthy choices, Johnson offers the following tips:

Store unhealthy foods out of sight. Put these foods away in a cabinet or container that's not transparent. Keep a bowl of fruit on the kitchen counter instead of a cookie jar.
Buy smaller or individually wrapped portions. Instead of buying a half-gallon of ice cream, choose individually packaged low-calorie frozen treats.
Brush your teeth right after you eat. Having minty fresh breath will make sneaking another treat less tempting.
Stock up on sugarless gum. The sweetness of chewing gum can calm cravings for treats with sugar and more calories.
Don't overdo it. If you do give in to temptation, do so in moderation. Have a small portion and share the rest, or put it away.

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Zika No Longer 'Global Health Emergency,' WHO Says

By E.J. Mundell

FRIDAY, Nov. 18, 2016 (HealthDay News) -- Zika, the mosquito-borne virus that can cause severe birth defects in the infants of infected mothers, is no longer a "global health emergency," the United Nation's World Health Organization (WHO) declared Friday.

A WHO advisory panel said that while the spread of Zika remains of great importance, it should now be classed with other mosquito-borne maladies such as malaria or yellow fever, The New York Times reported.

"We are not downgrading the importance of Zika," Dr. Peter Salama, executive director of the WHO's emergencies program, told the newspaper. "We are sending the message that Zika is here to stay and the WHO response is here to stay."

Not everyone agreed with the agency's decision, however.

Dr. Anthony Fauci is a renowned virologist and director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID). He believes it's too early to lift the state of emergency, since Zika is a seasonal disease.

"Are we going to see a resurgence in Brazil, Colombia and elsewhere? If they pull back on the emergency, they'd better be able to reinstate it," he told the Times. "Why not wait a couple of months to see what happens?"

Fauci said that NIAID is continuing to fund research into a vaccine against Zika, which has so far been tied to thousands of cases of children being born with a birth defect known as microcephaly. The anomaly causes babies to have abnormally small skulls and underdeveloped brains.

The virus has also been linked to other issues, including fetal deaths, and babies born blind, deaf or with severely clubbed feet or permanent limb rigidity, the Times noted.

Earlier this year, mosquitoes carrying Zika virus made their first appearance in Florida, especially certain areas of Miami. The U.S. Centers for Disease Control and Prevention has advised that pregnant women should not travel to the affected areas, or should take measures to avoid mosquito bites.

SOURCE: The New York Times, Nov. 18, 2016

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Are You Ready for Flu Season?

FRIDAY, Nov. 18, 2016 (HealthDay News) -- With flu season right around the corner, U.S. health officials are urging everyone to get their flu shot now so they'll be protected from the potentially serious complications of influenza.

"The fact that flu activity hasn't picked up dramatically yet means there is plenty of time for people to get vaccinated if they haven't already," said Lynnette Brammer, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

This year's flu season is starting out much like last year, Brammer said. Currently, influenza H3N2 is the predominant strain, she said, although H1N1 is also circulating. Last year, the H3N2 virus started out as the dominant strain, only to be displaced by H1N1 as flu season hit full swing. "It ended up being an H1N1 season," she said.

"It's similar to a lot of years right now," Brammer added. "Things should start to pick up in the next few weeks, but we'll see. Last year, things didn't really pick up until the first of the year. Right now, there is nothing that's really concerning."

Last year's flu season was particularly hard on older people.

In a typical flu season, flu complications -- including pneumonia -- send more than 200,000 Americans to the hospital. Death rates linked to flu vary annually, but have gone as high as 49,000 in a year, according to the CDC.

Most of the time flu activity peaks between December and March but can last as late as May.

This year's vaccine contains the strains currently circulating, which makes it a good match, Brammer said. The vaccine supply is also good this year, with more than 131 million doses available, she said.

How effective a vaccine is depends on how good a match it is to the strains of flu virus circulating that year. Most years, the vaccine is between 40 percent and 60 percent effective, according to the CDC.

The CDC recommends that anyone 6 months of age and older get a flu shot. "You want to make extra sure for people at high risk -- including pregnant women, the elderly and anyone with a chronic medical condition," Brammer said.

Women with newborns also need to get their flu shot to help protect their infants, who can't be vaccinated until they're at least 6 months old. Also at risk are seniors and people with chronic health problems, such as lung and heart disease, the CDC said.

Getting your flu shot soon is important because it can take several weeks to produce enough antibodies to give you maximum protection, officials noted.

One change this year is that the CDC's Advisory Committee on Immunization Practices does not recommend that the nasal spray vaccine be used by anyone, because it seems less effective than a shot, Brammer said.

SOURCE: Lynnette Brammer, M.P.H., epidemiologist, influenza division, U.S. Centers for Disease Control and Prevention

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Can Protein, Probiotics Help with Blood Sugar Control?

vendredi 18 novembre 2016

THURSDAY, Nov. 17, 2016 (HealthDay News) -- Adding protein-rich or probiotic-laden foods to your diet may help control your blood sugar levels, according to a pair of new studies.

Both proteins and probiotics appear to slow down digestion of carbohydrates, preventing blood sugar spikes that can lead to type 2 diabetes or exacerbate damage done by the disease, researchers found.

Eating tuna fish with a slice of white bread produced a slower rise in blood sugar than eating carbs alone, said Huicui Meng, who led one of the studies. She's a postdoctoral researcher at Tufts University's Human Nutrition Research Center on Aging in Boston in Boston.

Meanwhile, people who added foods rich in probiotics -- a type of "good" bacteria -- to their heart-healthy DASH diet achieved a significant reduction in their blood sugar levels, said Arjun Pandey, a student at Waterloo Collegiate Institute in Ontario, Canada.

The results of both studies were presented this week at the American Heart Association's annual meeting, in New Orleans. But until peer-reviewed for publication in a medical journal, the conclusions should be considered preliminary.

Although both were small-scale studies, the pair provide useful information that people can put into practice with their daily diets, said Dr. Prakash Deedwania, a professor of cardiology at the University of California, San Francisco. He is also vice chair of the American Heart Association's diabetes committee.

"These are lifestyle changes that are easy to do, and important for the large amount of the population who have metabolic syndrome or are prediabetic," said Deedwania. People with metabolic syndrome have risk factors that can lead to heart disease, diabetes and stroke.

For the protein-carbohydrate study, Meng's team asked four groups of about 20 people each to eat specific foods. Their blood sugar levels were measured at regular intervals over two hours.

The groups ate white bread accompanied by either rice squares cereal (carbohydrates), tuna fish (protein), unsalted butter (fat), or oat circles cereal (fiber).

The researchers wanted to see whether other types of nutrients affected the digestion of carbohydrates, Meng said.

"We don't eat carbohydrates on their own," Meng said. "Our meals consist of a blend of carbohydrates, fats, proteins and fiber."

Protein slowed the release of sugars into the bloodstream, but Meng and her colleagues were surprised to find no similar effect from the fats in butter or the fiber in the oat cereal.

"Protein may stimulate the release of some gut hormones that may slow the gastric empty rate," Meng said. That's the speed at which food leaves the stomach for digestion in the intestines.

In the other study, 80 people with high blood pressure adopted the DASH (Dietary Approaches to Stop Hypertension) diet -- a heart-healthy eating plan designed to lower blood pressure. But Pandey asked half of the participants to substitute probiotic foods for other items in the diet.

For example, they could substitute probiotic-rich yogurt as their low-fat dairy food, or eat probiotic granola or drink probiotic beverages, he said.

Pandey is a high school student, but experts with John Hopkins University in Baltimore and the Cambridge Cardiac Care Center in Ontario helped oversee his research.

The people who added probiotics to their diet showed no difference in blood pressure compared to the other group, but they did achieve a better reduction in their fasting blood sugar and their hemoglobin A1C levels, Pandey reported. Hemoglobin A1C is a standard biomarker for testing long-term blood sugar levels.

Probiotic bacteria appear to produce compounds that may make it easier for cells to use the hormone insulin to convert blood sugar into energy, Pandey said.

Deedwania said follow-up research involving larger groups would help bolster these findings, but that people who take the advice offered by these studies would face no great harm.

"Just having one container of probiotic yogurt is not going to be of consequence to anybody," he said.

At the same time, Deedwania noted that in the case of the probiotic study, the participants were asked to follow an overall heart-healthy diet.

"It's important to remember the authors used a very prudent diet to begin with, the DASH diet," he said. "You can't just have a very unhealthy diet and add probiotic supplementation. That's not going to do it."

SOURCES: Huicui Meng, Ph.D., postdoctoral researcher, Tufts University Jean Mayer USDA Human Nutrition Research Center on Aging, Boston; Arjun Pandey, student, Waterloo Collegiate Institute, Ontario, Canada; Prakash Deedwania, M.D., professor, cardiology, University of California, San Francisco; November 2016, American Heart Association, annual meeting, New Orleans

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Drug Stelara May Ease Crohn's Disease

THURSDAY, Nov. 17, 2016 (HealthDay News) -- People with moderate to severe Crohn's disease who haven't responded to other treatments may benefit from the drug ustekinumab (Stelara), a new study suggests.

Stelara is a monoclonal antibody that blocks the action of the inflammatory agents interleukin-12 and interleukin-23. The drug had been approved for the treatment of psoriasis and is now approved for treating Crohn's disease as well.

Crohn's disease is a chronic inflammatory condition of the gastrointestinal tract. Crohn's usually affects the end of the small bowel and the beginning of the colon. But it may affect any part of the gastrointestinal tract, from the mouth to the anus, according to the Crohn's and Colitis Foundation of America (CCFA).

Crohn's can cause diarrhea, rectal bleeding, an urgent need to move the bowels, stomach cramps, pain and constipation, the CCFA says.

"Stelara is effective for treatment leading to a clinical remission in patients with moderate to severe Crohn's disease," said study co-author Dr. William Sandborn. He's a professor of medicine at the University of California, San Diego.

Remission was defined as relief from abdominal pain and diarrhea, he said.

Stelara was well-tolerated and "we did not see increased rates of serious infection or cancer, compared with patients who received placebo," Sandborn said.

The drug is effective in patients who found no relief with anti-tumor necrosis factor (TNF) drugs, such as Remicade, Humira or Cimzia, and those patients who did, Sandborn said.

"These patients had limited treatment options previously, so this is a big advance. It is also very convenient for patients -- the maintenance dosing is only once every eight weeks and patients can inject themselves," he said.

Stelara can be given as a first-line or second-line therapy for Crohn's, Sandborn said.

For the new research, Sandborn and his colleagues recruited two groups of patients, one with more than 700 people, and the other with more than 600. These patients hadn't responded to anti-TNF treatment or had unacceptable side effects from it. The study volunteers were randomly assigned to receive either a single intravenous dose of Stelara or a placebo.

The researchers then took nearly 400 patients who showed a response to Stelara and then randomly assigned them to receive regular injections of Stelara or a placebo every eight weeks or 12 weeks.

After 44 weeks, 53 percent of patients receiving Stelara injections every eight weeks were in remission. For patients getting Stelara every 12 weeks, 49 percent were in remission. This compared with 36 percent of those receiving a placebo, the researchers said.

The drug treatment is covered by most insurance and Medicare, and costs will vary depending on your insurance, Sandborn said.

The report was published Nov. 16 in the New England Journal of Medicine. The research was funded by Janssen Research and Development, the maker of the drug.

Dr. Caren Heller is chief scientific officer of the CCFA. She said longer trials of Stelara need to be done. And researchers need to learn how long remission lasts and whether any healing of intestinal lining occurs. She also said longer studies on the safety profile of the drug are warranted.

Heller also suggested research looking at Stelara compared to anti-TNF, "so that the right immunotherapy can be administered at the right time and to the right patient."

SOURCES: William Sandborn, M.D., professor, medicine, University of California San Diego, La Jolla; Caren Heller, M.D., chief scientific officer, Crohn's and Colitis Foundation of America; Nov. 17, 2016, New England Journal of Medicine

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CDC Reveals Top 5 Causes of Death

THURSDAY, Nov. 17, 2016 (HealthDay News) -- Heart disease tops the list of what's most likely to kill you or someone you love, U.S. health officials reported Thursday.

The federal Centers for Disease Control and Prevention released data naming the five leading causes of death among Americans under age 80 for 2014. After heart disease, cancer was the most likely cause of death. Rounding out the list were stroke; chronic lower respiratory diseases, such as asthma, bronchitis and emphysema; and accidents, the report said.

Nearly two-thirds of deaths in the United States were caused by these five diseases or conditions.

And many of these deaths were preventable. Thirty percent of heart disease deaths, 15 percent of cancer deaths, 28 percent of stroke deaths, 36 percent of chronic lower respiratory disease deaths, and 43 percent of accident deaths were preventable, the CDC researchers said.

The good news in the report: between 2010 and 2014, there were declines in three of those five leading causes of preventable deaths.

Those declines included: a 25 percent drop in cancer deaths, which was helped by a 12 percent decrease in the age-adjusted death rate from lung cancer; an 11 percent decrease in stroke-related deaths; and a 4 percent decline in preventable heart disease deaths.

However, during the same time period, preventable deaths from unintentional injuries rose 23 percent (largely due to drug poisoning and falls), and preventable deaths from chronic lower respiratory disease rose 1 percent.

"Fewer Americans are dying young from preventable causes of death," CDC Director Dr. Tom Frieden said in an agency news release.

"Tragically, deaths from overdose are increasing because of the opioid epidemic, and there are still large differences between states in all preventable causes of death, indicating that many more lives can be saved through use of prevention and treatment available today," Frieden said.

Preventable death data help state and federal health officials establish prevention goals, priorities and strategies, according to the CDC.

The agency suggested that health care providers can help prevent premature deaths by providing patients with counseling on quitting smoking, protecting against heart disease and stroke, and avoiding accidental injuries.

SOURCE: U.S. Centers for Disease Control and Prevention, news release, Nov. 17, 2016

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CDC Reveals Top 5 Causes of Death

Almost 1 in 4 Face Surprise Bills After ER Visit

jeudi 17 novembre 2016

WEDNESDAY, Nov. 16, 2016 (HealthDay News) -- As if a trip to the ER isn't traumatic enough, many U.S. emergency room patients end up with major unexpected costs, a new study says.

Yale University researchers looked at 2.2 million ER visits made by patients younger than 65 nationwide between early 2014 and late 2015.

Nearly one-quarter of the patients who went to ERs within their health insurance networks were treated by an out-of-network doctor and ended up with unexpected expenses, the study found.

According to the findings, out-of-network emergency doctors charged up to 800 percent of Medicare rates, while in-network emergency physicians were paid around 300 percent of Medicare rates.

Patients were presented with an average bill of about $622, and potentially much more, if their insurer only covered in-network rates, the researchers reported.

Many patients would be hard-pressed to pay such a bill, the researchers said. They estimated that 47 percent of Americans could not cover an unexpected $400 expense without incurring credit card debt or selling assets, according to the U.S. Federal Reserve.

"Most patients with health coverage go to in-network emergency rooms and rightly expect to be treated by in-network doctors," said study co-author Zack Cooper, an assistant professor of public health and economics at Yale.

"Our study shows that nearly a quarter of people who visited in-network emergency rooms were exposed to potentially major costs. This is just wrong and we must do better. People should not face financial ruin from medical bills they cannot reasonably avoid," Cooper said in Yale news release.

Based on the findings, Cooper's team believes that state policies on surprise out-of-network billing are inadequate and the federal government has taken no action on the issue.

The researchers suggested that hospitals should be required by law to sell an emergency care package that includes physician services and facility fees. The hospital would then staff its own emergency room and pay the doctors directly.

However, two groups representing ER doctors took issue with the findings.

Dr. Rebecca Parker is president of the American College of Emergency Physicians (ACEP). She said the conclusions from the new study are based on "claims data from a large insurance company, which [is] not identified and not available for examination, showing the lack of transparency by the health insurance industry.

"Most emergency physicians prefer to be 'in-network,' as long as insurance companies pay fairly," Parker said in an ACEP statement.

Besides calling on insurance companies to release more transparent data, she believes that "state and federal policymakers need to ensure that health insurance plans provide fair payment for emergency services and provide adequate rosters of physicians."

Dr. Tim Seay is chair of the Emergency Department Practice Management Association, another trade group. In the same statement, he said the new research "ignores the fact that emergency physicians provide care without regard to the ability to pay. The problem is inadequate insurance coverage and high deductibles."

The study was published Nov. 16 in the New England Journal of Medicine.

SOURCES: Yale University, news release, Nov. 16, 2016; statement, American College of Emergency Physicians, Nov. 16, 2016

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Almost 1 in 4 Face Surprise Bills After ER Visit

New Drug May Brighten Outlook for Advanced Breast Cancer

WEDNESDAY, Nov. 16, 2016 (HealthDay News) -- A recently approved drug can help slow the progression of advanced breast cancer, a new clinical trial confirms.

The drug, called palbociclib (Ibrance), was approved in the United States last year for treating advanced cases of ER-positive breast cancer. That means the cancer uses the hormone estrogen to help fuel its growth.

The approval was based on an earlier-stage study where the drug, used along with a standard drug called letrozole (Femara), helped keep women's cancer at bay. Palbociclib doubled the time patients remained progression-free compared to letrozole alone.

The new findings, published in the Nov. 17 New England Journal of Medicine, confirm the earlier results in a larger group of women.

"We found that the degree of clinical benefit was, again, remarkable," said lead researcher Dr. Richard Finn, an assistant professor of medicine at the University of California, Los Angeles.

Among postmenopausal patients in the trial, those given the drug combination typically remained progression-free for just over two years. That compared to just over 14 months among women treated with letrozole alone.

"This is an incredibly important step" in improving the outlook for women with advanced breast cancer, said Dr. Antonio Wolff, a professor of oncology at Johns Hopkins University in Baltimore.

"We know this isn't the final answer," added Wolff, who wrote an editorial published with the study. Other drugs aimed at stalling advanced breast tumors are in development, he noted.

But palbociclib should be considered "a new standard" for treating advanced ER-positive breast cancer, Wolff said.

Palbociclib is the first in a new class of drugs designed to inhibit two enzymes called CDK4 and CDK6, which help ER-positive breast tumors spread. Palbociclib is a capsule taken once a day for three weeks, followed by one week off.

Letrozole, meanwhile, works by lowering estrogen levels in the body.

About two-thirds of breast cancers have receptors for estrogen and/or the hormone progesterone, according to the American Cancer Society.

In this latest trial, Finn's team tested palbociclib/letrozole as a first-line treatment for advanced cancer that had spread beyond the breast. They randomly assigned 666 women to receive the drug duo or letrozole alone, and followed them for up to three years.

At that point, 44 percent of women in the palbociclib group had either died or seen their cancer progress. That compared with 62 percent of women on letrozole alone, according to the study.

Women on the drug combo typically remained progression-free for nearly 25 months, versus roughly 14 months for women on letrozole, the researchers found.

Once patients like these have a progression, they can try other types of hormonal therapy, or eventually chemotherapy, Finn said. Since chemo has harsh side effects, delaying it could improve a woman's quality of life, he noted.

Palbociclib has side effects, too. One of the most common -- seen in two-thirds of women in this study -- is neutropenia. That's a drop in a type of white blood cell, and it could leave women vulnerable to serious infections.

However, Finn said, the neutropenia caused by palbociclib appears to be different from chemo-induced neutropenia -- in that it's "temporary."

Wolff agreed. The drug seems to put certain white blood cell precursors "to sleep," he explained, and the effect can be reversed by lowering the dose.

Side effects that could affect quality of life, Wolff said, include fatigue, nausea and pain. Each of those problems affected a little more than one-third of patients on palbociclib.

Most often, Finn said, those side effects were on the milder side, and happened in both treatment groups.

He and Wolff said the drug combination should be considered a standard treatment for advanced ER-positive cancer.

One big question, though, is whether palbociclib ultimately extends women's lives. The trial has not gone on long enough to determine that, Finn said.

"But the hope is, this will also improve overall survival," he said.

Another question, added Wolff, is whether some women with advanced cancer can do just as well with hormonal therapy alone, at least to start.

That's important, he said, because of palbociclib's side effects and price tag.

Pfizer, Inc., which funded the current trial, set the cost of palbociclib at close to $10,000 a month.

Ongoing studies are looking at whether the drug can also help prevent recurrences of earlier-stage breast cancer. In that scenario, the issues of side effects and cost will be even more important, Wolff said.

SOURCES: Richard Finn, M.D., assistant professor, medicine, Geffen School of Medicine, University of California, Los Angeles; Antonio Wolff, M.D., professor, oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore; Nov. 17, 2016, New England Journal of Medicine

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New Drug May Brighten Outlook for Advanced Breast Cancer

Moms' Rheumatoid Arthritis May Be Linked to Epilepsy Risk in Kids

WEDNESDAY, Nov. 16, 2016 (HealthDay News) -- Some children born to mothers with rheumatoid arthritis may have higher-than-average odds of developing epilepsy, a new study suggests.

Children born to mothers with rheumatoid arthritis were one-third more likely to develop epilepsy by age 4 than other children. The risk of epilepsy later in childhood was one-quarter higher for those born to moms with rheumatoid arthritis, the study found.

But, experts stressed that the findings don't prove that a mother's rheumatoid arthritis causes epilepsy. So far, only an association has been found.

And even if children of women with rheumatoid arthritis have a higher epilepsy risk than other kids do, the odds are still low.

In the study of nearly 2 million children, the vast majority of those born to moms with rheumatoid arthritis did not develop epilepsy, said lead researcher Ane Lilleore Rom, of Copenhagen University Hospital in Denmark.

Still, she said, the findings raise the possibility that when a woman has rheumatoid arthritis, conditions in the womb might make the fetal brain more vulnerable to epilepsy later on.

Rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly creates antibodies that attack the lining of the joints. Epilepsy, meanwhile, is a seizure disorder caused by disrupted electrical activity in the brain.

In theory, "autoimmune factors" in the womb -- such as those self-attacking antibodies -- might make some children more prone to epilepsy, Rom speculated.

However, she stressed, much more research is needed to know whether that's true.

The findings are based on health records from over 1.9 million Danish children. The children were born between 1977 and 2008. Roughly 13,500 had a mother with rheumatoid arthritis. About 6,300 had a father with the disease.

During a 16-year follow-up, more than 31,000 children from the whole group developed epilepsy.

According to Rom, there were some hints that exposure to rheumatoid arthritis in the womb was key to the higher risk of epilepsy. For one, there was no link between fathers' rheumatoid arthritis and children's risk of epilepsy.

What's more, children whose mothers had full-blown rheumatoid arthritis during pregnancy were 90 percent more likely to be diagnosed with epilepsy in early childhood, versus kids born to moms without rheumatoid arthritis. The risk was lower -- but still higher-than-normal -- if the mother's rheumatoid arthritis was diagnosed after pregnancy.

That, the researchers said, suggests that rheumatoid arthritis itself -- rather than rheumatoid arthritis medications -- may be the critical factor. Even in the "pre-clinical" stage, rheumatoid arthritis-related antibodies may be circulating in the body.

But that's just speculation for now, according to Rom.

And, she said, context is important.

"We have to remember that even though children were up to 90 percent more likely to develop epilepsy if their mother had rheumatoid arthritis at time of birth, this translates to 3 percent of the children," Rom said.

A rheumatologist who wasn't involved in the study cautioned against making too much of the findings.

"I think you could see this study as hypothesis-generating," said Dr. Michael Lockshin, who's with the Hospital for Special Surgery in New York City.

"But," he added, "I'm not at all convinced that this means rheumatoid arthritis is the cause."

There could be many differences between children whose mothers have rheumatoid arthritis and those whose moms don't have the disease, Lockshin pointed out. The researchers were able to account for a few factors -- such as children's birth weight and vital signs at birth. But, they couldn't account for everything, he said.

According to Rom, future studies should try to weed out the reasons for the rheumatoid arthritis-epilepsy connection.

"The implications of our findings relate mainly to the understanding of how epilepsy develops," Rom said. "They suggest that factors related to autoimmunity could be involved in the development of some types of epilepsy in children of mothers with rheumatoid arthritis."

The study findings were released online Nov. 16 in the journal Neurology.

In the United States, an estimated 2.2 million people have epilepsy, according to the Epilepsy Foundation. The root causes vary, the group said. For children, a head injury, certain congenital conditions or infections of the brain may precipitate seizures. In cases where there's no clear cause, it's thought that genetic factors may play a role.

SOURCES: Ane Lilleore Rom, Ph.D., researcher, Women's and Children's Health, Copenhagen University Hospital, Denmark; Michael Lockshin, M.D., rheumatologist, Hospital for Special Surgery, New York City; Nov. 16, 2016, Neurology, online

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Moms' Rheumatoid Arthritis May Be Linked to Epilepsy Risk in Kids

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