Americans Still Making Unhealthy Choices: CDC

TUESDAY, May 21 (HealthDay News) -- The overall health of Americans isn't improving much, with about six in 10 people either overweight or obese and large numbers engaging in unhealthy behaviors like smoking, heavy drinking or not exercising, a new government report shows.

Released Tuesday by the U.S. Centers for Disease Control and Prevention, the report found Americans continuing to make many of the lifestyle choices that have led to soaring rates of heart disease, diabetes and other chronic illnesses, including the following:

About six of 10 adults drink, including an increase in those who reported episodic heavy drinking of five or more drinks in one day during the previous year.Twenty percent of adults smoke, and less than one-half of smokers attempted to quit in the past year.Only one in five adults met federal guidelines for both aerobic activity and muscle-strengthening exercise. One in three was completely inactive when it came to any leisure-time aerobic activity.

The one bright spot in the report came in the area of sleep behavior. About seven in 10 adults meet the federal objective for sufficient sleep.

The findings have been gleaned from nearly 77,000 random interviews conducted between 2008 and 2010.

The numbers reflect persistent trends, said report author Charlotte Schoenborn, a health statistician at the CDC's National Center for Health Statistics.

"Changes have not been enormous," Schoenborn said. "It's been a very, very slow process of changing awareness of personal choices for healthier ways of life. All of the health-related federal agencies, and a lot of nonfederal groups, are putting a lot of resources to make people aware of the effect they can have on their own health. This report is just designed to say where we are."

The findings did not surprise Rich Hamburg, deputy director of Trust for America's Health, a nonprofit public health organization.

"I think we're in a situation now where we're at a crossroads," Hamburg said. "We have two paths to go. We're hopeful that if we continue to invest in community-based prevention, if we promote healthy eating and active living, these rates will begin to decrease."

Public health organizations use this report to determine which groups of Americans are susceptible to unhealthy behaviors, study author Schoenborn said.

For example, while overall people are getting enough sleep, it turns out that doesn't hold true for people with marital problems, she said. About 38 percent of divorced, separated, or widowed adults have trouble getting enough sleep, compared with 27 percent of married folks.

While this is not the federal government's official report on obesity, its findings jibe with both public and private research into the epidemic, said Hamburg at Trust for America's Health.

At this point, only seven states have overweight and obesity rates that are under 60 percent, he said.

"We've seen for nearly three decades a rise in adult rates of overweight and obesity," Hamburg said. "We're hoping we are reaching a plateau, but we've hoped for that in the past."

Young adults provide the most hope for the future, it appears. For example, those aged 18 to 24 were the only age group to show a decline in smoking, from 23.5 percent to about 21 percent.

"Smoking has remained very stubborn at one in five adults. It's just a terrible addiction," Schoenborn said. "The one small little glimmer of hope I saw was in the 18- to 24-year-olds, where we saw some improvement. You hear so much about overweight and obesity and chronic diseases, and how much of our health lies in our hands, but nothing seems to be changing much."

For his part, Hamburg said that despite the lack of progress, it is vital to continue pressing the case that Americans have the power to improve their health through their personal choices. Without lifestyle changes, chronic disease will flourish and health care spending will skyrocket.

"If we can lower obesity trends by a small amount, say 5 percent in each state, we could save millions of American from health problem and save billions of dollars in health spending," he said.

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Health Highlights: May 22, 2013

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Mystery Illness Kills 2 in Alabama

A respiratory illness of unknown origin has hospitalized five people and killed two others in southeast Alabama, state health officials announced Tuesday.

Over the past few weeks, the patients were admitted to hospitals with cough, fever and shortness of breath, Alabama Department of Health spokeswoman Mary McIntyre said in a statement, the Associated Press reported.

Lab tests are currently underway to try and identify the nature of the illnesses and McIntyre said preliminary results are expected by Wednesday or Thursday.

So far, "we're only aware of [cases in] the Southeast, but we don't know, we haven't received reports from anywhere else," McIntyre told the AP. "That's why we're trying to get the information out."

-----

Report Backs Park Service Response to Yosemite Virus Outbreak

A federal probe into a deadly viral outbreak last year among campers at Yosemite National Park found that park officials acted appropriately.

Nine tourists staying at the California park fell ill with hantavirus and three died. An investigation traced the infections to deer mice nesting within the double walls of new tents in Yosemite's Curry Village family camping site, according to the Associated Press.

The new report from the Interior Department's Office of Inspector General found that the National Park Service responded appropriately and according to department policy.

"When the outbreak was identified, NPS mobilized to contain and remediate the outbreak and to prevent further outbreaks," Mary Kendall, a deputy inspector general, wrote in a letter tied to the report, the AP reported.

Current park policy did not require that park officials approve design changes to the tents linked to the outbreak, the report found. However, the park service should initiate cyclical pest monitoring and inspections of public accommodations to minimize the threat, the report's authors said.

Delaware North Companies Parks and Resorts, the concessionaire responsible for the Curry Village tents, said it would adhere to the recommendations in the new report and is removing the type of tent cabin implicated in the outbreak.

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More Kids Getting Donor Organs, But Gaps Persist, Study Finds

WEDNESDAY, May 22 (HealthDay News) -- Over the last decade, the number of American children who die each year awaiting an organ donation dropped by more than half, new research reveals. And increasing numbers of children are receiving donor organs.

During that time, the overall pool of potential organ donors expanded to include not just patients who've experienced brain death but also those with a "circulatory determination of death."

But it's unclear how much that shift in donor criteria helps children waiting for transplants.

"There are a couple of bottom lines, the first being that there are simply not enough donor organs for people on the waiting list, whether they're children or not," said study lead author Dr. Jennifer Workman, a fellow in pediatric critical care medicine at the University of Utah School of Medicine in Salt Lake City. "So we have to do anything we can as a medical community to chip away at the stark numbers.

"And in trying to get as many organ donors as possible, we have to think of who are the possible donor candidates," Workman added. "Traditionally, it's been those who met brain death criteria. But if the family has a child or adult who has such severe injuries or is so severely ill that there is no way to make any recovery they may choose to withdraw life-support, regardless of whether or not there's brain death. And in that situation that patient can still be an organ donor, and some families may feel that participating in this process is appropriate and meaningful for them."

The study authors noted that regardless of trends, the overall picture for those currently awaiting an organ donation continues to be dire.

Currently, the waiting list for organ transplants exceeds 117,000 American adults and children. And although roughly 28,500 transplants took place in 2011, that same year 7,000 people died while waiting for an appropriate donor match.

Against that backdrop, many in the medical community have turned to the prospect of enlarging the donation pool by accepting organs from both pediatric and adult patients deemed to have experienced circulatory death, even in the absence of full brain death.

The researchers noted that donation after circulatory determination of death (DCDD) was actually the norm when organ transplants first came to the fore back in the 1950s and 1960s. "We didn't actually have brain death criteria until the 1980s," Workman said. "So when transplants first became an option, DCDD was the only way to donate."

But with advances in medical technology, a shift got under way toward relying solely on organs sourced from patients who had lost all brain function, or to those who had lost both circulatory and respiratory function.

The pendulum started to swing back, however, in the 1990s in light of both growing recipient need and the wish on the part of family members of circulatory death patients to participate in the donation process.

In 2006, the Institute of Medicine, an independent panel that advises the federal government, encouraged medical facilities to develop and adopt guidelines outlining under what exact conditions such donations are to take place.

To explore how this may have affected the pool of young patients up to age 17 awaiting an organ, the study authors examined data collected by the Organ Procurement and Transplantation Network from 2001 through 2010.

By looking at the statistics covering all liver, kidney, heart, lung, pancreas and small bowel donations, the team found that just over 14,200 American children received an organ transplant in that time frame.

For the most part, the number of annual donations to children in need rose over the decade, from a low of 1,170 in 2001 to a high of 1,628 by 2009. However, there was a dip to 1,475 donations by 2010.

And while the number of pediatric donors dipped by 15 percent over the study time frame, more than two-thirds of donations to children were cases in which a child donor gave to a child recipient.

As had been the case in prior years, most organs given by child donors actually ended up being given to adult recipients.

Circulatory death donations to child recipients continue to be just a small fraction of the overall donation pool, the research team found. Just 31 such donations taking place in 2010, although that figure is way up from 2001, a year in which just a single such donation transpired.

The new findings appear in the June print issue of the journal Pediatrics.

On a decidedly positive note, Workman's team found that although the number of children on the transplant waiting list held steady throughout the study period, the number of children who died while awaiting a donation plummeted from a high of 262 in 2001 to 110 by 2010.

"So while this decline is great, from what we looked at we can't directly say that increasing DCDD donations has been the reason," Workman said. "But it seems logical to conclude that the more organs made available, the more it will help to relieve the waiting list strain. Even if these DCDD organs go to adults, it frees up other organs that might go to children. So everybody benefits."

Dr. Craig Lillehei, an associate professor in Harvard Medical School's department of surgery, and program director of Boston Children's Hospital's department of surgery, seconded the thought.

"I would totally agree with that," said Lillehei, who co-wrote an editorial accompanying Workman's study. "What we have is a big problem for both adults and children. And it is absolutely right that increasing the availability of organs overall ultimately helps everybody."

More information

To learn more about organ donations, visit the U.S. Department of Health and Human Services.

SOURCES: Jennifer Workman, M.D., fellow, pediatric critical care medicine, School of Medicine, University of Utah, Salt Lake City; Craig Lillehei, M.D., associate professor, department of surgery, Harvard Medical School, and program director, department of surgery, Boston Children's Hospital; June 2013, Pediatrics

Copyright c 2013 HealthDay All rights reserved.

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Health Tip: Make Healthy Foods Taste Better

(HealthDay News) -- The better foods taste, the more likely you are to eat them.

So the Academy of Nutrition and Dietetics suggests how to make healthy foods more flavorful and appealing:

Cook absorbent grains such as barley and rice in reduced-sodium, low-fat beef or chicken broth.When making dough, before baking add ingredients such as sun-dried tomatoes, herbs or cheese.Experiment with different herbs such as coriander, cumin, basil or caraway.Use a sharp, grated cheese such as romano on salad, pasta, vegetables or rice.Use dried fruits (cranberries, figs, apricots) to add flavor; moisten them by soaking in broth, fruit juice or cooking wine.Season foods with a sweet, savory or tangy marinade. Just check the label to make sure it's low in sodium.
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COPD May Be Over-Diagnosed Among Uninsured

WEDNESDAY, May 22 (HealthDay News) -- Roughly four in 10 uninsured patients who have been diagnosed with chronic obstructive pulmonary disease (COPD) actually do not have the lung disease, a small new study suggests.

At issue: Faulty diagnoses were made based on an evaluation of symptoms, rather than by means of the so-called "gold standard" disease test known as spirometry, which shows how well a patient's lungs are working by measuring the amount of air they can exhale and how long that takes.

The study is scheduled for presentation Wednesday at the American Thoracic Society annual meeting in Philadelphia. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

COPD is a progressive disease that makes it hard to breathe. Symptoms include coughing, wheezing, shortness of breath and chest tightness, according to the U.S. National Heart, Lung, and Blood Institute. Cigarette smoking is the top cause of COPD.

"While there have been many studies of the under-diagnosis of COPD, there has not been a U.S.-based study that has quantified the problem of over-diagnosis," Dr. Christian Ghattas, a second-year medical resident at Saint Elizabeth Health Center in Youngstown, Ohio, said in a society news release. "And yet, the cost of treating someone for COPD is high."

How high? The study team cited statistics suggesting the cost exceeds $4,100 per year.

The researchers re-evaluated 80 patients, average age 53, being treated at a federally funded health center based in Akron, Ohio, that is designed to offer medical care to the uninsured and Medicaid patients. All the patients had been diagnosed in 2011 or 2012 as having COPD or as needing an inhaler device often given to treat COPD.

Investigators found that less than 18 percent of the patients had undergone spirometry testing, despite a Global Obstructive Lung Disease recommendation that COPD not be diagnosed without such a test.

Once conducted, spirometry testing revealed that nearly 43 percent of the patients did not have any obstruction that could be construed as COPD.

What's more, another quarter of the patients had a reversible condition that is more typical of asthma than COPD.

"We were shocked at the percentage," Ghattas said. He noted that, overall, probably half the patients were misdiagnosed.

"Although the number of patients in our study was small, I believe this study is representative of an uninsured and underserved patient population," he added. "However, the findings might be different among patients who are insured. They might be higher or lower. We simply don't know," Ghattas said.

But, "it is obviously detrimental to be on medications that won't work for you," Ghattas cautioned. "You won't feel better -- and that by itself can take a psychological toll -- and you may experience side effects that can compromise other aspects of your health."

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Abused Children at Risk for Obesity as Adults: Study

WEDNESDAY, May 22 (HealthDay News) -- Children who are physically, sexually or emotionally abused or neglected are at greater risk for obesity later in life, a new review suggests.

British researchers found that abused children are 36 percent more likely to be obese as adults. They concluded that child abuse could be viewed as a modifiable risk factor for obesity.

"We found that being maltreated as a child significantly increased the risk of obesity in adult life," study author Dr. Andrea Danese, a child and adolescent psychiatrist at King's College London's Institute of Psychiatry, said in a news release from King's College. "Prevention of child maltreatment remains paramount, and our findings highlight the serious long-term health effects of these experiences."

In conducting the study, the researchers examined data on more than 190,000 people enrolled in 41 studies around the world. They found the link between child abuse and adult obesity could not be explained by childhood or adult socioeconomic status, smoking, alcohol intake or level of physical activity.

Child abuse was also not associated with obesity among children or teens, the researchers added, suggesting the children were not abused because they were overweight or obese.

However, the researchers did find depression might explain why some abused children become obese as adults. They noted that additional research is needed to determine the effects of depression on the body, specifically the brain, hormones that regulate appetite and metabolism.

The study authors added that more research is needed to determine what treatment strategies would prevent abused children from becoming obese later in life.

"If the association is causal, as suggested by animal studies, childhood maltreatment could be seen as a potentially modifiable risk factor for obesity -- a health concern affecting one third of the population and often resistant to interventions," Danese said.

While the study found an association between child abuse and obesity later in life, it did not prove cause and effect.

The study was published May 21 in the journal Molecular Psychiatry.

More information

The U.S. Centers for Disease Control and Prevention provides more information on obesity.

SOURCE: King's College London, news release, May 21, 2013
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Children Who Have CT Scans May Face Higher Cancer Risk

WEDNESDAY, May 22 (HealthDay News) -- Children and teens exposed to radiation during CT scans are 24 percent more likely to develop cancer, according to a large, long-term study.

The risks, however, are still low: Among a group of 10,000 young people who each had one CT scan, only about six extra cancers would be expected to occur within 10 years, according to researchers from Australia and Europe.

The researchers said doctors should carefully weight the risks to patients when making decisions about CT (computed tomography) testing. The study was published online May 21 in the journal BMJ.

The researchers used data from Australian Medicare records and national cancer records to compare cancer rates among patients who had a CT scan by age 19 to those who had never undergone the test.

The study involved nearly 11 million young people born between 1985 and 2005. The average length of follow-up for those who underwent a CT scan was 9.5 years, and about 17 years for those who did not have a CT scan.

Of the participants, about 680,000 had a CT scan at least one year before they were diagnosed with cancer. Among those diagnosed with cancer, 18 percent had more than one scan.

By the last follow-up in 2007, the researchers found that 3,150 of those who had a CT scan and about 57,500 of those who didn't had been diagnosed with cancer.

After taking the participants' age, gender and year of birth into account, the rate of cancer was 24 percent higher among those who had a CT scan. That risk increased by 16 percent for each additional scan.

Nearly 60 percent of CT scans involved the brain, according to a BMJ news release. Although the prevalence of brain cancer among those who had a CT scan decreased over time, the study authors found that the incidence was still higher more than 15 years after they had their first scan.

Children exposed before age 5 had the greatest risk. The older a patient is at first exposure to a CT scan, the lower their risk, the researchers said. But even among the oldest participants -- between 15 and 19 -- the study revealed that risk for all cancers combined was still higher.

For cancers involving tumors other than brain cancer, the researchers found the proportional increase in risk was 23 percent among females and 14 percent among males.

The researchers, led by John Mathews, a professor at the University of Melbourne's School of Population and Global Health, said that in some cases brain cancer may have resulted in a CT scan and not the other way around. They added that participants may have developed cancer beyond the final follow-up period in 2007. As a result, they concluded that the "eventual lifetime risk from CT scans cannot yet be determined."

Although the study found an association between having a CT scan in childhood and a higher risk of developing cancer, it did not prove a cause-and-effect relationship.

It's important to realize the incidence of cancer among children is extremely small, said Dr. Aaron Sodickson, who wrote an accompanying journal editorial. Sodickson is the section chief of emergency radiology and medical director of computed tomography at Brigham and Women's Hospital and Harvard Medical School in Boston.

"A 24 percent increase makes this risk just slightly less small," Sodickson wrote. He added that there are many ways to adjust radiation doses and that more accurate assessments of patients' risk can help doctors make more informed decisions about CT scans and other imaging tests.

More information

The U.S. National Institutes of Health has more about CT scans and the risks involved.

SOURCE: BMJ news release, May 21, 2013
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Depression May Raise Low Blood Sugar Risk in Diabetics

 TUESDAY, May 21 (HealthDay News) -- Depression can affect almost every aspect of life, but some of the changes brought about by the disorder can be downright dangerous for those with diabetes.

New research has found that people with diabetes who are depressed have more than a 40 percent higher risk of having a severe low blood sugar (hypoglycemia) episode that lands them in the hospital compared to people with diabetes who aren't depressed.

"Depression is a very common accompanying condition for people with diabetes. It's important to know that depression can lead to hypoglycemic episodes," said study author Dr. Wayne Katon, a professor of psychiatry at the University of Washington Medical School in Seattle.

"About one-quarter of all severe drug side effects that lead people to an ER visit or hospitalization are related to dramatic drops in blood sugar. Hypoglycemia is a dangerous and expensive problem. And, for people with diabetes, depression increases the risk of serious hypoglycemia by about 40 percent over five years, and leads to a greater number of hypoglycemic episodes," he explained.

Results of the study are published in the May/June issue of the Annals of Family Medicine.

People with diabetes generally take medication that helps lower their blood sugar levels. These medications can be pills, or in the case of the hormone insulin, injections. However, sometimes these medications work too well, and they drop blood sugar levels too low. It's the glucose (sugar) in the blood that fuels the body and the brain. Without enough glucose, the body and brain can't work properly. If blood sugar levels drop too low, people can pass out. If the hypoglycemic episode is severe enough, people can even die.

So, someone living with diabetes has to maintain a balance between the medications they take to lower their blood sugar and what they eat. Other factors, such as physical activity and stress, also can affect blood sugar levels.

The study included just over 4,100 people with diabetes. Nearly 500 of these people met the criteria for having major depression during the five-year study period.

The average age of the study volunteers was 63, and the average duration of diabetes was 10 years. Most -- 96 percent -- had type 2 diabetes. About one-third were taking insulin to control their diabetes. Just 1.4 percent were experiencing complications of diabetes.

In the five years before the study began, 8 percent of those with both depression and diabetes reported having had a severe hypoglycemic episode compared to 3 percent of the non-depressed people with diabetes. During the five-year study, nearly 11 percent of the depressed people with diabetes had a severe hypoglycemic episode compared to just over 6 percent of the non-depressed people with diabetes.

The risk of hypoglycemia was unaffected by the type of treatment received. People taking oral medications were just as likely to have a hypoglycemic episode as those taking insulin, according to the study.

Overall, people with diabetes who were depressed had a 42 percent greater risk of having a severe hypoglycemic episode, and a 34 percent higher risk of having a greater number of hypoglycemic episodes.

Katon said there are two likely explanations for these increased risks. One is that depression leads to psychobiological changes that cause big fluctuations in blood sugar levels, which may make it harder to prevent low blood sugar levels.

The other possibility is that depression leads to a lack of interest in the self-care that's necessary to manage diabetes well. "People who are depressed may be less likely to test their blood sugar levels regularly. They may adhere to their medications less well. They may forget if they've taken them, and then end up taking an additional dose," said Katon.

Another expert, Eliot LeBow, a therapist with a diabetes-focused practice in New York City, and a type 1 diabetic himself, agreed that "depression can affect a person's ability to manage their diabetes." But, he said there was an important piece of information missing from the study: how much diabetes education a person has had. People who've had more diabetes education would probably be less likely to have a severe hypoglycemic episode, LeBow suggested.

He also noted that high blood sugar symptoms can look a lot like depression symptoms. "Sometimes, when you make a few changes in how someone is managing their diabetes, their depression may lift," said LeBow.

Both experts agree that people with diabetes who are depressed need to get help. And, fortunately, there are treatments available -- psychotherapy and medications. Katon said there are depression medications that don't significantly affect blood sugar levels.

According to the U.S. National Institute of Mental Health, depression symptoms include:

Long-term sadness, anxiety or hopelessness.Feelings of guilt and worthlessness.A loss of interest in activities you once enjoyed.Sleep and appetite changes.Trouble remembering things.Difficulty concentrating or making decisions.Suicidal thoughts.

Although the study found an association between depression and greater risk of hypoglycemic episodes, it did not prove a cause-and-effect relationship.

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Cost of Treating Strokes in U.S. Could Soar to $180B Annually by 2030: Report

(HealthDay News) -- Over the next two decades, the cost of treating strokes in the United States is expected to more than double, topping more than $180 billion a year, according to new research.

The main factor driving the increase: an aging population. The report, from the American Heart Association (AHA) and the American Stroke Association, was published May 22 in the journal Stroke.

"Strokes will absolutely strain the health care system," Dr. Bruce Ovbiagele, chairman of the department of neurology at the Medical University of South Carolina, said in an AHA news release.

One expert who reviewed the report agreed.

"The forecasts in this article are indeed dire -- the predicted direct and indirect costs of stroke could place a heavy burden on our society, and they may be underestimates," said Dr. Stanley Truhim, director of the Mount Sinai Stroke Center in New York City.

According to the AHA, the highest uptick in stroke prevalence will be among Americans between 45 and 64 years of age, who will experience about a 5 percent increase in strokes over the next 20 years. Finances will be strained to meet the care needs of these younger stroke victims, who are too young to receive Medicare, less able to afford medications and often suffer from obesity or diabetes.

People who do not have health insurance also have a 24 percent to 56 percent greater risk of death from stroke than those with coverage, according to the AHA statement.

The AHA also predicted the following will occur by 2030:

Overall, nearly 4 percent of U.S. adults -- an additional 3.4 million people -- will have a stroke. Stroke treatment costs will increase from $71.6 billion in 2010 to $183.1 billion. Stroke-related costs tied to lost work productivity will rise from $33.7 billion to $56.5 billion. Stroke prevalence among Hispanic men will increase. Strokes are more prevalent among Hispanics and blacks than whites.

The costs associated with caring for people are often high because an attack can lead to long-term disability, Ovbiagele said. "Ninety percent of stroke patients have residual disability and only 10 percent recover completely after a stroke," he said. "Policy makers at all levels of governance should be aware of this looming crisis so we can consider practical ways to avert it."

According to the AHA, stroke remains the fourth leading cause of death in the United States and one of the most significant causes of preventable disability.

Recognizing a stroke when it happens and getting the patient to medical help quickly are imperative. "During every minute of delayed treatment, brain cells are dying," Ovbiagele said. "[Emergency workers] should take patients directly to a designated stroke center equipped to quickly diagnose and administer drugs to restore blood flow to the brain."

Dr. Richard Libman, vice chairman of neurology at the Cushing Neuroscience Institute in Manhasset, N.Y., called the AHA report "realistic and sobering."

"It emphasizes the importance of stroke prevention -- that is, paying attention to the frequent risk factors plaguing our country, including high blood pressure, smoking, obesity, diabetes and lack of exercise," he said. "It also reminds us that even if we cannot prevent all strokes, continued investment in research to find new treatments and rehabilitation strategies can prevent suffering on the human level and also save billions of dollars in health care costs."

According to the AHA, the Affordable Care Act is expected to expand health care coverage to an additional 32 million Americans. The legislation also is shifting the focus to prevention and wellness. The researchers believe health-care reform should help reduce the number of strokes and deaths as well as stroke-related costs.

Truhim agreed. "It is quite possible that health-care expenditures mandated by [Affordable Care Act] provisions will more than pay for themselves in indirect cost savings when people who otherwise may have had strokes or other debilitating illnesses remain productive members of society," he said.

More information

The U.S. Centers for Disease Control and Prevention provides additional stroke facts and statistics.

SOURCE: Stanley Tuhrim, M.D., director, Mount Sinai Stroke Center, and professor, neurology and geriatrics and palliative medicine, Mount Sinai Medical Center, New York City; Richard Libman, M.D, vice chairman, neurology, Cushing Neuroscience Institute, Manhasset, N.Y.; American Heart Association, news release, May 22, 2013
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Health Tip: Protect Your Sight

(HealthDay News) -- Protecting your vision must be a "priority just like eating healthy and physical activity," urges the U.S. Centers for Disease Control and Prevention.

The agency suggests how to keep your eyes healthy:

Schedule regular eye exams that include dilation; be aware of your family history of eye problems.Eat healthy foods that boost vision, such as dark, leafy green vegetables and fish rich in omega-3 fatty acids.Maintain a healthy body weight, and don't smoke.Protect your eyes with glasses or goggles when playing sports, doing yard work or during home repair.Wear sunglasses that block harmful UVA and UVB rays.Thoroughly wash hands before handling contact lenses, and properly disinfect contacts before using.

Copyright c 2013 HealthDay. ?All rights reserved.

HealthDayNews articles are derived from various sources and do not reflect federal policy. healthfinder.gov does not endorse opinions, products, or services that may appear in news stories. For more information on health topics in the news, visit Health News on healthfinder.gov.

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Yoga May Help Ease High Blood Pressure, Study Finds

(HealthDay News) -- People who follow the ancient practice of yoga may be getting an added health boost, with a new study suggesting it can fight high blood pressure -- also known as hypertension.

"This study confirms many people's feelings that exercise may be useful in the control of hypertension," said Dr. Howard Weintraub, a cardiologist and associate professor of medicine at NYU Langone Medical Center in New York City. Weintraub was not connected to the new study.

Based on the new findings, "yoga would be a useful adjunct in the lowering of blood pressure in certain populations," he said.

In the study, researchers led by Dr. Debbie Cohen of the University of Pennsylvania tracked 58 women and men, aged 38 to 62, for six months.

Although the study couldn't prove a cause-and-effect relationship, doing yoga two to three times a week was associated with an average drop in blood pressure readings from 133/80 to 130/77, the researchers said.

In comparison, the average decrease in blood pressure was smaller (134/83 to 132/82) among people who ate a special diet but did not do yoga.

In a bit of a surprise, doing yoga in tandem with a special diet did not outperform doing yoga alone -- blood pressure numbers fell only slightly (135/83 to 134/81) among people who ate a special diet and also did yoga, the researchers said.

The small decline in blood pressure among people who ate a special diet and did yoga may be because doing both required a greater amount of time, making it more difficult for participants to stick with their regimens, the authors said.

Weintraub said the study shows that "yoga can have a favorable effect" on hypertension. Although the amount of change was small, he said, "some large population studies have suggested that changes of this magnitude could have very significant long-term benefits."

The study did have some limitations, including its relatively short length and the fact that most participants were young and had milder forms of high blood pressure, Weintraub said.

Another expert agreed that the ancient Indian practice of yoga might ease hypertension.

"Yoga, along with deep breathing exercises, meditation and inner reflection, is a good adjunctive and integrative cardiovascular approach to better health, including lowering blood pressure, as this data suggests," said Dr. David Friedman, chief of Heart Failure Services at the North Shore-LIJ Plainview Hospital, in Plainview, N.Y.

"In addition to proper diet and aerobic physical fitness most days of the week, I recommend that my patients take time each day for the above measures of finding disciplined inner peace, for improved health and well-being," he said.

The findings were presented Wednesday at the annual scientific meeting of the American Society of Hypertension, in San Francisco. Findings presented at medical meetings typically are considered preliminary until published in a peer-reviewed journal.

More information

The American Academy of Family Physicians has more about high blood pressure.??

SOURCES: David Friedman, M.D, chief, heart failure services, North Shore-LIJ Plainview Hospital, Plainview, N.Y.; Howard Weintraub, M.D., associate professor, department of medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York City; American Society of Hypertension, news release, May 15, 2013

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Erectile Dysfunction Tied to Long-Term Narcotic Use in Men

(HealthDay News) -- If you're a man, the pain-killing medications known as opioids may do more than relieve pain -- they may also put a damper on your sex life.

A new study found that men who were prescribed medications for erectile dysfunction or low testosterone levels were more likely to be taking opioid (narcotic) medications for chronic back pain.

"People who have persistent pain problems need to know that a potential side effect of long-term opioid use may be erectile dysfunction," said lead study author Dr. Richard Deyo, a clinical investigator for the Kaiser Permanente Center for Health Research in Portland, Ore. "This is not a well-known potential side effect among patients, and it should be considered when thinking about treatment."

Deyo also noted, however, that "the nature of this study as an observational study limits our ability to make a causal [cause-and-effect] inference. Opioid use and erectile dysfunction seem to go together, but we have to be cautious about saying one causes the other."

Results of the study were published in the May issue of the journal Spine.

More than 4 million people use opioids on a regular basis, Deyo said. Commonly prescribed opioids include hydrocodone, oxycodone and morphine. In this study, use of opioids was considered long-term if patients used them for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drugs.

The study included data on about 11,000 men who had back pain. In that group, more than 900 received medications for erectile dysfunction or testosterone replacement. Those who were given prescriptions for erectile dysfunction medications or testosterone were older than those who didn't get such prescriptions. They also were more likely to have depression and other health conditions.

And those who were taking erectile dysfunction medications or testosterone tended to be smokers or users of sedative medications, according to the study.

Erectile dysfunction drug prescriptions were for sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Age was the most significant factor in getting a prescription for erectile dysfunction, according to the study. Men between the ages of 60 and 69 were 14 times more likely to receive a prescription for an erectile dysfunction medication than men who were between 18 and 29.

After adjusting the data to account for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods were about 50 percent more likely to take erectile dysfunction medications or testosterone replacement therapy.

Dr. Daniel Shoskes, a professor of urology at the Cleveland Clinic's Glickman Urological and Kidney Institute, said the study doesn't prove that the pain medications cause the erectile dysfunction.

"A direct association between long-term opioid use and [erectile dysfunction] has not been clearly defined," said Shoskes, who was not involved in the study. "The reason these men were having [erectile dysfunction] could be related to the pain or the things that are causing the pain. You can't conclude from this study that opioid use causes [erectile dysfunction]."

Study author Deyo said there's evidence that men who stop taking opioids after using them for a short time will see an improvement in erectile dysfunction, but he said it's not clear if the same is true after long-term use.

Deyo added that opioids can be effective for short-term use, but there's "growing evidence that long-term opioid use may not be effective for chronic pain. The body compensates for taking long-term pain medications, and changes in the brain and spinal cord may make people more sensitive over time."

Effective alternatives include a tailored exercise program and cognitive behavioral therapy designed to help reduce people's fear of pain, Deyo said.

Shoskes said other factors that contribute to erectile dysfunction include diabetes, heart disease, peripheral vascular disease and alcohol use. He said this study may prompt doctors who treat men with chronic pain to ask about erectile dysfunction, although he said it's not clear from this study whether the erectile medications were helpful for these men.

More information

Learn more about erectile dysfunction from the U.S. National Library of Medicine.

SOURCES: Richard Deyo, M.D., clinical investigator, Kaiser Permanente Center for Health Research, and professor of family medicine, Oregon Health and Science University, Portland; Daniel Shoskes, M.D., professor and staff physician, department of urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio; May 2013 Spine
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Gene Variations May Explain Weight Gain Among Men, Women

 WEDNESDAY, May 15 (HealthDay News) -- Weight gain in men and women is predicted by two different genetic variations -- so-called polymorphisms, according to a new study from the Netherlands.

Men with a certain mutation of the FTO gene had an 87 percent greater risk for gaining weight over 10 years. Meanwhile, women with a different variation on the MMP2 gene had a two and a half times increased risk for weight gain over the course of a decade, the researchers found.

The research involved two groups of people: The first group, which consisted of 259 people, maintained a stable weight; the second group consisted of 237 people who were considered weight gainers. These participants gained about 17 pounds over 10 years.

Starting body-mass index -- a measurement of body fat based on a person's ratio of height to weight -- for the participants ranged from normal to obese. Participants were between 20 and 45 years old when the study began.

The research, led by Freek Bouwman, from Maastricht University, and Dr. Jolanda Boer, from the Netherlands' National Institute for Public Health and the Environment, focused on several different polymorphisms associated with weight gain in previous studies.

The genetic distribution of a particular FTO polymorphism in men was consistently different between the weight-stable group and the weigh-gainer group, the study revealed, according to a news release from the European Congress on Obesity.

Similarly, among the women, the genetic distribution of the MMP2 polymorphism varied between those considered weight stable and those in the weight-gainer group.

"We found that FTO in men and MMP2 in women are predictors for weight gain over a 10-year follow-up period," the study authors wrote.

They suggested that more research into these polymorphisms could help determine who is at greatest risk for weight gain and improve weight-control strategies. They said differences in male and female hormone levels also could play a role in weight regulation.

The study was presented Tuesday at the European Congress on Obesity in Liverpool, England. Findings presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Health Highlights: May 15, 2013

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Mental Health Official Softens Stance on New Psychiatric Manual

Debate over the validity of the latest version of what is considered the diagnostic "bible" of psychiatry eased Tuesday after a top government health official who had criticized the manual softened his position in a public statement.

Set to be released Saturday, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association (APA). This latest edition has raised some concerns because of changes in the diagnoses of some disorders, most notably in the area of autism spectrum disorders.

But the issue that Thomas Insel, director of the U.S. National Institute of Mental Health (NIMH), recently took with the manual was more fundamental.

Insel wrote in a blog post that the manual is "at best, a dictionary, creating a set of labels and defining each," and that its "weakness is its lack of validity."

In his post, Insel added that his agency would instead steer its research toward a new set of diagnostic parameters known as Research Domain Criteria (RDoC), because "DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

However, in a joint release issued Monday, Insel and APA president-elect Jeffrey Lieberman noted that the DSM-5 "represents the best information currently available for clinical diagnosis of mental disorders."

The new statement further clarified that while the manual is used by practitioners, it "is no longer sufficient for researchers," and so RDoC will be the new focus for NIMH.

"Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories," the statement explained. "This is the focus of the NIMH's Research Domain Criteria [RDoC] project. RDoC is an attempt to create a new kind of taxonomy for mental disorders by bringing the power of modern research approaches in genetics, neuroscience and behavioral science to the problem of mental illness."

The latest statement also pointed out that the DSM and RDoC "represent complementary, not competing, frameworks. . . . As research findings begin to emerge from the RDoC effort, these findings may be incorporated into future DSM revisions and clinical practice guidelines."

-----

U.S. Files Appeal to Delay Non-Prescription 'Morning After' Pill

The Obama administration on Monday filed an eleventh-hour appeal to delay the over-the-counter sale of "Plan B" emergency contraception to girls of any age.

Last month, U.S. District Judge Edward Korman ruled that the so-called "morning after" pill be made available without a prescription, with a deadline for any appeal set for Monday. On Friday Korman denied a U.S. government request to put a hold on his order while the Obama administration readied an appeal.

The appeal was filed Monday just before the noon deadline, the Associated Press reported. In the document, the government contends that Korman overstepped his authority.

But Korman said politics are driving moves by U.S. Health and Human Services Secretary Kathleen Sebelius to block over-the-counter access to Plan B. Earlier this month, the U.S. Food and Drug Administration lowered the age limit for access to the emergency contraceptive from 17 to 15 years of age, but Korman believes that doesn't go far enough.

In the meantime, the Center for Reproductive Rights, which instigated the lawsuit behind Korman's decision, said it would answer the Obama administration's filing within 10 days, the AP reported. In papers filed before the court, the center said that delays in access to Plan B could be "life-altering" for some women, the AP said.

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People With High Blood Pressure May Crave Salt

High-salt diets have long been linked to high blood pressure, but new research finds that those with the condition may have a far greater preference for salty foods than those with normal blood pressure.

In a small study of older adults, researchers from the University of Sao Paulo in Brazil found that participants with high blood pressure, or hypertension, favored bread dusted with the highest concentration of salt more than twice as much as those with normal blood pressure. Adding other seasonings to the salted bread, however, diminished the preference for salt across both groups.

The question remains: Are people with high blood pressure naturally drawn to salty foods, making them more prone to the condition?

"This is difficult to answer, but I believe that the genetic factor to salt appetite can be the beginning of the process," said study author Patricia Villela, a nutritionist and doctoral student at the university. "I was surprised by the fact that added seasonings may have changed the preference of the elderly, decreasing [their] appetite for salt."

The study was scheduled to be presented Wednesday at the annual meeting of the American Society of Hypertension, in San Francisco. Research presented at scientific conferences has typically not been peer-reviewed or published, and results are considered preliminary.

About 67 million American adults -- roughly one in three -- have high blood pressure, according to the U.S. Centers for Disease Control and Prevention, as do nearly 1 billion people worldwide. The condition puts people at risk for heart disease, kidney damage, strokes and vision loss, among other health problems.

Villela and her team analyzed 44 seniors with an average age of 73, including 16 with normal blood pressure readings. All were initially given three pieces of French bread with varying amounts of salt on each. In that test, 68 percent of participants with high blood pressure preferred the bread with the highest concentration of salt, compared with 31 percent of those with normal blood pressure.

Fifteen days later, participants underwent a similar test, but this time other seasonings had been added to the salted bread. In that case, only 14 percent of patients with hypertension and none with normal blood pressure favored the bread with the highest salt content.

Dr. Domenic Sica, president-elect of the American Society of Hypertension, said the findings may have been influenced by the limited number of patients involved.

"The concept of taste retraining in hypertensive patients, either young or old, is at the foundation of this [research] and is studied in a creative manner," said Sica, a professor of internal medicine and nephrology at Virginia Commonwealth University, in Richmond. "How rapidly salt preference fell in this study is surprising, and may relate to the small number of subjects studied and a possible training effect."

Some previous studies have pointed to a genetic predisposition to craving salty foods, Villela said, and although there is no way of knowing who may have this predisposition, patients should know it is important to avoid salt despite the cravings.

"[In future research], it would be important to demonstrate that changes in habits can be maintained in the long term and the effect of these changes is reducing cardiovascular risk," she said.

More information

The U.S. National Library of Medicine has more about high blood pressure.

SOURCES: Patricia Villela, M.S., nutritionist and doctoral student, University of Sao Paulo, Brazil; Domenic Sica, M.D., professor, internal medicine and nephrology, Virginia Commonwealth University, Richmond, and president-elect, American Society of Hypertension; May 15, 2013, presentation, American Society of Hypertension meeting, San Francisco
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FDA: Lower Ambien's Dose to Prevent Drowsy Driving

WEDNESDAY, May 15 (HealthDay News) -- The U.S. Food and Drug Administration has approved new, lower-dose labeling for the popular sleep drug Ambien (zolpidem) in an effort to cut down on daytime drowsiness that could be a hazard while performing certain tasks such as driving.

The move follows the FDA's request to manufacturers in January that drugs containing zolpidem carry instructions that lower the recommended dose and provide more safety information to patients.

"FDA has approved these changes because of the known risk of next-morning impairment with these drugs," the agency said in a statement released Tuesday on its website.

Sleep medications containing zolpidem include Ambien, Ambien CR, Edluar and Zolpimist, as well as generic versions of Ambien and Ambien CR.

"The purpose of the lowering is to help decrease the risk of next-morning impairment of activities that require alertness," Dr. Ellis Unger, director of the Office of Drug Evaluation I at the FDA's Center for Drug Evaluation and Research, said at the time of the agency's request to manufacturers. "We're particularly concerned about driving. A large fraction of the population drives and driving is an inherently dangerous activity."

Lowering the nighttime dose means there will be less residual drug in the blood by the time the person wakes up. Extended-release forms of the drugs tend to stay in the body longer, the FDA said.

The FDA has told manufacturers that recommended doses for women should be cut in half, from 10 milligrams to 5 milligrams for immediate-release products (Ambien, Edluar and Zolpimist) and from 12.5 mg to 6.25 mg for extended-release products (Ambien CR).

For men, the agency has asked manufacturers to change the labeling to recommend that doctors and other health-care professionals consider prescribing lower doses, meaning 5 mg for immediate-release products and 6.25 mg for extended-release products.

In explaining the different recommendations for men and women, Unger said that "women appear to be more susceptible to risk for next-morning impairment because they eliminate zolpidem from their bodies more slowly."

It's not clear why women eliminate the substance from their bodies more slowly than men.

Although there have been reports of adverse events, including motor vehicle accidents possibly related to zolpidem, the link has not and probably cannot be definitely established, Unger said.

The changes were spurred by new driving-simulation studies showing that currently prescribed levels of drugs containing zolpidem may be high enough to impair alertness the next day, he explained.

The FDA will be requiring driving-simulation studies for new sleep medications, and it is assessing other insomnia medications on the market. Eventually, Unger said, "we want driving data on all sleep medications."

Unger emphasized that next-day impairment is not limited to medications containing zolpidem but to all sleep medications.

"For all sleep medications, doctors should prescribe and patients should take the lowest dose," he said.

People taking any kind of sleep medication should not change their dose without first talking to their health-care professional, he stressed.

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Noisy Operating Rooms May Jeopardize Patient Safety

Background noise in the operating room -- such as the sounds of surgical equipment, chatter or music -- can affect surgeons' ability to understand what is being said to them and might result in a breakdown of communication among surgical team members, according to a new study.

This is particularly worrisome since miscommunication is cited as a common reason for medical errors that could have been prevented, the study authors said. Surgeons have critical conversations during operations, and information on medications, dosing and blood supply could sound similar. The researchers emphasize that clear communication during surgical procedures is essential to ensure the safety of patients.

The study was published in the May issue of the Journal of the American College of Surgeons.

"The operating room is a very fast-paced, high-demand, all-senses-running-on-all-cylinders type of environment," study co-author Dr. Matthew Bush, an assistant professor of surgery at the University of Kentucky Medical Center, in Lexington, said in a journal news release. "To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room."

The researchers gave an example of a possible miscommunication: A request for heparin might be heard as "Hespan," an entirely different drug.

In conducting the study, the researchers simulated a noise environment similar to the noise levels found in an operating room. Fifteen surgeons with between one and 30 years of experience were tested on their ability to understand and repeat words under four different conditions: quiet, noise filtered through a surgical mask, background noise without music and background noise with music.

The surgeons were tested while performing a specific surgical task as well as when they were not engaged in a task.

Noise interfered with the surgeon's speech comprehension when the words spoken to them were unpredictable, the study showed. This interference with speech comprehension was worse when there was noise in the operating room.

Background music also impaired the surgeons' ability to understand what was said to them while they were performing a surgical task.

The researchers concluded that background noise in operating rooms could impair surgeons' ability to process what they hear, particularly when music is being played. The situation becomes even more problematic when surgical teams are trying to communicate critical and unpredictable information.

"Our main goal is to increase awareness that operating room noise does affect communication and that we should foster the best environment in which we can communicate better," Bush said. "This effort means that the surgical team needs to work diligently to create the safest environment possible, and that step may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical mistakes."

The researchers plan to continue their research on a larger scale and also examine the effects of operating room noise on anesthesiologists, nurses and surgeons who are hearing impaired.

"I think it's important to demonstrate the effect of environmental operating noise on communication on a variety of different players in the operating room setting," Bush said. "Another step from here is to not only see how noise affects our understanding of speech, but how it affects our tasks and how it affects our ability to perform surgical procedures efficiently and effectively."

More information

The American Academy of Orthopaedic Surgeons has more about operating room distractions.??

SOURCE: Journal of the American College of Surgeons, news release, May 10, 2013
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FDA Approves New Drug to Fight Advanced Prostate Cancer

WEDNESDAY, May 15 (HealthDay News) -- The U.S. Food and Drug Administration announced Wednesday that it has approved a drug to help men with advanced prostate cancer whose disease has spread to the bones.

The drug, Xofigo, is targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, the FDA said in a news release. It is meant for patients who have already undergone surgery and/or drug therapies such as hormone-based treatments.

The FDA said Xofigo, marketed by Wayne, N.J.-based Bayer Pharmaceuticals, was approved more than three months ahead of the original August 2013 deadline the agency had set for a complete review. Instead, the drug was reviewed under the agency's "priority" review program, designated for medicines that appear safe and effective in a context where no good alternative therapy exists.

"Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, explained in the news release.

In a clinical trial involving more than 800 men with symptomatic prostate cancer that was resistant to hormonal therapy and had spread to the bones, men on Xofigo survived a median of 14 months compared to a little over 11 months for men taking a placebo. Side effects from Xofigo included nausea, diarrhea, vomiting and swelling of the legs and feet. Low levels of red and white blood cells, as well as platelets, were also reported among some patients taking Xofigo, the FDA said.

Pazdur noted that "Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer." The other drug, Xtandi, was approved by the FDA last August for men with hormone treatment-resistant prostate cancers that have spread or recurred, and who had previously been treated with the drug docetaxel.

According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.

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Cellphone Calls During Blood Pressure Readings May Skew Results

WEDNESDAY, May 15 (HealthDay News) -- New Italian research offers some cautionary advice for patients with high blood pressure: The next time you take a blood pressure reading, turn off your cellphone.

The reason: Answering a cellphone call during a reading may cause a temporary but significant spike in blood pressure, rendering the results inaccurate and misleading.

"The cellular phone has burst into our everyday life, and is often an indispensable communication tool for business and social relations," said study author Dr. Giuseppe Crippa, head of the hypertension unit at Guglielmo da Saliceto Hospital in Piacenza, Italy. "[Now] we know that the radio-frequency field generated by mobile phones does not affect blood pressure, and should not increase blood pressure in subjects suffering from hypertension.

"But what is the effect of the noise generated by the phone ringing and of the intrusion into our life of an unscheduled phone conversation?" Crippa asked. "In our study, we have shown that blood pressure, particularly systolic blood pressure, increases quickly and significantly in this situation."

The study authors said one in three Americans (and 1 billion people worldwide) currently struggles with high blood pressure.

Those grappling with keeping their high blood pressure under control often are instructed to either come in for routine readings taken by a health care professional, or to use one of many at-home monitoring kits that give patients the option of taking their own readings on a regular basis.

To explore the question of how cellphones might affect such readings, the authors focused on 49 Italian women with an average age of 53, all of whom were taking medication to control high blood pressure.

After discussing their general cellphone usage habits, all underwent two sets of multiple blood pressure readings, each set registering six readings at one-minute intervals. All the readings took place in a physician's office, where patients were left alone (in what the researchers described as a "comfortable" setting) after the first reading.

During one of the two readings, an investigator disabled caller ID and anonymously called each patient's cellphone three times, with a patient's response to at least one of the calls being deemed sufficient for testing purposes.

The result: By comparing readings taken with and without incoming calls, the team found that patients' systolic numbers (the top figure in a blood pressure reading, indicating blood pressure as the heart contracts) went up "significantly" whenever the patients answered their phones.

Patients who had indicated relatively heavy routine cellphone usage (30 or more calls per day), however, experienced a less steep rise in their systolic numbers during incoming calls. Since heavy users tended to be younger, the team theorized that a greater cellphone comfort level among younger patients may protect them from the cellphone dynamic.

Incoming calls had no impact on patients' diastolic numbers (the bottom figure in a reading, indicating blood pressure while the heart is at rest), nor did patients' overall heart rates shift when the cellphone rang.

The team concluded that patients should be advised to turn off their cellphones whenever and wherever they have a blood pressure reading, to ensure accuracy.

"It is noteworthy that the great majority of the patients recruited for this survey were not used to turning off the mobile phone, even during a medical examination, and easily answered the calls even when an automated device was measuring blood pressure," Crippa said.

"Therefore, we believe that it is important to advise patients that the unnecessary and exaggerated use of cellphones can increase, at least temporarily, their blood pressure," he said.

Dr. Gary Schwartz, a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn., said the issue is not the disturbance of a cellphone call, but rather any disturbance in general.

"I wouldn't look at this study and say cellphones are bad for you," Schwartz said. "But American Heart Association standards call for the need to be quiet, whether you're getting your blood pressure measured at a doctor's office or at home.

"Just engaging in conversation, whether or not it's on the phone, can raise the numbers and give an inaccurate reading," he said. "It's the same principle behind why we don't measure a person's blood pressure while they're playing tennis. What we want is for patients to be quiet and at rest."

Crippa and his colleagues are scheduled to present their findings Wednesday at the American Society of Hypertension annual meeting in San Francisco. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Health Tip: Pay Attention to Baby's Communication

(HealthDay News) -- Young infants may not be able to speak, but that doesn't mean they're not trying to communicate.

The American Academy of Pediatrics says parents should watch newborns for early signs of communication, checking for any possible signs of delay. The academy says babies should achieve these milestones by the first birthday:

Discovering the source of sounds.Recognizing and responding to their name.Waving goodbye and pointing to things they want.Babbling as though speaking in sentences, and engaging in "conversation" with give and take. Saying at least one word.

Copyright c 2013 HealthDay. All rights reserved.

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The Consumer: Doctors’ Lucrative Industry Ties

Viktor Koen

Dr. Alfred J. Tria is the chief of orthopedic surgery at St. Peter?fs University Hospital, a 478-bed facility in New Brunswick, N.J., and to the medical technology company Smith & Nephew, his good word is worth a million bucks. Well, $940,857, to be precise.

That?fs how much the company paid Dr. Tria in fees for promoting its products and training doctors in Asia to use them from 2009 to 2011, according to disclosures required by the state of Massachusetts, where Dr. Tria is licensed. In 2010, Dr. Tria earned $421,905 from private industry ? more than any other Massachusetts-licensed physician that year.

Dr. Tria may be an outlier, but gifts and payments to physicians from drug and medical device companies have been rampant in medicine for decades. Over a two-and-a-half-year period, device and drug companies shelled out over $76 million just to physicians licensed in Massachusetts, according to a study published online this month in The New England Journal of Medicine. That amount does not include outlays of less than $50, which are exempt from disclosure.

The companies treat doctors to dinner, pay them to attend lectures, and underwrite conferences and continuing medical education courses. Asked whether such payments could pose a conflict of interest for physicians, Dr. Tria said, ?gIt?fs a legitimate concern.?h

A spokesman for St. Peter?fs said Dr. Tria had disclosed his financial relationships with industry to the hospital and refused to elaborate on the hospital?fs policy.

Information about these sorts of payments to physicians is available for the first time now in a handful of states that have passed laws requiring corporations to disclose payments to health providers. Next year, the data should be available nationwide when the federal Physician Payment Sunshine Act goes into effect. Corporations were supposed to start collecting the information last year.

?gFor many decades, we had no information ? these were closely held industry secrets,?h said Susan Chimonas, of Columbia University, who has researched industry payments to physicians. ?gWe are just starting to get a sense of how much money companies are spending on the marketing and consulting arrangements.?h

The data will be a treasure trove for researchers. For patients, the question is what to make of this information and whether to seek it out when choosing a physician or making an important medical decision. Orthopedic surgeons, cardiologists and psychiatrists received the most lucrative payments, the new study found. Primary care physicians ? such as internists and pediatricians ? were least likely to receive payments.

In Massachusetts, companies are required only to broadly categorize the purpose of the payments, and nearly 90 percent of them were described as ?gcompensation for bona fide services.?h Dr. Aaron S. Kesselheim, an assistant professor at Harvard and the lead author of the new study, says that though the reported information can be vague, it can still be useful.

?gIt?fs another piece of data for patients to examine as they consider treatment options,?h he said. ?gIf they go to an orthopedic surgeon who recommends a knee transplant, and they go to another who recommends watching and physical therapy, it might be interesting for the patient to wonder to what extent those two physicians have relationships with industry.?h

The question may also be appropriate if a physician changes a patient?fs prescription for no apparent reason, or prescribes a new or more expensive drug instead an older, tried-and-true alternative, said Dr. Joseph S. Ross, an internist and assistant professor of medicine at Yale.

?gWe know physicians are more likely to overprescribe or potentially prescribe inappropriately when they have a financial relationship with industry,?h Dr. Ross said. His own research has found that many physicians do not think there is anything inappropriate about industry gifts as long as they?fre not too lavish.

The size of the gift is not a determinant of its influence, experts say. Even a small gift can generate positive feelings and influence attitudes and behavior. ?gI don?ft think doctors ever set out to make decisions that are not in the best interest of their patients,?h said Dr. Deborah R. Korenstein, associate professor at Mount Sinai and a co-author of the study by Dr. Ross.

?gBut there are subconscious influences that people can?ft control, and that?fs why patients, and doctors, need to be concerned,?h she said.

A paper Dr. Korenstein published in 2011 found that more than a dozen expert panels that developed national clinical practice guidelines for managing diabetes and high cholesterol were dominated by physicians with financial conflicts of interest ? that is, they were receiving payments from companies with an interest in how these diseases are managed.

Physicians often do not realize that they are being manipulated when drug companies offer to pay them consulting fees ? for example, for listening to pharmaceutical representatives describe new medications and evaluating their performance. The real purpose ?gis just to get the doctor to listen to the reps over and over again,?h said Dr. Adriane Fugh-Berman, director of PharmedOut, a project at Georgetown University Medical Center that focuses on the influence of drug company marketing.

Dr. Fugh-Berman advises patients to avoid physicians who see drug reps and dispense samples. ?gAsk, ?eCould I have a tried-and-true drug??f ?eCould I have a generic version??f??h

Although many schools and hospitals have adopted new policies that guide interactions with industry, they exempt physicians who are not staff employees and do not restrict the doctors?f income. Tufts University Medical Center adopted a policy in 2010 that required physicians to get approval and review if they were paid more than $25,000 in a year by a private company. But a Tufts associate professor, Dr. Yoav Golan, an infectious disease specialist, was paid $340,754 by drug companies in 2011, including $100,000 from Forest Laboratories, $73,918 from Merck and $42,109 from Pfizer, according to disclosures filed in Massachusetts.

A Tufts spokeswoman, Julie Jette, said the payments were approved by the university. The policy wasn?ft intended to be a cap, she said. Dr. Golan did not respond to an e-mail requesting comment.

Dr. Chimonas said she would encourage physicians and their professional groups to think about how all the information that is coming out is going to be interpreted or understood by the public.

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Hard Cases: The Traps of Treating Pain

Wesley Bedrosian Dr. Abigail Zuger on the everyday ethical issues doctors face.

I hadn?ft seen Larry in a dozen years when he reappeared in my office a few months ago, grinning. We were both grinning. I always liked Larry, even though he was a bit of a hustler, a little erratic in his appointments, a persistent dabbler in a variety of illegal substances. But he was always careful to avoid the hard stuff; he said he had a bad problem as a teenager and was going to stay out of trouble.

It was to stay out of trouble that he left town all those years ago, and now he was back, grayer and thinner but still smiling. Then he pulled out a list of the medications he needed, and we both stopped smiling.

According to Larry?fs list, he was now taking giant quantities of one of the most addictive painkillers around, an immensely popular black-market drug most doctors automatically avoid prescribing except under the most exceptional circumstances.

?gI got a bad back now, Doc,?h Larry said.

Doctors hate pain. Let me count the ways. We hate it because we are (mostly) kindhearted and hate to see people suffer. We hate it because it is invisible, cannot be measured or monitored, and varies wildly and unpredictably from person to person. We hate it because it can drag us closer to the perilous zones of illegal practice than any other complaint.

And we hate it most of all because unless we specifically seek out training in how to manage pain, we get virtually none at all, and wind up flying over all kinds of scary territory absolutely solo, without a map or a net.

The events of the last few decades haven?ft helped much. First came a consumer-driven ?gpain power?h movement ? justified, for the most part ? pointing out that pain was wildly undertreated by most doctors. And then, more recently, came the new statistics on the widespread abuse of prescription narcotics, which now saturate street corner markets everywhere and cause more overdose fatalities than heroin and cocaine combined.

In other words, we are now cautioned in the strongest possible terms against giving too little medication and too much, being too free and too parsimonious, underprescribing to the right people and overprescribing to the wrong. Most official guidelines and policy statements, even fuller than usual of vacuous general principles, aren?ft of much help in figuring how to do any of this.

One of the most accurate, articulate and heartfelt reflections on the situation was written a few years ago in Archives of Internal Medicine by Dr. Mitchell Katz, who now directs the Los Angeles County health department. Dr. Katz described his slow disillusionment with the standard approach to pain control, which involves escalating from nonnarcotic to narcotic medication, then prescribing as much as needed to eradicate the pain, while deploying measures like written contracts, pill counts and urine tests to make sure the patient is taking it all as prescribed.

It is awfully hard to take that road without turning into the patient?fs parole officer. And so, Dr. Katz suggested, how about a regulatory body establishing a reasonable cap for narcotic dosing, at least for people without malignant diseases who are likely to be taking them long-term? Also, how about formally acknowledging that sometimes pain cannot be entirely eradicated? ?gLeaning how to cope with pain can be more empowering for patients than trying to find a pill to completely eliminate it,?h he wrote.

Clearly Larry?fs last doctor wasn?ft buying into these sentiments, given the quantities of medication Larry was asking for ? assuming there actually was a previous doctor in Larry?fs life. All I had for evidence was a list, in Larry?fs handwriting. The pills themselves, the bottles? ?gThey got stolen off me on the bus here,?h Larry said.

When was that?

?gLast month,?h Larry said.

Ultimately, all careful nomograms fall aside in the face of the particular patient. I was lucky enough to know Larry pretty well, although in some ways that only made things more difficult. I knew he was a decent and intelligent guy, with a pretty sophisticated understanding of his own problems and a hard time keeping straight. I also knew he was clearly walking with the careful ?gdon?ft touch me?h gait of someone with a really bad back.

And Larry, of course, knew me well, too ? well enough not to be surprised when I sent him off with a sheaf of referrals to evaluate his back, a weaker, nonnarcotic pain reliever, and not a single one of the requested pills. He just smiled and said, ?gI knew you wouldn?ft give them to me.?h

These decisions are always harder than hard; you have nothing but instinct and experience to guide you, and you never know if you?fve done the right thing. I think about Larry periodically, but I haven?ft seen him since.

Dr. Abigail Zuger on the everyday ethical issues doctors face.

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Well: Heart Disease and Dogs

Karsten Moran for The New York Times After reviewing the evidence, the American Heart Association has concluded that dog ownership, in particular, may lower heart disease risk.

The nation is largest cardiovascular health organization has a new message for Americans: Owning a dog may protect you from heart disease.

The unusual message was contained in a scientific statement published on Thursday by the American Heart Association, which convened a panel of experts to review years of data on the cardiovascular benefits of owning a pet. The group concluded that owning a dog, in particular, was ?gprobably associated?h with a reduced risk of heart disease.

People who own dogs certainly have more reason to get outside and take walks, and studies show that most owners form such close bonds with their pets that being in their presence blunts the owners?f reactions to stress and lowers their heart rate, said Dr. Glenn N. Levine, the head of the committee that wrote the statement.

But most of the evidence is observational, which makes it impossible to rule out the prospect that people who are healthier and more active in the first place are simply more likely to bring a dog or cat into their home.

?gWe didn?ft want to make this too strong of a statement,?h said Dr. Levine, a professor at the Baylor College of Medicine. ?gBut there are plausible psychological, sociological and physiological reasons to believe that pet ownership might actually have a causal role in decreasing cardiovascular risk.?h

Nationwide, Americans keep roughly 70 million dogs and 74 million cats as pets.

The heart association publishes about three scientific statements each month, typically on more technical matters, but the group was prompted to take a stance on the pet issue by the growing number of news reports and medical studies linking pet ownership to better health.

Dr. Levine noted that the more traditional methods of risk reduction for heart disease had proven effective, and that now was a good time to investigate alternative approaches. ?gWe felt this was something that had reached the point where it would be reasonable to formally investigate,?h he said.

Dr. Richard Krasuski, a cardiologist at the Cleveland Clinic, viewed the new statement as an indictment of societal attitudes toward exercise.

?gVery few people are meeting their exercise goals,?h he said. ?gIn an ideal society, where people are actually listening to physician recommendations, you wouldn?ft need pets to drag people outside.?h

The new report reviewed dozens of studies, and over all it seemed clear that pet owners, especially those with dogs, the focus of most of the studies, were in better health than people without pets.

?gSeveral studies showed that dogs decreased the body?fs reaction to stress, with a decrease in heart rate, blood pressure and adrenaline-like hormone release when a pet is present as opposed to when a pet is not present,?h Dr. Levine said.

Pet owners also tended to report greater amounts of physical activity, and modestly lower cholesterol and triglyceride levels. Some research showed that people who had pets of any kind were also more likely to survive heart attacks.

In one of the only randomized controlled studies included in the report, 48 stressed stockbrokers with hypertension were put on medication that lowered their blood pressure, and then researchers divided them into groups. Those in one group were told to adopt a dog or cat. Six months later, the researchers found that when the stockbrokers who had adopted pets were around their new companions, they were markedly calmer in the face of stressful events than the stockbrokers without pets.

But nearly all of the other studies included in the report were correlational, meaning they could not prove cause and effect. And the research also strongly suggested that among dog owners, there was a sharp contrast between those who walked their dogs themselves and those who did not.

Data from the Centers for Disease Control and Prevention shows that pet owners are just as likely to be overweight as people without pets. One large study involving thousands of people found that 17 percent of those who walked their dogs were obese, compared with 28 percent of dog owners who did not walk their dogs and 22 percent of those without pets.

Dr. Levine said that he and his colleagues were not recommending that people adopt pets for any reason other than to give them a good home.

If someone adopts a pet, but still sits on the couch and smokes and eats whatever they want and doesn?ft control their blood pressure, he said, that is not a prudent strategy to decrease their cardiovascular risk.

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Well: My Stroke of Luck

 A stroke in 2011 landed the writer in the hospital.

Twenty-two months ago, I interrupted my nonstop reporting about paths toward a sustainable future for our species to focus on sustaining myself. The hiatus was not by choice, but was?mandated by a stroke ? the out-of-the-blue variant, the rare kind of ?gbrain attack?h (the term preferred by some neurologists) that is most often seen in otherwise healthy, youngish middle-aged people.

It?fs Fourth of July weekend, 2011 ? a beautiful, if hot, morning for a run in the Hudson Valley woods with my son Daniel, back from brief service in the Israeli army. I?fm eager to be pushed hard. I?fm not even a?lapsed?middle-aged athlete; I?fm truly negligent when it comes to exercise.

We?fre jogging up a steep path, and my breathing gets deeper and faster. At a particularly tough turn, I pause, hands on knees.

?gCome on, keep it up, Dad.?h

I?fm panting but don?ft want to disappoint. We press on. But I stop again, this time insisting that Daniel run ahead. I rest in the mottled shade and sunlight of the woods until he returns. Then I realize that through my left eye, the world appears paisley ? as if I were looking through a patterned curtain. Something is really wrong.

We make it back to the car. Daniel takes the wheel. Back home, I take a shower, thinking that cooling off will help.

For the first time, a thought flickers. Could this be a stroke? Almost unconsciously, I take half a dozen baby aspirin. I know enough about aspirin?fs blood-thinning properties to think this can?ft hurt.

I call my doctor?fs office and the receptionist says I should go to the emergency room.

We head to the hospital. Although it?fs a designated stroke center, there is no stroke neurologist around on this holiday weekend. A CT scan shows nothing. Vitals are normal. But I realize something is still wrong when I get an eye test in a hallway. I can see the letters on the eye chart, but not the?hand?of the nurse pointing to a particular row.

Also, my pupils are different sizes, a condition that I later learn is called?Horner syndrome and can presage a stroke.

Nonetheless, the hospital plans to release me. I push back, recalling that months earlier my doctor, as a midlife precaution, had recommended ultrasound scans of my carotid arteries to be sure there wasn?ft any buildup of plaque. Maybe they should try this?

Preparations are made for an ultrasound of my arteries. But the technician holding a gel-covered probe against my neck has a puzzled look. She can?ft find my left internal carotid artery. She asks for a second opinion.

I vividly recall hearing the words, ?gThere?fs no flow in your carotid artery.?h

My first reaction: How can that be the case while I?fm sitting here conscious and listening to you?

I would later learn that my left internal carotid artery had no flow because of what is known as a ?gspontaneous dissection.?h The artery lining had peeled away and blocked the vessel.

This kind of injury can result from certain?yoga moves, painting the ceiling, tipping your head back?for that soothing shampoo at a salon, possibly a?chiropractor visit (research is equivocal), even a coughing fit. Or, evidently, a tough run on a hot day.

In hindsight, all I can think about is the doctors?f mantra about stroke: ?gTime is brain.?h More accurately: Time wasted is brain lost. It seems to me the hospital staff ramped down their concern about my case just when they should have been swinging into high gear. The ultrasound, at least, confirms there is a serious problem.

The doctors arrange a transfer to a bigger regional hospital. My wife, who had been at a job interview, has caught up with me, and we have an ambulance-and-Prius parade to Westchester Medical Center.

I haven?ft had a stroke yet; stroke is loss of brain function. But it is coming. At the hospital, there are more tests and tubes. Finally, I get intravenous heparin to prevent blood clots, but probably too late.

Seeing the Damage

I?fm sent to the neurology ward, which is a deeply unsettling experience from the start. The man in the bed next to mine, an actor with an aneurysm, alternates between saying he?fs dying and calling nurses to insist that he needs to leave to get to the set of ?gBoardwalk Empire.?h Late that night, I fall asleep to the moaning and howling of an unseen old woman down the hall.

If you can avoid the neurology ward, do so.

An M.R.I. scan shows the area of neuron death after the stroke.

Sometime that night, blood clots break away from the damaged artery lining and flow up the middle cerebral artery into my brain. I awake to a bad headache, a throbbing left eye socket and the realization that three fingers of my right hand aren?ft working.

Now M.R.I. scans do show damage. I?fve had a stroke. I learn I have to remain in the hospital for a week as I?fm put on warfarin, a blood thinner also used as rat poison.

A week in the hospital. What to do?

Blog, of course. I hunt and peck, writing a post for my blog, Dot Earth, on the need to sustain your health if your broader goal is sustaining the a thriving planet. I also get focused on building stroke awareness on Twitter.

Don?ft stress your carotid arteries if you like your brain and the things it does for you.

? Andy Revkin (@Revkin) July 3, 2011

Tapping on my laptop with unfamiliar fingers, I learn that stroke?kills 130,000 Americans a year?and is the leading cause of disability. Horner syndrome, I find, is often the first sign of carotid dissection. Recent studies have found the mean age of stroke occurrence is declining, with 19 percent of strokes in people younger than 55. Some stroke specialists who have studied misdiagnosis in stroke victims younger than 50 have proposed a push for ?gyoung stroke awareness?h in staff in hospital emergency departments. The American Academy of Neurology has created a task force on stroke in young adults.

And I learn of a solution for hospitals, like the one in my suburb, when they have no stroke specialists on duty: telemedicine.

Through something like Skype on steroids, any stroke specialist could provide virtual care in any emergency room. The technology is most developed in places like Arizona, where it connects big urban teaching hospitals to dispersed rural health care centers that will never have a stroke neurologist. Most of the signs of stroke are visual, meaning an expert diagnosis and swift application of the right medication are possible without laying on hands.

I interview Dr. Yulun Wang twice, first using his technology ? with me at a Long Island hospital and Wang in Santa Barbara ? and then when I visit his company,?InTouch Health, a few months later. Here?fs Dr. Wang describing these tools and the hurdles to wider adoption of the technology:

The merits of telemedicine seem utterly obvious, but I learn that Medicare and insurers don?ft reimburse for this sort of care, with a few exceptions, because the doctor is not physically at the bedside.

Well, there was no living, breathing stroke specialist at my bedside to bill in those first vital hours. Give me a virtual doctor any day.

There are other impediments to what?fs called telestroke technology, including licensing roadblocks preventing doctors from practicing across state borders.

You can learn more about research showing the cost-effectiveness of telemedicine for stroke and the hurdles to its adoption in?my Skype chat with Dr. Bart Demaerschalk, the director of the Mayo Clinic Telestroke Program in Arizona and an author of an important 2012?paper on telestroke cost-effectiveness.

New Chance, New Vows

After my week in the hospital, I dive into my physical and occupational therapy. I also make lots of vows.

??? I vow to write a hard-hitting print article about stroke care.

??? My wife gives me a card for a personal trainer. I start working out.

??? In the interest of not torturing my neck, I vow no more red-eye flights.

??? I?fve played guitar since I was 17, but never with much discipline. I start doing scales.

So how am I doing? I?fve stuck with almost none of those commitments.

Run-ins with the reaper cut in two directions. Part of you swears to slow down, to smell the roses, to get closer to loved ones. But part of you ? me, anyway ? says life is short and tenuous. Get everything done now!

I posted 322 times to Dot Earth in 2012. The flow of news on my beat pushed my stroke article to the far back burner. My workout routine and guitar scales faded. I?fve taken several red-eyes, with more coming. I?fm on the run, in many ways, more than ever.

But I am humbled by one thing that I learned. I was pretty smug, once I recovered, about having scarfed down those aspirin early on. Experts tell me that act probably did mitigate the effects of my stroke. (My fingers and vision are fine.)

In my later research, however, I realized that if I?fd had a bleeding stroke, the kind that almost killed?Jill Bolte Taylor ? the neuroscientist who wrote ?gMy Stroke of Insight?h ? the aspirin might?fve killed me. Roughly 1 in 10 strokes are of the bleeding variety.

So yes, this was my stroke of luck. As it turns out, luck played a bigger role in my being here today than I?fd like to admit.

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