Monday, June 30, 2008

Analysis Shows Heart Attacks Under-Treated Following Hospitalization

According to an analysis published Junes 23 in the Archives of Internal Medicine, one in five patients experience angina (chest pain) within the first year after a heart attack, at least once a week. The association was strongest in younger patients, those who have had coronary bypass surgery (CABG), smoke, experience depression and had symptoms at rest during hospitalization. The study was led by Dr. Thomas M. Maddox, from the Denver Veterans Affairs Medical Center, Colorado. Data was obtained from the Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recover (PREMIER) registry.

Co-author, Dr. John S Rumsfeld (Denver Veterans Affairs Medical Center) believes smoking and depression should be a major focus that physicians should target to help patients improve outcomes after experiencing a heart attack. He urges doctors to remain vigilant during the first year in order to provide continuous care to this sector of patients. “Right now our healthcare system is set up to provide care in small episodes: either you’re in the hospital or not, or in the clinic or not - and that’s not a patient- centered healthcare model", says Dr. Rumsfeld.

What happens at home, after a patient is discharged from the hospital and returned to the care of their primary physician, is a concern. Dr. Rumsfeld believes that care following a heart attack requires some quality improvements to “make a real difference to patients’ quality of life and how long they live.”



It’s normal to experience depression after a heart attack. Many patients have difficulty with smoking cessation. Past studies have shown that depression alone accelerates the risk of poor outcomes, including re-hospitalization, recurrent chest pain and greater physical limitations(1). Studies also show that younger women are more prone to depression after a heart attack.(2)

Patients and family members can take an active role by reporting symptoms of depression and ongoing chest pain. It’s important to understand that self-help includes compliance with medication and open communication with your family physician. The American Heart Association has valuable resources for patients and caregivers. You can visit their site for more help and information about a “heart healthy life”. Don’t leave it all up to your doctor – take an active role in your care and discuss treatment options for smoking cessation, treatment of depression and cardiac rehabilitation programs.


(1)http://www.theheart.org/article/746501.do
(2)http://www.theheart.org/article/690835.do

Ref: http://www.theheart.org/article/877761.do
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Thursday, June 19, 2008

Annual Blood Pressure Screening for Children Recommended by AHA

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The American Heart Association recommends that children over age 3 receive annual blood pressure measurements, noting that even babies can have high blood pressure. A new analysis of blood pressure studies shows that high blood pressure in childhood is a predictor of high blood pressure in adults.

Annual check-ups to include blood pressure statistics should allow for early intervention, decreasing the risk of heart disease, stroke and heart attacks in adulthood. Lifestyle modifications, such as dietary changes and weight loss, rather than medication use, will help young people control t blood pressure, also limiting the risk of type 2 diabetes. . "Lifestyle modification is preferred rather than medication when appropriate to help young people to control their elevated blood pressure to a desirable level. A healthy diet and adequate exercise can also help reduce the risks of developing many other chronic diseases such as obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease," says Dr. Youfa Wang, from Johns Hopkins University, Baltimore MD., one of the study’s authors.

The conclusions were obtained by accessing a PubMed database. Studies published in English, Chinese, or Japanese between January 1970 and July 2006 were reviewed that assessed BP tracking from childhood to adulthood, and included 50 studies. More than 80% of the subjects were white in the American studies, but no significant differences were seen between ethnic groups. Of the 50 studies, 58% came from the US 22% from, and 12% from Asia

The researchers recognize the persistence of high blood pressure and cardiovascular disease in developing countries, as well as the increasing childhood obesity epidemic in supporting further research focused on blood pressure tracking throughout life.

You can help your child avoid high blood pressure throughout life, by encouraging proper nutrition, and exercise. Teach your children at an early age, the importance of good health habits. Incorporate exercise into their daily routine, the same as dental and physical hygiene. Discourage overeating by engaging your child in activities that are satisfying and fun.

Source: The study is published online in the June 16 issue of Circulation, performed by Drs Xiaoli Chen and Youfa Wang from Johns Hopkins University, Baltimore, MD.

Resources:
Childhood Nutrition
Helping Your Overweight Child
Helping young children understand the importance of a healthy lifestyle
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Monday, June 16, 2008

Medication Program Effective for Remission of Newly Diagnosed RA

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Newly diagnosed rheumatoid arthritis (RA) patients might find new hope through a systematic medical program. A new study shows that the guided approach offered complete remission of rheumatoid arthritis for nine months to a year in 51% of the patients studied, and 15% of the patients were able to avoid traditional drugs used to treat rheumatoid arthritis during their 8.2-year follow-up.

Successful treatment was found “by adhering to a tight step-up DMARD [disease-modifying anti-rheumatic drug] treatment scheme aimed at remission - starting with low-dose methotrexate, with stepped-up dosing if necessary, followed by the addition of other traditional DMARDs or an anti–tumor necrosis factor–alpha (TNF-alpha) inhibitor,” according to Ina Kuper, MD, a staff rheumatologist at the Medisch Spectrum Twente in Enschede, the Netherlands. The study was reported at the European League Against Rheumatism Annual Congress, (EULAR, 2008)



The patients initially received 15mg/week of Methotrexate. If remission had not occurred in eight weeks, the dose was increased to 25mg/week. If needed by week twelve, 2grams/day of sulfasalazine was added, and increased to 3grams/day by by week 20. If no remission occurred at week 24, adalimumab (Humira) was added. The medicines were adjusted every three months to provide sustained remission, as determined by the patient’s disease activity score calculator (DAS28). Additions to treatment included non-steroidal anti-inflammatory drugs and low dose Prednisolone, not to exceed 10mg/day. The authors of the study noted that the average time to remission was 25 weeks, with the onset at 20 weeks. Fifteen percent of patients responded during the initial eight weeks.


The study was performed in the Netherlands, where patients and physicians find it risky to begin treatment with high doses of steroids because of the side effects. Guidelines for the treatment of RA restrict prescribing TNF-blockers unless the disease affects 28 joints, per the DAS28 score, after the administration of Methotrexate.

Patients who have a family history of RA, obesity, history of smoking, or who have had RA for longer periods, were not as likely to respond. Lab findings that limited the patient’s success included the presence of immunoglobulin M rheumatoid factor, anticyclic citrullinated peptide (anti-CCP) antibodies, and shared epitope alleles. Non-smokers, with new onset of RA, low body mass index, older age, and with absent anti-CCP antibodies were the most responsive to the prescribed regimen.

The findings give hope for anyone who has been newly diagnosed with rheumatoid arthritis. Obtaining an early diagnosis, smoking cessation and weight loss can contribute to successful treatment of patients with new-onset rheumatoid arthritis.

EULAR 2008: The European League Against Rheumatism Annual Congress: Abstracts OP-0002and OP-0003. Presented June 11, 2008. ◦
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Thursday, June 12, 2008

Study Compares Diabetes Care Between Blacks and Whites

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Black patients have been found to have less success with diabetes control when compared to whites, according to a new study. The disparity is being attributed to individual differences in physician care, according to a report in the June 9 issue of the Archives of Internal Medicine. The study was led by Dr. Thomas D Sequist from Brigham and Women’s Hospital, Boston, Ma. The results show that blacks are less likely to achieve good cholesterol, blood pressure and blood sugar control than white patients treated by the same doctor. The findings raise questions about barriers that may exist between physicians and black patients.

Dr. Sequist says, “What we see is that the black patient does not achieve outcomes as good as the white patient, which suggests that there might be something going on differently in terms of the effectiveness of the interaction between the patient and their doctor and that there might be differences by race”. He says the findings revealed that “all physicians across the board contribute in a moderate way”.

It is not about health insurance either. The same testing was performed on whites as blacks - 95% of the patient records that were reviewed showed that the patients had insurance. The only conclusion that could be drawn is that blacks with diabetes don't achieve that same results as whites. To put the information to good use, the authors believe physician education might improve cultural competency and patient/physician communication among minority populations. The idea is to teach doctors to explore cultural differences so they can tailor the health care of minorities.

Dr. Sequist says it’s not an issue of blame. He suggests that variables probably exist, contributing to the problem. It’s about doctors becoming aware of patient resources, and neighborhoods, like exercise facilities, pharmacies, and grocery stores. To evaluate the effectiveness of improved education, physicians in Eastern Massachusetts completed an eleven-month educational program. The results will be published this fall.

As a nurse, I know that family members, case managers, and ancillary healthcare staff, such as respiratory therapists and other home healthcare staff are a ready source of patient information to physicians. The question then becomes, is there good communication between the physician and all team members?

It's also extremely important for patients to do all they can to let the physician know how active they are in managing their own health, and what obstacles they might be facing.

What factors do you think might be responsible for the findings of this study?

Source: Heartwire

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Monday, June 9, 2008

Ten Percent of Adolescent Girls Admit to Either Binge Eating or Purging

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According to the June 9, 2008 issue of the Archives of Pediatric and Adolescent Medicine, one in ten teenage girls either binge eats or purges at least once a week. The incidence of purging was highest among younger adolescent girls. Binge eating among boys was 3%, and boys were less likely to engage in purging. Alison E. Field, ScD, associate professor of pediatrics, in the division of adolescent medicine at Children’s Hospital, Boston, in Massachusetts said, "I would believe that 10% [of girls] would at least experiment with these behaviors, but once a week is quite severe." The authors also found that girls who diet frequently and are concerned about their weight are at greater risk for developing eating disorders. Girls, younger than 14, were three times as likely to binge or purge if their mother had a history of an eating disorder.

Data was analyzed from questionnaires submitted by 6916 girls and 5618 boys who were part of the Growing Up Today Study (GUTS), children of women participating in the Nurses' Health Study II and aged 9 to15 years at the start of the study. Information was updated every 12 to 18 months from September 1, 1996 to November 11, 2003, and in 2004, a questionnaire was sent to their mother. Among the children in the study, 19.8% of girls and 23.2% of boys were considered overweight or obese.

What’s Happening?

Teasing from boys and comments from dad seem to increase the risk that your teen will develop disordered eating. Dr. Field suggests, “this is an important area to focus on, because you might be able to prevent some children from becoming disordered eaters." Watch what you say to your kids about their weight, and recognize that boys can also be affected. Suggestions include emphasizing that children practice healthy behaviors, shifting discussions away from weight loss.
Dr. Field also points to the effect of media, saying it’s important to teach children that people in movies, magazines and TV, have figures that are “completely unattainable". Billboard ads and magazines that emphasize men with six-pack abs produce unreasonable self-expectations for boys.

No one knows yet whether adolescent eating disorders pose long- term problems, or whether it’s experimental. "We're trying to understand now who are the young people who just experiment with the behavior — say, do it for 1 year and then stop — vs. those who go on to have a very persistent problem."

It’s important to discuss healthy eating habits and promote exercise and beneficial recreational activities with your children. Body image is important, especially during adolescence. Negative remarks about weight can leave scars. Engage in open discussions with your children – note their reactions to what they see and read. Speak with your doctor if you expect that your child is engaging in binge eating or purging. The study is an important reminder to parents. ◦
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Sunday, June 8, 2008

Health Update - Routine Blood Sugar Testing no Longer Recommended


According to new recommendations, there is little to be gained from routine screening for Type 2 diabetes. The exception is hypertensive patients without diabetes symptoms, and blood pressure readings 135/80 or higher. "Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations”, says the US Preventive Services Task Force (USPSTF). The report is published in the June 3 issue of the Annals of Internal Medicine.

The impetus for the review was to determine the risks and benefits for routinely screening adults for Type 2 diabetes at the doctor’s office, and to update guidelines from 2003. To determine the best practice, the reviewers looked at data from the Cochrane Review and Medline for studies and observations that would tell them a little more about outcomes of pre-diabetic and diabetic treatments in patients who had the condition for less than a year. Patients with high blood pressure and diabetes have a 10-year risk of developing cardiovascular disease, making routine screening more valuable. Testing decisions should still be determined on an individual basis by your family doctor, with consideration for your overall risk factors.

Estimates show that 26% of adults already have abnormal fasting glucose levels and impaired glucose tolerance. Despite the estimates, the benefits of early detection and treatment remain unclear. We don’t know enough about how well diabetics respond to early aggressive treatment. Evidence is inconclusive that cholesterol-lowering medications will prevent diabetic complications. The authors feel that screening everyone will lead to wider use of potentially harmful medications.

High blood pressure and diabetes co-exist, so you might expect your doctor to perform a test for diabetes type 2 if your blood pressure is 130/85 or higher. Speak with your doctor if you think you have symptoms of diabetes. Excessive thirst, frequent urination and excessive hunger are the three most common symptoms. Given the updated guidelines, it’s likely that insurance companies will no longer pay for glucose testing during your annual office visit, unless there's a good reason.

Sources:
http://www.medscape.com/viewarticle/570316
http://www.medscape.com/viewarticle/575602?sssdmh=dm1.357946&src=nldne
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Saturday, June 7, 2008

Study – Long Term Marijuana use Toxic to the Brain



Recent studies show that marijuana may cause psychosis, increase the risk of heart disease, and provoke heart attack. Researchers now tell us that marijuana may be toxic to the brain, especially the left hippocampus. The hippocampus is responsible for short-term memory, spatial navigation, and the left hippocampus plays a large role in language dominance. The study is published online in the June issue of Archives of General Psychiatry, led by Murat YĆ¼cel, PhD


Changes in the brain were seen by way of MRI in fifteen heavy marijuana users. All were found to have reductions in hippocampal volume. The participants were male, smoked for more than 10 years without using other drugs, and reportedly smoked more than five joints daily. The study is reportedly the first to measure the long-term effects of marijuana on humans. It’s not completely understood whether the change in brain volume comes from loss of neurons, which make up half of the central nervous system, or glial cells, which comprise the other half. Other possibilities include smaller cells, or alternatively, decreased synapse density - tiny cells that transmit information across neurons. Additionally, "the left hippocampus may be particularly vulnerable to the effects of cannabis exposure and may be more closely related to the emergence of psychotic symptoms”.

Another finding included a 7.1% reduction of the smoker’s amygdala, the portion of the brain that lies close to the hippocampus and affects emotions, arousal, hormonal secretions and fear response.

Further research is planned to measure “the degree and mechanisms of long term cannabis-related harm and the time course of neuronal recovery after abstinence."

Abstract
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Analysis Links Low Level Air Pollution to Stroke



Short-term exposure to low level air pollution may increase our risk of stroke, according to data compiled from Neuces County, Texas, home of several oil refineries. Researchers found a 3% increase in strokes and TIA (mini-stroke) the day of, and the day following exposure to fine particulate matter. The report is the first to reveal scientific evidence that air pollution might be related to stroke. Past studies show that air pollution is associated with increased risk for heart disease.

Scientists used information from the Brain Attack Surveillance in Corpus Christi (BASIC) database, a study that compiles information about stroke variances in ethnic populations. Lead investigator, Lynda Lisabeth, PhD, from the University Of Michigan School Of Public Health, in Ann Arbor, reports, "In this particular community, we found there was an association between both acute and short-term exposure to fine particulate matter and stroke and TIA risk. We looked at counts of stroke and TIAs on given days and correlated that with the amount of air pollution on that day.”

Incidence of strokes that occurred between 2001 and 2005 were identified and paired with information from the Texas Commission on Environmental Quality's monitoring operations database. A centrally used monitor, positioned upwind of the oil refineries, was used to find information on fine particulate matter and ozone. Surprisingly, pollution levels were low, leading to concerns about the population at large, many of whom breathe even worse air.

Follow up plans include trying to measure the impact on those with existing lung disease, congestive heart failure, and other subgroups as well as other demographic areas.

Researchers aren’t sure exactly what happens with air pollution to increase the risk of stroke, but Dr. Lisabeth suggests strokes might occur as the result of acute vasoconstriction, or strangulation of blood flow to the brain, and increased blood viscosity. Vasocontstriction is also a common cause of heart attacks. It will be interesting to see further research. We can hope that as studies pile up current air quality standards will be further addressed.


Abstract
http://www.medscape.com/viewarticle/575674
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Monday, June 2, 2008

Zoledronic Acid Found to Improve Breast Cancer Outcomes


Women, who took Zoledronic acid (a bisphosphonate) in a recent trial, were found to have a 36% reduction of breast cancer recurrence when compared to a group who did not take the drug. Zoledronic acid is currently used to treat patients with bone metastasis, and was recently approved for osteoporosis treatment in post –menopausal women. It is marketed under the names Zometa and Reclast. The benefit of administering zoledronic acid to breast cancer patients proved significant in an Austrian trial of 1803 premenopausal women who showed improvement in all events associated with it's spread and recurrence.

The anti-cancer effect of bisphosphonates has been previously studied, but results of studies have been inconsistent. Lead investigator, lead investigator Michael Gnant, MD, professor of surgery at the Medical University of Vienna and president of the Austrian Breast and Colorectal Cancer Study Group (ABCSG) says, “this is the first study to translate these effects into a clinical benefit”.

Comparison was made among women with early pre-menopausal breast cancer with estrogen-receptor and/or progesterone-receptor positive tumors. Five percent of the women received chemotherapy prior to surgical removal of the primary tumor. None received chemotherapy afterwards, but were treated with ovarian suppression hormone (luteinizing hormone-releasing hormone) combined with tamoxifen or Arimidex. One group also received 4 mg. of intravenous Zoledronic acid every six months for three years. After five years, the outcomes were measured.

More studies are needed before zoledronic acid receives widespread recommendations. Pre-menopausal women with hormone responsive early breast cancer, who are receiving endocrine treatment should receive the drug, a point emphasized by breast cancer expert Eric Winer, MD, from Harvard Medical School, in Boston, Massachusetts, who moderated the American Society of Clinical Oncology 44th Annual Meeting’s press conference where the study results were presented. Martine Piccart-Gebhart, MD, PhD, from the Institut Jules Bordet, in Paris, said: "This is not a practice-changing trial — yet!" There are still several questions that need to be answered, and there is a need for confirmation from other trials "before we can recommend widespread use of zolendronic acid in routine care," she said. "I am convinced that we have to wait." Dr. Piccart-Gebhart is an internationally renowned breast cancer specialist.

The study lends support that younger women with early breast cancer, who are at low or moderate risk for disease progression, may not need treatment with chemotherapy. Drugs that suppress cancer-promoting hormones in women include Tamoxifen and aromatase inhibitors. Each works differently. Studies are ongoing to compare the benefits of giving Tamoxifen or aromatase inhibitors, either separately or together to enhance breast cancer outcomes. The role of these drugs has remained unclear.

Abstract; http://www.abstract.asco.org/AbstView_55_35897.html
Sources: http://www.medscape.com/viewarticle/575394?sssdmh=dm1.356379&src=nldne
http://www.cancer.gov/cancertopics/treatment/breast/aromatase-inhibitors0307
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