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Most heart attack survivors skip cardiac rehab

HeartJan 31 08

Approximately two thirds of patients in the United States who survive a heart attack do not undergo outpatient cardiac rehabilitation, a program proven to reduce the risk of illness and death, and to also improve psychological recovery, according to findings reported by the Centers for Disease Control and Prevention in Atlanta.

“Programs and policies directed at increasing the number of patients who are referred to and participate in cardiac rehabilitation need to be strengthened,” CDC researchers report in this week’s issue of the Morbidity and Mortality Weekly Report.

“Future research should focus on identifying barriers to cardiac rehabilitation participation and interventions to improve referral and receipt of outpatient rehabilitation services,” they add.

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Antioxidants more likely to raise cancer risk

CancerJan 31 08

Taking antioxidant supplements won’t reduce cancer risk, according to a new analysis of a dozen studies including more than 100,000 patients. In fact, the researchers found, smokers who take beta carotene supplements could be increasing their risk of smoking-related cancer and death.

While antioxidants have been touted for cancer prevention, different antioxidants have different effects, and their effects may also vary depending on the part of the body involved, Dr. Aditya Bardia of the Mayo Clinic in Rochester, Minnesota and colleagues note in their report.

To investigate, the researchers looked at 12 trials that compared antioxidant supplements with placebo on cancer incidence and mortality.

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Testosterone seen unrelated to prostate cancer risk

Prostate CancerJan 31 08

Natural levels of a man’s testosterone do not affect his prostate cancer risk as some had thought, a finding that should spur scientists to rethink their approach to the disease, researchers said on Tuesday.

Nearly two dozen studies have examined a potential link between testosterone and prostate cancer risk but so far results have been inconclusive, said Andrew Roddam, an epidemiologist at the University of Oxford who led the study.

In the Journal of the National Cancer Institute, Roddam and colleagues said they found no such relationship after collecting worldwide data on hormone levels of 3,886 men who eventually developed prostate cancer and 6,438 men who did not.

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6 simple steps to protect against and stop the spread of noroviruses

InfectionsJan 31 08

Recent outbreaks of norovirus–also known as stomach flu–indicate the highly contagious, fast-moving virus is again a public health concern. The Association for Professionals in Infection Control and Epidemiology (APIC) has six simple steps to protect families against noroviruses.

Norovirus is the second most frequent cause of illness after the common cold. Symptoms include nausea, vomiting, diarrhea, and abdominal pain, and occur between 24 and 48 hours after exposure. Norovirus can be life-threatening for the elderly and immunocompromised.

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Breast cancer diagnosis comes late for women in gentrifying neighborhoods

Breast CancerJan 31 08

Women who live in Chicago’s gentrifying neighborhoods are more apt to receive a late diagnosis of breast cancer than women who live in poverty-stricken neighborhoods, University of Illinois at Chicago researchers have found.

The surprising finding is in a study published in the January issue of the Annals of Epidemiology.

“There’s been a lot of social change in American cities since 1990, but we know very little about how gentrification impacts health outcomes,” said Richard Barrett, researcher at the UIC Institute for Health Research and Policy and lead author of the study. “We know that minority women in Cook County are more likely to be diagnosed with late-stage breast cancer and to die from it compared with white women, but we were interested in how neighborhood change impacts breast cancer diagnosis.”

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The HLA-DRB1 gene and premature death in rheumatoid arthritis

Arthritis • • Genetics • • Heart • • ImmunologyJan 31 08

People with rheumatoid arthritis (RA), an inflammatory autoimmune disease, tend to die younger and, largely from cardiovascular disease (CVD). One explanation for this increasingly recognized fact is that inflammation promotes atherosclerosis. A marker of inflammation, elevation of the C-reactive protein (CRP) level has been shown to predict CVD in the general population. However, other highly inflammatory diseases—Crohn’s, for example—do not carry the same high risk of premature death from heart disease.

To identify other possible suspects, researchers in the United Kingdom investigated whether genetic variants linked to the likelihood of developing RA might also make patients more likely to die from CVD. Led by Dr. Tracey M. Farragher at the University of Manchester and funded by the Arthritis Research Campaign (arc), the study focused on two genes—HLA-DRB1and PTPN22—and their interactions with known RA risk factors. The evidence, presented in the February 2008 issue of Arthritis & Rheumatism, implicates HLA-DRB1 genotypes, already associated with RA susceptibility and severity, as a predictor of premature death from CVD for inflammatory arthritis patients. For RA patients in particular, having the shared epitope (SE)—a group of HLA-DRB1 alleles with kindred amino acid traits—plus anti-cyclic citrullinated peptide (anti-CCP) antibodies and current smoking is an especially deadly combination.

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Anemia treatment may be a double-edged sword

AnemiaJan 30 08

Erythropoietin has so far been known to doctors as a hormone that boosts red-blood-cell production. Now, a mouse study led by Lois Smith, MD, PhD, an ophthalmologist at Children’s Hospital Boston, shows it also keeps blood vessels alive and growing in the eye. The findings not only add a new function to the hormone, but also give doctors a reason to pause before prescribing it to patients with diseases affected by abnormal blood-vessel growth, such as retinopathy and cancer.

The study, published in the February issue of the Journal of Clinical Investigation (online January 24), also found that whether the hormone is a risk or benefit depends on the timing of administration.

Smith and first author Jing Chen, PhD, worked in mice with retinopathy, an eye disease that begins when healthy blood vessels nourishing the retina die. Numerous vessels then grow in, but they are deformed. Ultimately, the deformed vessels may pull the retina off the back of the eye, causing blindness.

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Deep brain stimulation may improve memory

BrainJan 30 08

Deep brain stimulation (DBS) surgery, which is used to treat Parkinson’s disease and other movement disorders, is now being studied for its potential to treat a variety of conditions. For example, DBS of the hypothalamus has been used to treat cluster headaches and aggressiveness in humans, and stimulating this area influences feeding behavior in animals. A new study found that hypothalamic DBS performed in the treatment of a patient with morbid obesity unexpectedly evoked detailed autobiographical memories. The study will be published online in the Annals of Neurology, the official journal of the American Neurological Association.

Led by Andres Lozano, Professor of Neurosurgery and Canada Research Chair in Neuroscience and his team at the Toronto Western Hospital in Toronto, Ontario, researchers conducted an experimental study to treat a 50-year-old man with a lifelong history of obesity in whom a variety of treatment approaches had failed.

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Carbon monoxide may cause long-lasting heart damage

HeartJan 29 08

Lack of oxygen isn’t the only way that carbon monoxide (CO) damages the heart, say researchers at Rhode Island Hospital.

According to the findings of a new study, published in the January issue of Academic Emergency Medicine, CO also causes direct damage to the heart muscle, separate from the effects of oxygen deprivation, which reduces the heart’s pumping capacity and permanently impairs cardiac function.

“These findings suggest that heart damage caused by carbon monoxide may have long-lasting effects even after its been eliminated from the blood, making the diagnosis of carbon monoxide poisoning even more critical,” said lead author Selim Suner, M.D., M.S., director of emergency preparedness and disaster medicine at Rhode Island Hospital.

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Viruses for a healthy pregnancy

PregnancyJan 29 08

Sequences of DNA in the human genome that originated from ancient viral infections have some surprising effects on our bodies and are even essential for a healthy pregnancy, according to an article in the February issue of Microbiology Today.

Retrovirus infections represent the most intimate host-pathogen relationship. The virus inserts a copy of its genome into the DNA of the host cell, resulting in an irreversible, stable and sometimes lifelong infection. If a sperm or egg cell is infected, the virus DNA can be passed down generations, permanently fixed in the germ line. As a result, an endogenous retrovirus (ERV) can exist for millions of years.

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Heart transplants: Do more or do none, Johns Hopkins study suggests

HeartJan 29 08

Heart surgeons at Johns Hopkins have evidence to support further tightening rather than easing of standards used to designate hospitals that are best at performing heart transplants.

In a study to be presented Jan. 29 at the 44th annual meeting of the Society of Thoracic Surgeons in Fort Lauderdale, Fla., the Hopkins team recommends that the benchmark for designation as a high-volume hospital rise from 10 heart transplants per year to 14. High-volume centers consistently show higher survival and fewer complication rates.

However, the standard, which is officially set by the U.S. Centers for Medicare and Medicaid Services and which qualifies medical centers for federal reimbursement, was recently lowered from 12 per year to 10.

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Study finds increasing rates of diabetes among older Americans

DiabetesJan 29 08

The annual number of Americans older than 65 newly diagnosed with diabetes increased by 23 percent between 1994 to 1995 and 2003 to 2004, according to a report in the January 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“The prevalence of diabetes mellitus is increasing, in part because of population aging, but also in younger persons,” according to background information in the article. The high rate of existing diabetes also contributes to a high rate of diabetes-related complications and premature death. “Awareness of the importance of active monitoring and management of diabetes has become more widespread; however, adherence to recommended practices remains low.”

Frank A. Sloan, Ph.D., and colleagues at the Duke University Medical Center, Durham, North Carolina, and colleagues analyzed Medicare program data for patients first diagnosed with diabetes during 1994 (33,164 patients), 1999 (31,722 patients) and 2003 (40,058 patients). This data was compared with that of two control groups consisting of individuals without the disease who were of similar race and ethnicity to those with diabetes. Death and complications of diabetes such as cardiovascular, cerebrovascular (damage to blood cells in the brain), ophthalmic (eye), renal (kidney) and lower extremity events were recorded.

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Antidepressants Unproven as Treatment for Low Back Pain

Backache • • DepressionJan 29 08

Antidepressants might be worthless for treating low back pain, suggests a new review that found no evidence to support using the drugs in this way. Yet, up to 23 percent of U.S. physicians report prescribing antidepressants to patients with low back pain.

“The prescription of antidepressants as a treatment for back pain remains controversial,” Donna Urquhart, Ph.D., research fellow at Monash University in Melbourne, Australia, and lead review author.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

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Tips for Dry Winter Skin

Skin CareJan 29 08

By itself, dry skin isn’t a medical worry, but serious cases can result in cracks and fissures that invite infection and inflammation. This is one problem that hasn’t suffered from lack of attention in the marketplace, though: there are dozens of creams and lotions for dry skin. But what ingredients should you look for in a moisturizer? Well-controlled studies are few and far between. The fact is that despite the long lists of obscure ingredients and the pseudoscientific hokum, all moisturizers help with dry skin for a pretty simple reason: they supply a little bit of water to the skin and contain a greasy substance that holds it in, reports the February 2008 issue of the Harvard Health Letter.

One reason for the proliferation of moisturizers is the continuing search for a mix of ingredients that holds in water like petrolatum—a greasy substance known to many people as Vaseline—but feels nicer on the skin. The good news is that despite all the unknowns, you really can’t go wrong. Almost all the moisturizers on the market will help with dry skin, and in most cases, the choice comes down to simply whether you like the feel and smell.

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Lack of sleep tied to retained pregnancy weight

Pregnancy • • Sleep AidJan 29 08

Insufficient sleep during the months after childbirth may play a role in the retention of weight gained during pregnancy, research suggests.

“Even relatively short periods of sleep deprivation (6 months after delivery) may influence weight,” Dr. Erica P. Gunderson told Reuters Health.

Gunderson, an epidemiologist with Kaiser Permanente, in Oakland, California, and colleagues found that women who got less than an average of 5 hours of sleep daily during the first 6 months after childbirth were likely to weigh at least 5 kilograms (about 11 pounds) more than their pre-pregnancy weight at one year after childbirth.

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