février 2017

Youth with Type 2 Diabetes Develop Complications More Often Than Type 1 Peers

mardi 28 février 2017

News Release

Tuesday, February 28, 2017

NIH, CDC funded study finds many in both groups quickly develop kidney, nerve, eye diseases.

Teens and young adults with type 2 diabetes develop kidney, nerve, and eye diseases – as well as some risk factors for heart disease – more often than their peers with type 1 diabetes in the years shortly after diagnosis. The results are the latest findings of the SEARCH for Diabetes in Youth study, published Feb. 28 in the Journal of the American Medical Association.

Funded by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), SEARCH researchers examined how quickly and often youth developed signs of kidney, nerve and eye diseases, among the most common complications of diabetes. They also measured several risk factors for heart disease. Participants had diabetes an average of under eight years at the end of the study.

The study is the largest of its kind in the United States. Key findings are:

For youth with type 2 diabetes, nearly 20 percent developed a sign of kidney disease by the end of the study, compared to about 6 percent of youth with type 1 diabetes.
For youth with type 2, about 18 percent developed nerve disease, versus about 9 percent with type 1.
For youth with type 2, about 9 percent developed eye disease, compared to about 6 percent of youth with type 1.
Measures for two risk factors for heart disease (hypertension and arterial stiffness) were greater for youth with type 2 but close to equal for a third risk factor (cardiovascular autonomic neuropathy).

Though youth with type 2 diabetes showed signs of complications more often in nearly every measure than their peers with type 1, many youth in both groups developed complications.

“There’s often the assumption that young people don’t develop complications from diabetes, but that’s just not true. We saw that young people with diabetes are developing signs of major complications in the prime of their lives,” said Dr. Barbara Linder, a study author and senior advisor for childhood diabetes research within the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Particularly for youth with type 2, this research demonstrates the clear need to learn how to reduce or delay the debilitating complications of diabetes, itself a huge challenge for young people to manage.”

SEARCH examined 1,746 youth with type 1 diabetes (averaging about 18 years old) and 272 with type 2 diabetes (average age about 22) between 2002-2015. All were diagnosed before age 20. Youth were identified at five clinical centers – Kaiser Permanente Southern California in Pasadena, University of Colorado in Denver, Cincinnati Children’s Hospital Medical Center, University of North Carolina at Chapel Hill, and Seattle Children’s Hospital. Wake Forest University in Winston-Salem, North Carolina, served as coordinating center.

The researchers looked at factors including glucose control, body mass index, waist-to-height ratio and blood pressure, but no factor could explain why people with type 2 developed more complications than counterparts with type 1.

By about age 21, about 1/3 of participants with type 1 diabetes and about 3/4 of participants with type 2 had at least one complication from diabetes or were at high risk for a complication.

“This study highlights the need for early monitoring for development of complications among young people with diabetes,” said Dr. Sharon Saydah, senior scientist at CDC and an author on the paper. “If young people can delay onset of these complications from diabetes by even a few years, that can ease their burden and lengthen their lives.”

Type 1 diabetes typically develops in young people. In type 1, the body does not make insulin, a hormone needed to live. In type 2 diabetes, the body does not make enough insulin or does not use insulin well. In the past, type 2 diabetes was extremely rare in youth, but occurrences have risen alongside the obesity epidemic. Find health information on diabetes at http://ift.tt/2ciroUE.

About the CDC: CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency.

The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe, and disabling conditions affecting Americans. The Institute’s research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. For more information, visit www.niddk.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.

NIH…Turning Discovery Into Health^®

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Youth with Type 2 Diabetes Develop Complications More Often Than Type 1 Peers

Hip Fracture's Link to Early Death May Last Years

MONDAY, Feb. 27, 2017 (HealthDay News) -- Older people who suffer a hip fracture face a much higher risk of death soon after the injury, but the risk persists over the longer term, a large study indicates.

Researchers found that the risk of death among people over 60 nearly tripled during the first year following a hip fracture.

However, hip fractures were also still linked to a nearly twofold increased risk of dying eight years or more after the injury.

The new findings are similar to those of previous studies on hip fracture, said study lead author Michail Katsoulis. He's a medical statistician with the Hellenic Health Foundation in Athens, Greece.

Katsoulis noted that "post-operative complications, such as cardiac and pulmonary ones, have been mostly implicated for the excess short-term mortality after the fracture, that is within the first year after." Those complications included both blood clots and pneumonia.

The study can't definitively show a cause-and-effect relationship. But Katsoulis suspects that older hip fracture patients "are unlikely to remain physically active and more likely to experience functional decline and disability."

It's also possible that chronic inflammation develops after a fracture, which could contribute to persistent frailty, the researchers suggested.

The findings are based on a review of data including nearly 123,000 men and women. The adults were enrolled in eight different studies. The studies began between the late 1980s and the early 2000s. Most study volunteers joined during the 1990s.

Seven studies were conducted across Europe (the Czech Republic, Germany, Greece, Norway, Sweden and the United Kingdom), the United States and the United Arab Emirates, and one study included only U.S. patients.

All of the study volunteers were at least 60 years old when the studies started. None had previously fractured their hip.

The studies lasted an average of almost 13 years, during which almost 4,300 hip fractures occurred. The report also noted 28,000 deaths.

The association between breaking a hip and risk of death during the study period was found to be somewhat stronger among men. The risk of death tapered off a bit once participants reached the age of 70, presumably due to a generally higher overall risk of dying among older participants, the study authors noted.

People with a chronic disease -- such as heart disease, cancer or diabetes -- at the time of their hip fracture faced the highest overall death risk, the findings showed.

In the United States, an estimated 300,000 people 65 and older are hospitalized for hip fractures each year, according to the U.S. Centers for Disease Control and Prevention.

The bottom line, Katsoulis said, is that prevention is key.

"For example, people should avoid smoking and high alcohol consumption, be physically active and follow a varied diet rich in calcium and vitamin D, as well as fruits and vegetables," he said.

"It is also important to provide better health care services to those older individuals that have already experienced a fracture, to give them the opportunity to walk again as soon as possible so that we can provide them better quality of life and survival," Katsoulis said.

Dr. Robert Recker, president of the National Osteoporosis Foundation, said the review's findings weren't surprising. He cited the "sadly neglected disease" of osteoporosis as the principal cause.

For example, he noted that only about 23 percent of discharged hip fracture patients are ever diagnosed and treated for osteoporosis. Osteoporosis is the most common underlying cause of hip fracture, Recker said.

The risk of having another break is 2.5 to five times greater following the initial fracture, added Recker, who is also director of the Osteoporosis Research Center at Creighton University in Omaha, Neb.

The study was published recently in the Journal of Internal Medicine.

SOURCES: Michail Katsoulis, Ph.D., medical statistician, Hellenic Health Foundation, Athens, and Farr Institute of Health Informatics Research, University College London, England; Robert Recker, M.D., president, National Osteoporosis Foundation and director, Osteoporosis Research Center, Creighton University, Omaha, Neb.; Jan. 17, 2017, Journal of Internal Medicine

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

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Valium May Be Useless for Acute Lower Back Pain

By E.J. Mundell

MONDAY, Feb. 27, 2017 (HealthDay News) -- For decades, emergency room staff often gave Valium to patients for an acute bout of bad lower back pain.

But a new head-to-head trial in an ER environment casts doubt on the notion that Valium or potent painkillers can really help.

As reported Feb. 22 in the Annals of Emergency Medicine, the trial found that Aleve (naproxen) and a "dummy" placebo pill were as effective as naproxen plus Valium (diazepam) in treating ER patients with acute lower back pain.

"Our study contributes to the growing body of literature indicating that, in general, most medications do not improve acute lower back pain," lead researcher Dr. Benjamin Friedman, of the Albert Einstein College of Medicine in New York City, said in a journal news release.

"One week after being discharged from the emergency department, lower back pain patients had improved equally, regardless of whether they were treated with naproxen and diazepam or naproxen and placebo," Friedman said. "By three months after visiting the emergency department, most patients had recovered completely, regardless of what treatment they received."

The new findings are in tune with guidelines issued Feb. 13 by the American College of Physicians. That group also strongly recommends that people with low back pain try drug-free remedies -- from simple heat wraps to physical therapy -- before resorting to medication. And if medications are used, patients should stick to milder painkillers such as naproxen or ibuprofen, or muscle relaxants.

One expert in treating lower back pain agreed lower back pain can be extremely tough to treat.

"Low back pain is one of the top reasons that people visit emergency departments, accounting for about 2.7 million ED visits per year nationally," said Dr. Eric Cruzen. He directs emergency medicine at Lenox Health Greenwich Village, in New York City.

"Despite how common this complaint is, there has never been much agreement on the most effective treatment," Cruzen said. The new findings "suggest that providers should consider other options for the treatment of non-traumatic low back pain," he added.

The New York City study included 114 ER patients who received either naproxen and a placebo or naproxen and Valium.

After one week, moderate or severe back pain was still reported by 31.5 percent of patients in the Valium group and about 22 percent of those in the placebo group.

After three months, the rates were 12 percent and 9 percent, respectively, the researchers found.

"Millions of patients come to the ER every year seeking relief for back pain, which can be debilitating," Friedman said. "Unfortunately, we have yet to come up with the silver bullet in pill form that helps them. If anything, we may be overmedicating these patients."

Overmedication -- especially when potentially addictive drugs such as opioids or benzodiazepines are used -- comes with its own dangers, Cruzen said. Valium is a benzodiazepine.

"Since benzodiazepines are controlled substances secondary to their addiction and abuse potential, they should only be given if they actually help the patient's condition," Cruzen said.

Dr. Robert Duarte directs Northwell Health's Pain Center in Great Neck, N.Y. He reviewed the study and said it did have some limitations -- for example, people with a preexisting history of back pain or sciatica weren't included in the trial, and the study didn't test the effectiveness of Valium on its own (without naproxen).

Nevertheless, Duarte agreed that the study seems to give more weight to the notion that Valium is of little use in these cases.

"This study helps to further support the fact that diazepam or any benzodiazepines should not be considered an initial option for patients for acute back pain," he said.

SOURCES: Eric Cruzen, M.D., director, emergency medicine, Lenox Health Greenwich Village, New York City; Robert Duarte, M.D., director, Northwell Health's Pain Center, Great Neck, N.Y.; Annals of Emergency Medicine, news release, Feb. 16, 2017

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What Works Best to Help Overweight Folks Eat Healthier?

MONDAY, Feb. 27, 2017 (HealthDay News) -- Getting overweight adults to adopt new heart-healthy eating habits is an uphill battle. But giving them a handout about nutrition may be better than nothing, new research suggests.

There's "an urgent need for innovative approaches to support the implementation of current dietary advice," said Dr. David Jenkins, lead author of the new study from the University of Toronto.

To prevent chronic disease, U.S. nutrition guidelines recommend diets rich in fruits, vegetables and whole grains, plus foods that lower cholesterol such as oats, barley, nuts and soy.

Jenkins, who is chair of nutrition and metabolism at the university, and his team tried three ways of encouraging these healthy habits. The researchers randomly assigned more than 900 overweight adults to one of four groups.

One group received advice about diet through phone calls. Another got a weekly food basket but no advice about diet. The third group got both advice and food baskets. A fourth group, used as "controls," did not receive advice or food baskets. Everybody in each group got a "food guide" handout about diet.

Six months later, participants overall had only slightly increased their consumption of healthier foods like fruits and vegetables, regardless of group. The researchers said the only consistent increases were seen in the group that received both food and advice.

And by 18 months, that slight increase in healthy eating was dwindling, the investigators found.

Still, weight and blood pressure dipped a bit in all the groups, including the control group, according to the study.

The results were published Feb. 27 in the Journal of the American College of Cardiology.

"These data demonstrate the difficulty in effectively promoting fruit, vegetable and whole grain cereals to the general population using recommendations that, when followed, decrease risk factors for chronic disease," Jenkins said in a journal news release.

But the author of an accompanying journal editorial suggested looking at the results as a "glass half-full."

"Each country and scientific society must prioritize the strategies best adapted to local customs and regulations," wrote Dr. Ramon Estruch, an internist at the Hospital Clinic of Barcelona, in Spain.

"However, it appears that simply giving a copy of healthy dietary guidelines causes small changes in the right direction. Perhaps we should start with this extremely simple, no-cost procedure at schools, workplaces, clinics or sports centers, while the other strategies are slowly developed and implemented," Estruch suggested.

Jenkins disclosed grant funding from several food-related companies.

SOURCE: Journal of the American College of Cardiology, news release, Feb. 27, 2017

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Kids Mean Less Shuteye for Mom, While Dad Slumbers on

lundi 27 février 2017

SUNDAY, Feb. 26, 2017 (HealthDay News) -- This will come as no surprise to mothers, but a new survey finds that women with children living at home are more likely to be sleep-deprived than women without children.

However, the presence of children in the home did nothing to alter men's sleep patterns.

The researchers also found that women with children reported feeling tired more days a month than their child-free counterparts.

"Forty-eight percent of women with children reported at least seven hours of sleep, compared to 62 percent of women without children," said study leader Kelly Sullivan. She's an assistant professor of epidemiology at the Jiann-Ping Hsu College of Public Health at Georgia Southern University.

Sullivan and her colleagues analyzed data from a nationwide telephone survey of more than 5,800 men and women. The respondents reported how long they slept each night, with seven to nine hours considered optimal and less than six hours considered lacking. The men and women also reported how many days they had felt tired in the past month.

Women with young children at home said they were tired 14 days a month, compared to 11 days for those without children in the home, the findings showed.

Among the nearly 3,000 women who were 45 or younger, the only factor linked with insufficient sleep was having kids in the house.

"Each child in the house increased the odds of insufficient sleep by 50 percent," Sullivan said.

"For men, we did basically the same analysis and children had absolutely no impact on men [and their sleep]," she added.

Because only limited information was available from the survey, Sullivan can't say why this is so. Nor can she say whether the ages of the children were linked with sleep duration, as no age information was available on the kids. It is well known that women who are breast-feeding are likely to be sleep-deprived after getting up for night feedings, she added.

Sullivan's team looked at other factors -- including exercise, marital status and education -- but found none of them were linked to how long the women under age 45 slept each night.

Among men 45 and younger, having less than a high school education was tied to greater odds of being sleep-deprived. Among women, not working and having a higher household income were linked with getting more sleep, the researchers said.

Another sleep specialist urged caution in looking at the findings.

Even before having children, "men in general may be getting less sleep than women," said Jodi Mindell, associate director of the Sleep Center at Children's Hospital of Philadelphia.

In her research, Mindell has found that mothers with children who are newborn to age 3 typically get less sleep than mothers of children ages 3 to 6.

Mindell suggests parents make a plan as to who is going to take care of household duties, including child care, so each parent can have a goal of enough sleep.

"It doesn't have to be 50-50, but it's sharing it," she said. If one parent works outside the home during the week and the other doesn't, the stay-at-home parent can cover night-time child duty while the other parent takes over on weekends, she suggested.

Or, one may take night-time responsibility and the other morning duties, if that suits schedules better, Mindell said.

Sullivan said such schedules need to be individualized. And that can only happen when a person takes into account why she or he isn't sleeping, and makes a plan to overcome that.

The study findings are scheduled for presentation in April at the American Academy of Neurology's annual meeting in Boston. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

SOURCES: Kelly Sullivan, Ph.D., assistant professor, epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Ga.; Jodi Mindell, Ph.D., professor, psychology, St. Joseph's University, and associate director, Sleep Center at Children's Hospital of Philadelphia; April 25, 2017 presentation, American Academy of Neurology annual meeting, Boston

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Ice Fishing Can Invite Serious Injuries

SATURDAY, Feb. 16, 2017 (HealthDay News) -- Ice fishing may seem like a relaxing pastime, but it can result in broken bones, concussions and other injuries, according to surgeons from the Mayo Clinic.

"Ice fishing has become more popular in the last few years, and, with this, we have seen an increase in ice fishing-related injuries," study author Dr. Cornelius Thiels, a surgical resident, said in a hospital news release.

"What is even more concerning is that ice fishing injuries tend to be more severe than injuries associated with traditional fishing," Thiels said.

"We hope this research will bring awareness to the safety issues that surround this pastime and help prevent similar incidents," he said.

For the study, the researchers examined ER records of visits that occurred between 2009 and 2014. Overall, they identified 85 people treated for injuries sustained while ice fishing.

Ironically, burns are among the most common ice fishing injuries, the study revealed. Four of the anglers included in the study fell into the frigid water, but just as many suffered burns.

"Falling through the ice is the most feared risk of ice fishing," Thiels said.

"However, it turns out that burns are just as common, but rarely discussed. Ice fishing huts often contain rudimentary heating systems, and we have seen injuries from fires and carbon monoxide inhalation," he said.

Nearly 50 percent of the injuries, however, were broken bones, sprains and strains. Roughly 30 percent of these ER visits involved minor trauma, including cuts, scrapes, punctures and fishing hook injuries, the study found.

People hurt while ice fishing were more likely to have been drinking alcohol. They were also commonly under 40 years old, the study showed.

Most of patients treated for injuries didn't have to stay overnight in a hospital. But at least five people had serious injuries, including concussions, loss of a limb, and organ damage.

The study was published recently in the American Journal of Emergency Medicine.

SOURCE: Mayo Clinic, news release, Feb. 14, 2017

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Do You Need an Antibiotic?

FRIDAY, Feb. 24, 2017 (HealthDay News) -- Hoping to lessen their misery, most people would like to know whether the respiratory illness they've got could be helped by an antibiotic.

The key to finding out may lie in your nose. Or, more specifically, the mucus in your nose.

Researchers from Duke Health in Durham, N.C., said they've identified a group of proteins that could be used to tell if an infection is caused by a virus, which triggers cold or flu.

Antibiotics can only fight bacterial infections, not viral illnesses.

When detected in specific quantities in the mucus of runny noses and inflamed throats, the proteins targeted in the new study were 86 percent accurate in confirming a viral infection, the scientists said.

"In the past, science has focused on identifying the pathogen someone is infected with in the blood or other sample," said study lead author Thomas Burke. He's director of technology advancement and diagnostics at Duke.

"Our approach flips the paradigm of how we look for infection. Instead of looking for the pathogen, we study the individual's response to that pathogen," Burke said in a health system news release.

For the trial, the researchers infected 88 healthy adults with a common strain of cold or flu virus. They also collected fluid samples from the volunteers' nasal passages.

Some participants didn't get sick, but those who did had a distinct set of 25 proteins in their noses, the study showed.

The researchers said their findings could lead to quick, noninvasive tests for upper respiratory infections that could be easily done in a doctor's office.

Senior author Dr. Geoffrey Ginsburg is director of the Duke Center for Applied Genomics & Precision Medicine. "Every day, people are taking time off from work, going to emergency rooms, urgent care or their primary care doctors with symptoms of an upper respiratory infection," he said.

"Looking for these proteins could be a relatively easy and inexpensive way of learning if a person has a viral infection, and if not, whether the use of antibiotics is appropriate," Ginsburg said.

Being able to quickly diagnose a viral infection could help limit the unnecessary use of antibiotics, helping to prevent the rise of antibiotic resistance, the researchers said.

Easier, cheaper tools to diagnose viral infections could also benefit those people with reduced access to health care, the researchers added.

"The protein targets offer a faster, more cost-effective model for rapid screening and diagnoses of viral infections," said Dr. Christopher Woods, a senior author of the study. He's associate director of applied genomics.

"If the data are verified, the model could be valuable in many circumstances, such as rural settings or developing countries with less convenient access to health care, or even as an airport screening tool during an outbreak of a particularly threatening strain of flu," Woods said.

The study was published recently in EBioMedicine.

SOURCE: Duke Health, news release, Feb. 22, 2017

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Many Opioid Addicts in Treatment Take Narcotics on the Side

vendredi 24 février 2017

THURSDAY, Feb. 23, 2017 (HealthDay News) -- Opioid addicts who undergo "medication-assisted treatment" are often using other narcotics before long, a new study cautions.

Doctors frequently give addicts buprenorphine, a low-dose opioid, to minimize withdrawal symptoms while they try to get off opiates like oxycodone (Oxycontin) or heroin. The drug produces a weaker effect than those deadlier drugs.

But researchers from Johns Hopkins Bloomberg School of Public Health checked pharmacy records for 38,000 new buprenorphine patients in 11 states and found cause for concern.

Forty-three percent of addiction patients filled a prescription for a full-strength opioid like oxycodone while undergoing treatment, which was typically three months. And 67 percent did so in the year after treatment ended, the researchers found.

"Policymakers may believe that people treated for opioid addiction are cured, but people with substance use disorders have a lifelong vulnerability," said study leader Dr. G. Caleb Alexander, an associate professor of epidemiology at Hopkins.

While some of these drugs may have been legitimately prescribed after surgery or an accident, the researchers said this pattern suggests many patients lack well-coordinated treatment for opioid use disorders and chronic pain.

This could lead to higher rates of relapse or overdose, said Alexander, who is also co-director of the school's Center for Drug Safety and Effectiveness.

"Our findings highlight the importance of stable, ongoing care for these patients," Alexander said in a Hopkins news release.

The findings come alongside a new report saying the rate of drug overdose deaths in the United States has increased 2.5 times since 1999. That report was released Feb. 24 by the U.S. Centers for Disease Control and Prevention.

Methadone was long the low-dose opioid of choice for medication-assisted treatment, but increasingly patients have turned to buprenorphine. Though similar to methadone, it's known to be a shorter-acting opioid.

"Unlike methadone, buprenorphine can be prescribed for opioid use disorders in primary care, so it is an important treatment option for clinicians and patients to have," said study co-author Matthew Daubresse. "But many patients, especially those with shorter lengths of treatment, appear to be continuing to use prescription opioids during and after buprenorphine treatment."

Daubresse, a doctoral student in the epidemiology department, said better ways are needed to keep patients engaged in long-term treatment. "These efforts couldn't be more urgent given how many Americans continue to die or get injured from opioids," he added.

For the new CDC-funded study, the Hopkins researchers focused on non-buprenorphine prescriptions filled between 2006 and 2013.

The research team pointed out that their analysis didn't include heroin, meaning overall opioid abuse during and after treatment was likely even higher than the study numbers suggested.

The findings were published Feb. 23 in the journal Addiction.

SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, Feb. 23, 2017

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Could Parkinson's Disease Raise Stroke Risk?

THURSDAY, Feb. 23, 2017 (HealthDay News) -- A large new analysis suggests there may some type of link between Parkinson's disease and the risk for stroke.

However, the study can't prove that one condition causes the other -- or even which direction the link might travel, the researchers said.

For example, maybe Parkinson's somehow raises a person's odds for ischemic stroke -- the type that's caused by a clot and makes up the vast majority of strokes. Or, it could be that having a stroke weakens the brain, raising the risk that a patient will develop Parkinson's.

Or, as one expert who reviewed the findings said, a separate, unknown factor might independently link the two conditions.

"There may be some processes that occur with aging that increase the risk of both stroke and neurodegenerative disorders" such as Parkinson's, said Dr. Andrew Feigin, a neurologist at Northwell Health's Neuroscience Institute in Manhasset, N.Y.

More study will be needed to unravel the connection, said a team of researchers led by Dr. Benjamin Kummer, of Weill Cornell Medical College in New York City.

In the study, Kummer's team tracked outcomes for a sample of about 1.6 million U.S. Medicare recipients between 2008 and 2014.

The study found that the incidence of ischemic stroke among those already diagnosed with Parkinson's was just under 2 percent, compared with less than 1 percent for those who did not struggle with Parkinson's.

The investigators also looked at the situation from the opposite perspective. They found that among people who had suffered a stroke, nearly 1 percent went on to develop Parkinson's -- compared to less than half a percent of people with no such medical history.

The study also supported evidence from prior studies linking strokes and Alzheimer's disease. Kummer's team found that the incidence of Alzheimer's among patients who had experienced a stroke was more than 3.5 percent. This compared with just over 1 percent for those who'd never experienced an ischemic stroke, the researchers said.

Dr. Ajay Misra is chair of neurosciences at Winthrop-University Hospital in Mineola, N.Y. He said the finding suggests that, for seniors, "both Alzheimer's disease and Parkinson's disease [have an] increased incidence of stroke soon after the diagnosis is made."

Misra stressed that patients can take steps to minimize the risk of stroke and neurological illness, however. "Risk-reduction strategies for both are common -- abstain from smoking and excessive alcohol intake, get regular exercise, weight control, control of high blood pressure and the prevention of diabetes," he said.

The study was to be presented Thursday at the International Stroke Conference in Houston. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

SOURCES: Andrew Feigin, M.D., neurologist, Northwell Health's Neuroscience Institute in Manhasset, N.Y.; Ajay Misra, chairman, department of neurosciences, Winthrop-University Hospital in Mineola, N.Y.;American Stroke Association, news release, Feb. 32, 2017

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Study Links Psychiatric Disorders to Stroke Risk

THURSDAY, Feb. 23, 2017 (HealthDay News) -- Getting care at a hospital for a psychiatric disorder may be linked to a higher risk of stroke in the following weeks and months, new research suggests.

People who sought care at a hospital for serious mental health conditions -- such as depression, anxiety or post-traumatic stress disorder -- faced a tripled risk of stroke following their visit, the study authors contended.

The risk started to decrease after 30 days, but remained twice as high for at least a year after the ER visit or hospital stay, the researchers said.

"We have known for some time that people who have a stroke seem to be at an increased risk for later on developing some sort of psychiatric illness, depression or post-stroke psychosis," said study lead author Jonah Zuflacht. He's a fourth-year medical student at Columbia University's College of Physicians and Surgeons in New York City.

"But what has been less studied is the inverse of that. Meaning, if you have some sort of psychiatric illness, does it increase the risk for stroke?" he added.

"And what we found is that if you are hospitalized for some sort of mental illness, your risk of stroke is increased, and it's most increased over the two-week period following your hospitalization," Zuflacht said.

It's important to note that the study wasn't designed to prove a cause and effect; it only found that an ER visit or hospitalization for a psychiatric disorder was associated with a higher risk of stroke.

"As to why, we have theories, but they're only theories," Zuflacht said. "At this point we're not really able to offer a clear explanation as to why that is the case."

The researchers said they suspect that serious psychiatric illness may send the body's "fight-or-flight" stress response into overdrive. One reaction this might cause is elevated blood pressure, and high blood pressure is a leading cause of stroke.

"The other possibility is that there are behavioral reasons at work," Zuflacht said. "For example, are these patients maybe not taking the medications they should be taking to prevent a stroke -- like their high blood pressure meds -- because of their mental illness? We don't yet have the data to support either theory, but these are our hypotheses."

Nonetheless, the findings suggest that patients being treated for depression or other psychiatric illnesses may be vulnerable to stroke, Zuflacht said.

"Maybe down the road these patients could benefit from primary prevention strategies for stroke, like prescribing daily aspirin, for example. Of course, whether or not that would help and be of benefit we can't yet say," he added.

The study data came from California's Healthcare Cost and Utilization Project. The researchers analyzed more than 52,000 stroke "events" -- equally divided between men and women -- that had taken place between 2007 and 2009.

The researchers found that more than 3,300 patients -- just over 6 percent -- had sought hospital care for a psychiatric disorder at some point in the year leading up to their stroke.

These patients were more likely to be female. They also tended to need a longer hospital stay for their stroke treatment, compared with stroke patients who hadn't sought mental health care at a hospital.

The risk of stroke more than tripled within the first 15 days after receiving mental health care. The risk dropped slightly immediately afterwards, but was still more than triple the norm one month out, the study authors said.

And though it fluctuated over the following months, the risk was still more than double the norm through the 12-month mark.

Dr. Larry Goldstein, a spokesman for the American Stroke Association, said what this study adds "is the tantalizing possibility that interventions aimed at reducing psycho-social stress may also translate, potentially, into a reduction in stroke risk."

But right now, that's only a hypothesis that needs to be tested, he said.

Zuflacht and his colleagues are scheduled to present their findings on Thursday at the International Stroke Conference in Houston. Until published in a peer-reviewed journal, findings presented at meetings are generally viewed as preliminary.

SOURCES: Jonah P. Zuflacht, M.D.-candidate, Columbia University's College of Physicians and Surgeons, New York City; Larry Goldstein, M.D., American Stroke Association spokesperson, and professor and chairman, department of neurology, and co-director, Kentucky Neuroscience Institute; Feb. 23, 2017, American Stroke Association's International Stroke Conference, Houston

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Study Links Psychiatric Disorders to Stroke Risk

Treating Migraines: More Ways to Fight the Pain

jeudi 23 février 2017

MRIs Can Be Safe for People with Heart Devices

WEDNESDAY, Feb. 22, 2017 (HealthDay News) -- People with pacemakers or implantable defibrillators have long been told they can't undergo MRI scans. But a new study suggests that it can be safely done -- under the right conditions.

The study, published in the Feb. 23 issue of the New England Journal of Medicine, focused on patients with standard heart devices not designed to be MRI-compatible.

The study found that even for them, an MRI can be safely performed, when a specific protocol is followed.

"I think this really opens a door for these patients to have an MRI when medically indicated," said lead researcher Dr. Robert Russo, of the Scripps Research Institute, in La Jolla, Calif.

The big caveat, though, is that patients in the study were all screened and went through a specific protocol.

An expert in cardiac devices -- a doctor, physician's assistant or nurse practitioner -- had to be present during the MRI. Each patient's device was reprogrammed before the MRI scan, then restored to the original settings afterward. And during that time, patients' blood pressure, blood oxygen and heart rhythm were all monitored.

The bottom line is, patients cannot safely get an MRI at just any center, according to Dr. Emanuel Kanal, director of magnetic resonance services at the University of Pittsburgh Medical Center.

"Yes, some patients can be scanned, under specific circumstances," said Kanal, who was not involved in the study.

But he stressed that it should only be done at centers with the necessary expertise in managing patients with these heart devices.

MRI scans are done for a wide range of reasons, to help diagnose anything from tumors to bone and joint injuries, to internal bleeding. Unlike CT scans, an MRI scan doesn't involve radiation, Russo pointed out -- and it can sometimes give information that other types of imaging cannot.

So, he said, it's important that people with heart devices be able to undergo an MRI scan, if possible.

But because an MRI scan produces a powerful magnetic field, there has long been concern about its safety for heart-device patients. One of the biggest worries, Russo said, is that it could overheat the device wires, possibly injuring the heart muscle or altering how the device paces the heart.

So for years, people with pacemakers and implantable cardioverter defibrillators (ICDs) have been warned against undergoing an MRI.

In more recent years, manufacturers have developed so-called "MRI-conditional" heart devices, which are designed to minimize the potential risks of the scans.

Still, Russo said, many people have conventional devices -- an estimated 2 million in the United States alone. So his team looked at whether such patients can safely have an MRI, with the right precautions in place.

The study involved more than 1,200 patients with standard pacemakers or ICDs. They underwent a total of 1,500 MRI scans at 19 centers across the United States.

All of the scans were done using the same protocol. Each patient's device was "interrogated" -- tested non-invasively -- before the MRI, then reprogrammed accordingly. If possible, it was set to a "no-pacing" mode. But if patients had symptoms in that mode, their device was programmed a different way.

After the MRI, the device was restored to its original settings, then tested again to make sure it was working properly.

None of the patients, the study found, had a "failure" in their device or its wires during the MRI. And none suffered a dangerous heart-rhythm disturbance.

Six patients did have atrial fibrillation or atrial flutter -- a quivering in the heart's upper chambers. But each case was short-lived and stopped on its own, the study authors said.

One ICD patient needed to have the device generator immediately replaced after the MRI.

That, Russo said, was because "someone left the shock function on" before the scan. The device went into non-functional mode during the MRI, then couldn't be tested afterward.

But overall, Russo said, "we didn't find any true risk that should stop these patients from having a medically indicated MRI."

None of the patients had an MRI of the chest, however -- so it's not clear whether the findings apply to those scans, the researchers acknowledged.

To Kanal, the take-away for patients is this: "They're not necessarily precluded from having any MRI study of their body -- even if they have a device that's not MRI-conditional."

But he underscored the importance of having the scan done at the right center. He also pointed to one way patients can do their homework: Find out whether your MRI center has personnel certified by the American Board of Magnetic Resonance Safety.

Dr. David Wilber is editor-in-chief of the journal JACC: Clinical Electrophysiology. He called the study findings "good news," adding that "this protocol has been incorporated at many medical centers, and these findings confirm that it is quite safe."

However, given the personnel required, "it will probably be limited to relatively large centers," and may or may not be covered by patients' insurance whose devices aren't "MRI-conditional."

The study was partly funded by St. Jude Medical, Biotronik and Boston Scientific, all makers of heart devices.

SOURCES: Robert Russo, M.D., adjunct assistant professor, molecular and experimental medicine, Scripps Research Institute, La Jolla, Calif.; Emanuel Kanal, M.D., director, magnetic resonance services, and professor, radiology and neuroradiology, University of Pittsburgh Medical Center, Pittsburgh; David Wilber, M.D., editor-in-chief, JACC: Clinical Electrophysiology; Feb. 23, 2017 New England Journal of Medicine

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For Stroke Survivors, Exercise Is Good for The Brain

WEDNESDAY, Feb. 22, 2017 (HealthDay News) -- A structured exercise program can help stroke survivors recover not only physically but mentally as well, a new review says.

The analysis of 13 clinical trials found that exercise therapy was generally good for stroke patients' "cognition."

Cognition refers to vital mental processes such as thinking, learning, understanding and remembering. A stroke, which cuts off blood flow to the brain, can impair those abilities.

The findings bolster what experts have long believed: Exercise can aid stroke recovery in multiple ways.

"This isn't new," said Daniel Lackland, a spokesman for the American Stroke Association who was not involved in the research. "We've known that exercise is good after a stroke."

But, he said, the findings offer more clarity on exactly what works. They suggest, for example, that a combination of moderate aerobic exercise and training in strength and balance is most effective for improving stroke patients' mental acuity.

Lauren Oberlin, a graduate student at the University of Pittsburgh, led the study. She said the findings confirm the value of exercise after a stroke.

"It can improve mobility, strength and quality of life, as well as cognition," Oberlin said. And that mental boon, she noted, may give stroke patients "additional motivation" to start an exercise program.

For the study, Oberlin and her colleagues pooled the results of 13 clinical trials that involved a total of 639 patients recovering from a stroke.

The studies all differed in a number of ways -- including the type of exercise they tested, and the duration of the program.

But in general, Oberlin's team found that patients who exercised showed bigger gains in certain mental abilities -- namely, attention and processing speed -- versus those who did not exercise.

And it didn't take a long time, Oberlin said. Even exercise programs lasting four to 12 weeks were effective.

It also appears that exercise helps even when patients begin more than three months after their stroke. In fact, Oberlin said, those patients were, on average, about 2.5 years past their stroke.

The most effective programs offered patients exercises aimed at strength, balance, stretching and aerobic fitness -- the kind, Oberlin noted, that "gets your heart rate up and makes you sweat."

But that doesn't have to mean an intense workout, Oberlin noted. Walking on a treadmill does the job. And for people with balance problems or other physical limitations, she said, there are options like recumbent stationary bikes and rowing machines.

Does it necessarily take a formal exercise program? Maybe not, Oberlin said. As long as stroke patients have been cleared to exercise on their own, they may be able to do something as simple as take a daily walk.

"But if you have mobility issues, you might need a supervised program," Oberlin said. "What's critical is that you talk to your doctor first, to make sure that any activity you want to do is safe."

Lackland agreed, and also noted that exercise is just one part of stroke recovery. He said patients need to take "comprehensive measures" to improve their health and reduce the likelihood of suffering another stroke.

"That includes good blood pressure control, weight control, not smoking and limiting salt in the diet," Lackland said.

Why would physical activity benefit mental sharpness after a stroke?

Other research points to several possible reasons, Oberlin said: Exercise may improve blood flow to the brain, promote the growth of new brain cells and connections among those cells, and reduce inflammation, to name a few.

Oberlin was to present the findings Wednesday at the International Stroke Conference in Houston. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

SOURCES: Lauren Oberlin, M.S., graduate student, psychology, University of Pittsburgh; Daniel Lackland, Dr.P.H., spokesman, American Stroke Association, and professor, medicine, Medical University of South Carolina, Charleston; Feb. 22, 2017, presentation, International Stroke Conference, Houston

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Is Need for More Sleep a Sign of Pending Dementia?

WEDNESDAY, Feb. 22, 2017 (HealthDay News) -- Seniors who begin sleeping more than nine hours a night may face a higher risk of dementia down the road, a new study suggests.

The researchers estimated that the risk of dementia grew by almost 2.5 times for those who found themselves recently needing extra sleep. The chances of dementia rose sixfold for people without a high school degree who suddenly needed to sleep nine hours or more, the study contended.

The study authors said this finding hinted that education might somehow offer a bit of protection from dementia.

People with dementia often suffer from disrupted sleep, "but we don't know much about whether these changes come first," said study co-author Matthew Pase. He's a neurology fellow at the Boston University School of Medicine.

Dementia "is by no means a certain fate" in those who find themselves sleeping longer as they age, Pase said. The new study only found an association between added sleep and dementia, not cause and effect.

Still, Pase thinks monitoring sleep habits might be a good idea in certain cases. "If someone reported recently becoming a longer sleeper, they could undergo a memory assessment," he suggested.

Past research in this area compared people who already had dementia to those who didn't have it, instead of tracking people over time, he noted.

The new study tried a different strategy, Pase said. "We asked a very basic question: How does one's sleep duration relate to being diagnosed with clinical dementia in the future?"

The researchers looked at seniors in the Framingham Heart Study, which has tracked people and their descendants in a Massachusetts community since 1948. The researchers followed two groups of older people -- all over 60 -- from 1986-1990 and 1998-2001 onward.

Nearly 2,500 people were included in the study. Their average age was 72. Fifty-seven percent were women.

Over 10 years, 10 percent of the participants were diagnosed with dementia, with the wide majority thought to have Alzheimer's disease.

The researchers didn't find any heightened dementia risk in people who'd been sleeping nine or more hours a night for more than an average of 13 years.

But those who'd begun sleeping more than nine hours recently had nearly double the risk of dementia compared to other people -- 20 percent of the new long-sleepers were diagnosed with dementia.

These people also appeared to have smaller brain volumes, Pase said.

Pase said it appears that the extra sleep is a sign of something else, not a direct cause of dementia. It could indicate chemical changes that are happening in the brain, he said.

Or, he said, the development of dementia could make people more tired.

Dementia tests may be appropriate for older people who notice they're sleeping longer, Pase said. But he doesn't recommend people try to wake up earlier.

"They shouldn't restrict sleep," he said. "There are no implications for treatment based on our findings."

Dr. Jiu-Chiuan Chen is an associate professor with the Keck School of Medicine at the University of Southern California. He wasn't involved with the study, but said the research seems valid.

Chen agreed that there's no need to offer any special treatment to older people who start to sleep over nine hours, because it's not yet clear what's going on.

The next step for researchers is to study people as they sleep to better understand how sleep and dementia are connected, Pase said.

The study appears Feb. 22 in the journal Neurology.

SOURCES: Matthew Pase, Ph.D., senior research fellow, Swinburne University of Technology, Melbourne, Australia, and fellow, Department of Neurology, Boston University School of Medicine; Jiu-Chiuan Chen, M.D., Ph.D., Sc.D., associate professor, Keck School of Medicine, University of Southern California, Los Angeles; Feb. 22, 2017, Neurology

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No, Your Cat Isn't a Threat to Your Mental Health

mercredi 22 février 2017

TUESDAY, Feb. 21, 2017 (HealthDay News) -- Cat owners can breathe a sigh of relief: Your feline's litter box likely won't put your family's mental health at risk.

New British research challenges earlier beliefs that parasites in cat droppings might be linked to schizophrenia, obsessive-compulsive disorder and other mental health issues.

"The message for cat owners is clear: There is no evidence that cats pose a risk to children's mental health," said study author Dr. Francesca Solmi, of University College London Psychiatry.

Cats are carriers of an infectious parasite called Toxoplasma gondii (T. gondii). They may pass this infection on to humans through their feces. The researchers behind this study wanted to know if contact with cats during childhood raised risk for mental illness.

To find out, the researchers followed nearly 5,000 people born in the early 1990s until they were 18 years old. Specifically, the study looked at whether the participants' mothers had a cat during pregnancy or if the participants grew up in a home with a cat.

The researchers concluded that cat ownership in childhood is not linked to psychiatric or mental problems.

"Previous studies reporting links between cat ownership and psychosis simply failed to adequately control for other possible explanations," Solmi said in a university news release.

But mental health worries aside, pregnant women should still be cautious about exposure to cat litter boxes, another researcher warned.

"There is good evidence that T. gondii exposure during pregnancy can lead to serious birth defects and other health problems in children," said study senior author Dr. James Kirkbride.

"As such, we recommend that pregnant women should continue to follow advice not to handle soiled cat litter in case it contains T. gondii," said Kirkbride, who is also with UCL Psychiatry.

The findings were published Feb. 21 in the journal Psychological Medicine.

SOURCE: University College London, news release, Feb. 21, 2017

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U.S. Life Expectancy May Rise to Over 80 by 2030

TUESDAY, Feb. 21, 2017 (HealthDay News) -- By 2030, American women will live an average of more than 83 years, while men may reach an average of 80, a new study estimates.

These figures are up just slightly from current 2010 estimates. Right now, American women live to an average of 81, while men live to an average of 77.

But other developed countries are projected to do even better by 2030, according to the study in The Lancet.

In fact, after running 21 different statistical models across 35 different developed nations, investigators found that South Korea is projected to fare the best in terms of future life span.

For example, South Korean women, as of 2010, are expected to live on average to roughly 84 years of age. But there's a strong possibility that figure will reach more than 90 by 2030, the study authors said.

"As recently as the turn of the century, many researchers believed that life expectancy would never surpass 90 years," study lead author Majid Ezzati noted in a journal news release. Ezzati is a professor at Imperial College London's School of Public Health in England.

"Our predictions of increasing life spans," he added, "highlight our public health and health care successes. However, it is important that policies to support the growing older population are in place.

"In particular, we will need to both strengthen our health and social care systems and to establish alternative models of care such as technology-assisted home care," Ezzati said.

The research team said that the projections are estimates that, while highly probable, aren't necessarily how things will turn out.

That said, the investigators combined the results of various statistical models to come up with more accurate tallies than what they said would normally be generated by a single model alone.

They found that among women, France came in second to South Korea, with French women expected to live to 88.6 years by 2030. Japanese women were only slightly behind, with 88.4 years by 2030.

And apart from South Korea, the biggest jumps in terms of female longevity were seen in Slovenia and Portugal, both projected to see life expectancy rise by between four and five years by 2030.

Among men, South Korean men also came out on top, with 2030 projections pegging longevity at just over 84. Australian and Swiss men were right behind, with both populations expected to reach 84 years of age.

As for why American life expectancy is not growing as much, Ezzati's team suggested that current projections reflect a long-standing trend of lower growth in that regard.

The researchers suggested the absence of universal health care as one possible reason for the difference. Other possible factors include a high homicide rate, a growing obesity problem and rising economic inequality.

SOURCE: The Lancet, Feb. 21, 2017

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Heart Disease Linked to Anxiety, Negative Feelings

TUESDAY, Feb. 21, 2017 (HealthDay News) -- People with mild heart disease are more likely to say they have poorer health, anxiety and a negative outlook than people in the general population, a new study suggests.

These problems are more common among female patients than male patients, the research found.

In mild heart disease, there is partial blockage of blood flow to the heart. People with the condition are more at risk of heart attacks, other serious heart problems, and death from any cause.

The perception of overall physical and mental health, as well as personality, can have an impact on health outcomes, study senior author Paula Mommersteeg suggested.

The study was published Feb. 21 in the journal Circulation: Cardiovascular Quality and Outcomes.

"We were very intrigued by these sex and gender differences -- we had not thought they would be so apparent," Mommersteeg said in a journal news release. She is an assistant professor of medical and clinical psychology at Tilburg University in the Netherlands.

Mommersteeg added that because of this, doctors should consider factors such as a negative attitude as a potential heart disease risk factor.

The new study included more than 500 people with mild heart disease. There was also a control group of more than 1,300 people without heart trouble. The study volunteers were all between ages 52 and 70. The researchers asked them to complete questionnaires about their physical and mental health.

Although the study couldn't prove a cause-and-effect relationship, the research found that people with heart trouble reported significantly higher rates of poor health, anxiety and negative emotions combined with social inhibition compared to people in the control group.

Female patients reported higher rates of health problems and anxiety than male patients.

The researchers said there were a number of factors that might explain the gender differences. These include societal and cultural norms, age when diagnosed, education level, marital status, employment history and alcohol use.

SOURCE: Circulation: Cardiovascular Quality and Outcomes, news release, Feb. 21, 2017

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Kids Born to Older Moms Score Higher on Thinking Tests

mardi 21 février 2017

MONDAY, Feb. 20, 2017 (HealthDay News) -- Children born to older moms today have better thinking skills than those with younger mothers, a new study suggests.

The opposite was true 40 or 50 years ago -- a shift researchers say mirrors changing trends in parenting.

Women today tend to be older when they have their first child and, on average, first-borns do better on cognitive ability tests, which measure thinking skills. This may be because they get more attention from parents than siblings born after them.

"Cognitive ability is important in and of itself but also because it is a strong predictor of how children fare in later life -- in terms of their educational attainment, their occupation and their health," said study author Alice Goisis. She is a researcher at the London School of Economics and Political Science.

In the past, older moms were likely to be having their third or fourth child, stretching their energy and resources, the study authors noted.

Older mothers today also have advantages over younger ones, the researchers explained. They're often better educated, are more likely to have established careers and are less likely to smoke during pregnancy, which can harm the developing fetus.

"It's essential to better understand how these children are doing given that, since the 1980s, there has been a significant increase in the average age of women having their first child in industrialized countries," Goisis said in a school news release.

For the study, the researchers analyzed data from three studies of British children who were born in 1958, 1970 and 2001, and who took cognitive ability tests at ages 10 and 11.

In 1958 and 1970, kids born to mothers who were 25 to 29 years of age posted higher scores than those born to moms who were between 35 and 39. The reverse was true for the 2001 group, the findings showed.

The study was published recently in the International Journal of Epidemiology.

SOURCE: London School of Economics and Political Science, news release, Feb. 13, 2017

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Staying Socially Active Nourishes the Aging Brain

MONDAY, Feb. 20, 2017 (HealthDay News) -- Socializing with lots of relatives and friends may help you stay mentally sharp as you age, a new report co-sponsored by AARP finds.

"It's not uncommon for our social networks to shrink in size as we get older," said Marilyn Albert, professor of neurology and director of cognitive neuroscience at Johns Hopkins University in Baltimore.

"This report provides many helpful suggestions about the things we can do to improve the quality of our relationships with family and friends, which may be beneficial in maintaining our mental abilities," Albert said in an AARP news release.

The report also discusses the social benefits of having pets, how age-friendly communities boost social ties, how close relationships benefit both physical and mental health, and how social media (including Facebook and Skype) helps older adults maintain social connections.

The report is from the AARP and the Global Council on Brain Health (GCBH). Albert is chair of the GCBH.

In related news, a new AARP survey found that nearly four in 10 adults aged 40 and older said they lack social connections. Those people also reported worse brain health.

Sarah Lock is AARP senior vice president for policy and GCBH executive director. She said, "We know that loneliness and social isolation can increase physical health risks for older people."

So, Lock added, "The GCBH's consensus that people who are socially engaged have a lower risk for cognitive [mental] decline shows us just how important social connections are to brain health."

The AARP said older adults can boost their social ties by making new social connections, including with younger people. Other suggestions include joining a club or taking a class; visiting, calling or emailing regularly with relatives, friends, and neighbors; and volunteering or visiting a lonely neighbor or friend.

SOURCE: AARP, news release, Feb. 14, 2017

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Tired of The Ups and Downs of Yo-Yo Dieting?

MONDAY, Feb. 20, 2017 (HealthDay News) -- Anyone who has been on a diet knows the real challenge comes later, when you've got to fight tooth and nail to keep from regaining the lost weight.

Now, a new trial finds that regular "diet coaching" may help keep the weight off.

People were more likely to maintain successful weight loss if they took part in a series of post-diet coaching sessions conducted mostly by phone, said study author Corrine Voils. She is scientific director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin.

Dieters who received coaching had only regained about a pound and half, on average, a year after their initial weight loss, Voils said. Successful dieters who received no follow-up coaching regained about 5 pounds.

Typically, most people tend to regain weight at a rate of about 2 to 4 pounds a year, the study authors said in background notes.

"The program did slow the rate of regain over that period," Voils said.

Previous research has shown that people who are taught specific behavioral skills can better maintain weight loss, Voils said.

For this study, Voils and her colleagues combined several of those skills and regularly reinforced them with successful dieters during a 42-week period.

The participants were 222 patients at VA clinics in North Carolina who lost an average of 16 pounds as part of a structured weight-loss program.

Following their weight loss, these folks were randomly assigned to receive regular coaching from dietitians or were left to their own devices.

The coaching included a few group visits at first, but quickly transitioned into regular phone calls, Voils said.

"We started out with biweekly contacts, and then decreased to monthly and then to every two months," she said.

The coaching hit on four major themes for weight-loss maintenance, Voils said.

The first involved weighing oneself regularly to identify any sudden weight gain. Patients were told to react if they noticed that they'd put back on 3 pounds.

"Once you regain 3 pounds, this means that you're on a trajectory to regain weight. You need to go back to your weight-loss effort," Voils said. "It's easier to recuperate from a small slip than it is from a 20-pound slip."

Participants also were encouraged to:

Plan for situations where they might slip into old eating habits, such as holidays, travel, parties or church buffets.
Ask a friend or family member to help them maintain healthy habits that would keep weight off.
Make a list of the personal benefits from weight loss they'd experienced, as a way to keep them motivated.

Many weight-loss programs feature one or more of these strategies, but they are rarely combined and usually are emphasized during the initial weight-loss period, not as a part of long-term maintenance, Voils said.

After 42 weeks, patients were left alone for 14 weeks and then weighed again to see whether they'd experienced any weight gain.

Voils said the program was low-cost -- about $276 per participant for 56 weeks -- which makes it a fairly inexpensive way to help people stay healthy and fit following a weight-loss program.

"There could be a distinct phase after initial weight loss where this could benefit," Voils said. "There's accountability by somebody calling you regularly."

Dr. Donald Hensrud, editor of "The Mayo Clinic Diet," said the study "demonstrates that some follow-up in this period through telephone calls could be beneficial."

Hensrud also directs the Mayo Clinic Healthy Living Program, a wellness program that offers six months to a year of follow-up from coaches.

"We haven't done a research study like this, but we designed it [the program] for similar reasons," Hensrud said. "We think that staying in touch with people during this so-called maintenance phase is important. People respond to it."

Voils couldn't say whether people who've lost weight would require such coaching for the rest of their lives, to prevent regaining those pounds.

"I would love to do that next study to figure that out," she said.

The study was funded by the U.S. Department of Veterans Affairs, and the results were published Feb. 21 in the Annals of Internal Medicine.

SOURCES: Corrine Voils, Ph.D., scientific director, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison; Donald Hensrud, M.D., editor, "The Mayo Clinic Diet," and director, Mayo Clinic Healthy Living Program, Rochester, Minn.; Feb. 21, 2017, Annals of Internal Medicine

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Cutting Salt a Health Boost for Kidney Patients

vendredi 17 février 2017

THURSDAY, Feb. 16, 2017 (HealthDay News) -- Encouraging people with kidney disease to reduce their salt intake may help improve blood pressure and cut excess fluid retention, at least for a while, a new study suggests.

Study participants lowered their systolic blood pressure (the top number) by almost 11 points, on average, on a salt-restricted diet versus their usual diet. They also flushed out a liter of water (about one-quart) from their bodies, on average, by slashing salt in their diets, researchers said.

Having high blood pressure and retaining excess salt and water in the body stresses the heart and blood vessels, explained lead author Dr. Rajiv Saran of the University of Michigan.

For kidney disease patients, high blood pressure (or "hypertension") and excess fluid in the body can be a toxic combination. "They die predominantly of cardiovascular disease," said Saran, a professor of internal medicine and epidemiology in the nephrology division.

Yet doctors rarely have time or make time to counsel each patient about salt-restricted diets, he said.

Saran and co-investigators wondered whether having trained dietitians talk to patients with chronic kidney disease by phone or in person about ways to lower daily sodium intake would make a difference.

Dr. Ebele Umeukeje is an instructor of medicine in the division of nephrology and hypertension at Vanderbilt University Medical Center in Nashville, Tenn.

"This study's findings highlight the impact of motivational interviewing on improving blood pressure control in patients with [chronic kidney disease], simply by increasing adherence to a salt-restricted diet," said Umeukeje, who was not involved in the study.

Saran suggested that with sustained improvements, "it's conceivable that you would not only reduce the long-term effects of blood pressure, but also you may in fact reduce progression of chronic kidney disease."

Pamela Kent, a registered dietitian, explained that motivational counseling is much like coaching.

It's "not telling patients" to do something; "it's really engaging the patient in order to change behavior," said Kent, who is with the Shaker Heights, Ohio-based Centers for Dialysis Care.

Fifty-eight adults with chronic kidney disease in Michigan and North Carolina participated in the study. Each was randomly assigned to follow a salt-restricted diet or their usual diet over a four-week period. Then, after a two-week hiatus, each patient switched to the other diet.

During the salt-restricted diet, the goal was to consume less than 2 grams (2,000 milligrams) of salt a day. (One teaspoon of salt contains 2,300 mg of sodium.) That target is based on published recommendations for people with high blood pressure. Adherence to the diet was assessed by measuring salt in the urine.

People on the salt-restricted diet weren't eating prepackaged low-salt meals. Rather, dietitians trained in motivational techniques counseled them on cutting salt in their diets and encouraged them to make lower-sodium choices.

Patients' blood pressure was measured at the start of the study and after each four-week phase. The researchers also used a technique called bioelectrical impedance to measure changes in body fluid. This simple test involves placing electrodes on the body and getting a readout. (It's not routinely used in clinics yet, but Saran believes this study may help demonstrate its value in kidney disease.)

During the study period, nearly 80 percent of participants reduced their sodium. And two-thirds reduced it by more than 20 percent, "which is quite big," Saran said. "But there was obviously a lot of variability, so some people reduced it more than others," he added.

Saran acknowledges that a longer, larger study is needed to show whether patients can sustain salt-restricted diets -- and improved blood pressure and fluid levels -- over time.

An estimated 26 million Americans -- one in nine -- have chronic kidney disease, according to the American Society of Nephrology.

The study findings were published online Feb. 16 in the Clinical Journal of the American Society of Nephrology.

The study was funded in part by the U.S. National Institutes of Health. Two of Saran's co-investigators reported holding stock in Fresenius Medical Care, a kidney dialysis company.

SOURCES: Rajiv Saran, M.D., professor, internal medicine and epidemiology, nephrology division, University of Michigan, Ann Arbor; Ebele Umeukeje, M.D., instructor of medicine, division of nephrology and hypertension, Vanderbilt University Medical Center, Nashville, Tenn.; Pamela Kent, R.D., Centers for Dialysis Care, Shaker Heights, Ohio; Feb. 16, 2017, Clinical Journal of the American Society of Nephrology, online

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Flu Vaccine a Pretty Good Match for Viruses This Year: CDC

THURSDAY, Feb. 16, 2017 (HealthDay News) -- It's not perfect, but this year's flu vaccine is a fairly good match for the circulating viruses, U.S. health officials reported Thursday.

Overall, the vaccine is 48 percent effective. For the predominant circulating influenza A type H3N2 flu strain, its effectiveness comes in at 43 percent. But it's 73 percent effective against influenza B viruses, according to the U.S. Centers for Disease Control and Prevention.

"The effectiveness is a little bit lower than we would like to see, but it's similar to what we have seen for H3 viruses when the vaccine is a good match for what's circulating," said Brendan Flannery, a CDC epidemiologist.

Indications are that infections are still rising in certain regions of the country, like the Midwest, but declining in others, like the Northwest.

This is shaping up as a moderately severe flu season, he added.

In similar seasons, about 60,000 hospitalizations and about 2,000 deaths were prevented with vaccine effectiveness at about 45 percent, Flannery said.

"So, there are a lot of hospitalizations and deaths prevented when the vaccine is not as perfect as we would like," he noted.

The effectiveness of the vaccine is less than hoped because the H3N2 virus is able to mutate, Flannery explained.

While 40 percent to 50 percent effectiveness may not sound like much, when spread across an entire population, the effect is significant, he said.

"A 50 percent reduction in doctors' visits for flu means less time off work or taking care of a child who is not in school," Flannery said. "A 50 percent reduction in doctors' visits may translate to a similar or greater reduction in more severe outcomes like hospitalizations and complications of flu."

If vaccination prevents half of influenza illnesses across all age groups, "that's a big difference in the number of hospitalizations or deaths in a season like this one -- that's a big deal," Flannery said.

These findings were based on data from more than 3,100 children and adults with acute respiratory illness seen during Nov. 28, 2016, to Feb. 4, 2017, at five sites with outpatient clinics in the United States.

Flannery also urged people who come down with flu to get treated with antivirals when there's risk of severe disease. "Antivirals shouldn't be withheld pending influenza testing or based on whether you were vaccinated or not," he said.

The report was published Feb. 17 in the CDC's Morbidity and Mortality Weekly Report (MMWR).

Dr. Amesh Adalja is an affiliated scholar at Johns Hopkins University Center for Health Security in Baltimore.

"The current flu vaccine is the best preventative measure we currently have. But, the lack of high levels of protection conferred by vaccination underscores the need for new vaccines that provide substantially higher protection as the flu burden remains sizable, even with high levels of vaccination," Adalja said.

According to another report in this week's MMWR, influenza activity continues to increase in some parts of the country.

Influenza A type H3N2 is the predominant strain, said Lynnette Brammer, a CDC epidemiologist and co-author of the report.

"As you would expect in an H3N2 year, we are seeing more severe disease in people 65 and older and increasing rates of hospitalizations and deaths," she said.

Brammer added that folks aren't out of the woods yet. "The season hasn't peaked yet, and we don't know when the peak is going to happen," she said.

The CDC still recommends that people get vaccinated, and "if they get sick there are antiviral drugs that can help prevent severe complications, particularly for people at high risk or [who] have severe or progressive illness," Brammer said.

Dr. Louis Morledge, an internist at Lenox Hill Hospital in New York City, agreed that it's still worthwhile to get a flu shot.

"The season hasn't peaked, so there is some effectiveness from getting vaccinated even through the end of March," he said.

SOURCES: Lynnette Brammer, M.P.H., epidemiologist, Brendan Flannery, Ph.D., epidemiologist, both U.S. Centers for Disease Control and Prevention; Louis Morledge, M.D., internist, Lenox Hill Hospital, New York City; Amesh Adalja, M.D., affiliated scholar, Johns Hopkins University Center for Health Security, Baltimore; Feb. 17, 2017, Morbidity and Mortality Weekly Report

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Hey Fellas, Depression Can Strike New Dads, Too

THURSDAY, Feb. 16, 2017 (HealthDay News) -- Depression in and just after pregnancy is most often associated with moms-to-be, but a new study shows expectant dads can have similar symptoms.

Expectant and new fathers who are in poor health or have high levels of stress are at increased risk for depression, the New Zealand research showed.

Many men may not realize pregnancy-linked depression can hit them too.

"It is important to recognize and treat symptoms among fathers early and the first step in doing that is arguably increasing awareness," said a team led by Lisa Underwood of the University of Auckland.

The research involved more than 3,500 men, average age 33, who were interviewed while their partner was in the third trimester of her pregnancy. The men were then re-interviewed nine months after the birth of their child.

Elevated depression symptoms were reported by 2.3 percent of the men during their partner's pregnancy and by 4.3 percent of the men nine months after their child was born, Underwood's team found.

Men who felt stressed or who were in relatively poor physical health were more prone to elevated depression symptoms, the findings showed.

And after a child's birth, depression symptoms in fathers were associated with being stressed during the pregnancy, and being in poor health or having a prior history of depression.

Other, social or relationship factors -- no longer being in a relationship with the mother and/or being unemployed -- also increased the odds for being depressed after the birth of a child, the study authors noted.

Two experts in psychiatric care said the issue of depression in new fathers is understudied.

While much is known about postpartum depression in women, "far less information or attention has been paid to the role of paternal depression on the family unit," said Dr. Tina Walch. She is medical director at South Oaks Hospital in Amityville, N.Y.

Understanding and spotting the signs of paternal depression early "is the first step toward prevention or early treatment and improved health outcomes for fathers, mothers and their children," she said.

Dr. Ami Baxi directs adult inpatient psychiatric services at Lenox Hill Hospital in New York City. She agreed that "this study should emphasize the importance of paternal well-being during and after pregnancy," and the importance of keeping expectant and new dads stress-free and healthy.

The study was published online Feb. 15 in the journal JAMA Psychiatry.

SOURCES: Tina Walch, M.D., medical director, South Oaks Hospital, Amityville, N.Y.; Ami Baxi, M.D., director of adult inpatient services, department of psychiatry, Lenox Hill Hospital, New York City; JAMA Psychiatry, news release, Feb. 15, 2017

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Imaging Study Confirms Brain Differences in People with ADHD

jeudi 16 février 2017

WEDNESDAY, Feb. 15, 2017 (HealthDay News) -- Researchers who pinpointed brain differences in people with attention-deficit/hyperactivity disorder (ADHD) say their findings show the condition should be considered a brain disorder.

The international study -- the largest of its kind -- included more than 1,700 people with ADHD and more than 1,500 without the disorder. Participants were between the ages of 4 and 63.

"We hope that this will help to reduce stigma that ADHD is 'just a label' for difficult children or caused by poor parenting. This is definitely not the case, and we hope that this work will contribute to a better understanding of the disorder," said study author Martine Hoogman.

ADHD is characterized by inattention, overactivity and impulsivity that can interfere with learning and relationships.

Brain scans revealed that five brain regions in those with ADHD were smaller than in those without ADHD. The greatest differences were seen in children, according to Hoogman. She is a postdoctoral researcher at Radboud University Medical Center in Nijmegen, the Netherlands.

"These differences are very small -- in the range of a few percent -- so the unprecedented size of our study was crucial to help identify these. Similar differences in brain volume are also seen in other psychiatric disorders, especially major depressive disorder," Hoogman explained.

The study, published Feb. 15 in The Lancet Psychiatry, refutes the notion that ADHD is the result of poor parenting, the researchers said.

"The results from our study confirm that people with ADHD have differences in their brain structure, and therefore suggest that ADHD is a disorder of the brain," Hoogman said in a journal news release.

In an accompanying editorial, Dr. Jonathan Posner hailed the findings.

"This study represents an important contribution to the field by providing robust evidence to support the notion of ADHD as a brain disorder," he wrote. Posner is an associate professor of psychiatry at Columbia University Medical Center in New York City.

SOURCE: The Lancet Psychiatry, news release, Feb. 15, 2017

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More 'Extreme Preemies' Are Surviving

WEDNESDAY, Feb. 15, 2017 (HealthDay News) -- Babies born very early -- between 22 and 24 weeks of pregnancy -- are more likely to survive now than a decade or so ago, new research shows.

These extremely premature infants are also slightly more likely to avoid serious health complications now.

But it's still a rough road for these infants, who often weigh in at less than 2 pounds at birth. Just one in three survive, and many face challenges.

In a study that looked at a 12-year span, "survival increased and more infants went on to not have signs of developmental delay when tested around age 2," said lead author Dr. Noelle Younge. She's a neonatologist and assistant professor of pediatrics at Duke University School of Medicine in Durham, N.C.

Yet much progress remains to be made, Younge acknowledged.

Her research team reviewed the records of more than 4,200 infants born at 22 to 24 weeks of pregnancy, which is far earlier than the typical full-term length of 37 to 40 weeks. About 1 in 10 babies was born before 37 weeks in 2015, according to the U.S. Centers for Disease Control and Prevention.

The researchers looked at three periods, from 2000 to 2003, 2004 to 2007 and 2008 to 2011. The infants were born at 11 different U.S. medical centers.

The infants' median birth weight was about 600 grams, or about 1.3 pounds throughout the study periods.

Overall survival rose from 30 percent at the start of the research to 36 percent in the last time period, Younge said. Survival for the youngest of babies -- those born at 22 weeks -- remained the same, about 4 percent.

The babies' development was then assessed at around age 2. The number of babies who survived without neurodevelopmental problems at 2 increased from 16 to 20 percent.

However, the number of babies who survived and had neurodevelopmental problems didn't change much, from 15 percent in the first years to 16 percent in the last period.

Potential neurodevelopmental problems for these babies included cerebral palsy, hearing loss, vision problems, and trouble with thinking and memory, the study said.

The testing done at age 2 is not perfect, Younge said. Some of the babies could still go on to develop problems. But the decline in those who tested for such impairments is good news, she said.

But Younge added, "We have a long way to go."

Dr. David Mendez, a neonatologist at Nicklaus Children's Hospital in Miami who reviewed the findings, agreed. He called the results ''mildly good news."

The infants born at 22 weeks still face overwhelming odds to survive, he said.

Improvements in the past 30 years have been dramatic, Mendez said. And it's going to be difficult to match that progress in the next 30, he said.

Among the improvements that have helped to boost survival, he said, are the effective use of antibiotics to treat both mothers and infants, and effective treatment for respiratory problems in the infants.

"We have had a big focus on reduction of infection in the neonatal intensive care unit," and that has paid off, Younge noted.

Prenatal care is crucial. "That has the biggest impact," Mendez said. As soon as a woman finds out she is pregnant, she needs to see a doctor, he said.

Having good access to prenatal care is extremely vital, Younge agreed. Close monitoring during pregnancy is important, and women need to realize that anyone can be at risk for preterm delivery, she said.

The study is published Feb. 15 in the New England Journal of Medicine.

SOURCES: Noelle Younge, M.D., neonatologist and assistant professor, pediatrics, Duke University School of Medicine, Durham, N.C.; David Mendez, M.D., neonatologist, Nicklaus Children's Hospital, Miami; Feb. 16, 2017, New England Journal of Medicine

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