Monthly Archives: July 2016

'Managing' Elderly Patients Without Powerful Antipsychotics



By Randy Dotinga
HealthDay Reporter

MONDAY, July 25, 2016 (HealthDay News) -- About 25 percent of dementia patients in U.S. nursing homes are still quieted with risky antipsychotic medications. Now, a small study suggests that managing these difficult patients, instead of medicating them, could obtain better results.



"Drugs have a place, but should not be first-line treatments. They don't work well, and there are side effects," said study author Dr. Henry Brodaty, a professor of aging and mental health at the University of New South Wales in Sydney, Australia.



Antipsychotic drugs such as Risperdal (risperidone), Abilify (aripiprazole) and Seroquel (quetiapine) are approved to treat serious psychiatric conditions such as bipolar disorder and schizophrenia. But in seniors, they're often used to calm aggressive or violent behavior linked to dementia.



"They're basically a sedative," said Dean Hartley, director of science initiatives with the U.S.-based Alzheimer's Association. While he agreed that the drugs are warranted in some situations, he said dementia patients who take the powerful drugs are more susceptible to falls and have a higher risk of death.



The new study touts a program that trains nursing home staff members to focus on resolving specific issues bothering the patients and not to automatically sedate them.



It's not clear how much this kind of program would cost in the United States or whether nursing homes could adapt to a new way of doing things. But it's clear that the tranquilizers used on patients with dementia can be dangerous, said Hartley.



U.S. health officials have been trying to reduce the use of antipsychotics in long-term nursing homes. Since 2008, the U.S. Food and Drug Administration has required a boxed warning with all antipsychotic medications noting the increased risk of death in elderly patients with dementia-related psychosis.



The reported percentage of patients using the drugs dipped from 24 percent in late 2011 to 17 percent in 2015, according to background notes with the study.



Still, patients with dementia often need special management. According to Brodaty, 90 percent of people with dementia also experience agitation, depression, aggression, wandering, delusions and/or hallucinations.



His study included 156 patients at 24 nursing homes in Australia. All regularly took antipsychotic medications and were older than 60.



Nurses were trained how to handle difficult-to-manage behaviors without relying on drugs.



Of 135 patients taken off the antipsychotic drugs, 76 percent were still not using them 12 months later, the researchers said.



Hartley, the Alzheimer's Association scientist, said focusing on the needs of patients requires understanding the issues that burden them. For example, he said, they may suffer pain from urinary tract infections but are unable to tell their caregivers.



Hartley mentioned the case of a patient who kept wanting to leave a facility, saying that it was raining outside. When asked, she explained that her kids -- now grown -- needed to be picked up at the bus stop. "They said they'd pick them up for her," Hartley said, and the woman became calmer.



What about cost? This kind of program could actually reduce expenses, Hartley said, because patients would be less disruptive and need fewer emergency room visits due to injuries from falling.



Hartley cautioned that the study was small and needs to be validated. "It's an important study, but it's only the beginning," he said. Still, the approach "may help caregivers or families know that their family members are being treated in a humane way."



The study was scheduled for presentation Monday at the Alzheimer's Association International Conference in Toronto. Medical studies released at conferences should be considered preliminary until published in a peer-reviewed journal.



More information



For more about dementia, visit the Alzheimer's Association.



Women Smokers at Higher Risk for Brain Bleed



By Steven Reinberg
HealthDay Reporter

THURSDAY, July 21, 2016 (HealthDay News) -- Strokes characterized by bleeding inside the lining of the brain are more common among smokers, especially women, researchers report.



These serious strokes -- called subarachnoid hemorrhages -- are eight times more common among women who smoke more than a pack a day compared to nonsmokers, Finnish researchers found. They're three times more common among men who smoke the same amount.



Even light smoking tripled a woman's risk for this type of stroke, the study found.



"There is no safe level of smoking, and naturally, the best option is never to start," said lead researcher Dr. Joni Lindbohm of the University of Helsinki.



"The message for policymakers is that by implementing effective strategies against smoking, they can considerably reduce the burden of subarachnoid hemorrhage," said Lindbohm, who specializes in neurosurgery and public health.



Subarachnoid hemorrhages account for about 3 percent of all strokes, said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine.



These strokes often affect younger people and "can be quite devastating in terms of disability and death, with fatality rates around one in five," said Sacco, who wasn't involved in the study.



This type of stroke usually results from a bleeding aneurysm in the brain. An aneurysm is a small weak spot in a blood vessel that can burst at any time.



For the study, Lindbohm and colleagues collected data on nearly 66,000 adults listed in Finnish national surveys since 1972. Participants were followed for an average of 21 years, until they had a first stroke, died, or until the end of 2011.



The researchers found that among light smokers -- one to 10 cigarettes a day -- women were three times more likely to have subarachnoid hemorrhage, and men were twice as likely to have one compared to nonsmokers.



Among those who smoked 11 to 20 cigarettes a day, women were four times more likely and men two times more likely to suffer this type of stroke, the investigators found.



But those who quit smoking significantly reduced their odds of having a subarachnoid hemorrhage. After six months without smoking, their risk fell to the level of nonsmokers, the researchers reported.



Although subarachnoid hemorrhage is more common among women than men, the reasons why are unclear, Lindbohm and Sacco said. Lindbohm believes the elevated risk in women largely comes down to the harms of smoking.



The link between smoking and these strokes didn't come as a surprise, Sacco noted. "The association between cigarette smoking and subarachnoid hemorrhage has been known for years," he said.



"Although risks do rise with age, it is an important cause of stroke in the young," he added.



As with other strokes, some factors likely increase the risk of developing an aneurysm that eventually ruptures and causes a subarachnoid hemorrhage, he explained.



"Cigarette smoking and high blood pressure are two important modifiable risk factors for subarachnoid hemorrhage," Sacco said. "This study adds more evidence to the call to the public to never smoke, and control their blood pressure to avoid this type of stroke."



Lindbohm said that heavy-smoking females with unruptured aneurysms in their brain are a high-risk population, and their aneurysms should be treated.



The report was published online July 21 in the journal Stroke.



More information



For more on subarachnoid hemorrhage, visit the Brain Aneurysm Foundation.



Is Surgery Always Needed for Meniscal Tears of the Knee?



WEDNESDAY, July 20, 2016 (HealthDay News) -- A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.



Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.



Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.



According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year -- although there's debate over how valuable these procedures are for meniscal tears.



To help settle the matter, a team led by Nina Jullum Kise, an orthopedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.



These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.



Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.



After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise's team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.



Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.



According to Kise's group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.



Two knee specialists in the United States had differing views on the findings.



Dr. Matthew Hepinstall is an orthopedic surgeon at Lenox Hill Hospital in New York City. He said the new study "complements prior research" finding much the same thing, and he believes that "the majority of patients can experience significant improvement over weeks to months without undergoing surgery."



He did offer one caveat, however: the size and cause of the tear matters. "The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury," Hepinstall explained.



Still, "the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention," Hepinstall said.



But another orthopedic surgeon took issue with the study's design.



"Many important factors were not taken into account," said Dr. Victor Khabie, who co-directs the Orthopedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, N.Y.



"This study did not look at 'injuries,' it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopedics office; excluding these patients limits this study," Khabie said.



"My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen," Khabie said.



He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. "The study included 'all' meniscal tears," Khabie noted. "Most orthopedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient's symptoms."



According to Khabie, "The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopedic surgeon with experience in knee surgery can determine the best treatment option for any given patient."



The study was published July 20 in the BMJ.



More information



The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about knee problems.



Sleep Disorders 6 Times Higher Among Veterans



WEDNESDAY, July 20, 2016 (HealthDay News) -- Sleep disorders are six times more likely among American military veterans than in the general population, a new study finds.



And veterans with post-traumatic stress disorder (PTSD) seem to have the highest rates, the researchers said.



The research involved more than 9.7 million veterans treated by the Veterans Health Administration system between 2000 and 2010. The majority (93 percent) of these military service members were men. Slightly more than 750,000 were diagnosed with at least one sleep disorder, the study authors said.



Over the course of 11 years, the investigators found that the rate of sleep disorders rose from less than 1 percent to nearly 6 percent. Sleep disorders were most common among veterans who had experienced combat and those with PTSD.



"Veterans with PTSD had a very high sleep disorder prevalence of 16 percent, the highest among the various health conditions or other population characteristics that we examined," study senior author James Burch said in a news release from the American Academy of Sleep Medicine. Burch is an associate professor of epidemiology and biostatistics at the University of South Carolina.



The study doesn't prove that PTSD triggers sleep disorders, but the researchers noted that diagnosed cases of PTSD tripled over the course of the study.



Sleep apnea was the most commonly diagnosed sleep disorder among the study participants. Sleep apnea, which causes brief pauses in breathing during sleep, accounted for 47 percent of diagnosed sleep disorders, the researchers said.



Insomnia accounted for 26 percent of diagnosed sleep disorders, the findings showed.



Veterans with other chronic health issues -- including heart disease and cancer -- also had higher rates of sleep disorders than other study participants, according to the report.



The findings point to a need for improved management of sleep disorders among U.S. military veterans, the researchers concluded.



The study was published in the July issue of the journal Sleep.



More information



Find out more about sleep disorders from the National Sleep Foundation.



Obese Teens Take Weight-Loss Surgery in Stride



MONDAY, July 18, 2016 (HealthDay News) -- Severely obese teens who have weight-loss surgery may be able to walk faster and with less pain afterwards, new research suggests.



For the study, a team led by Justin Ryder, an assistant professor of pediatrics at the University of Minnesota Medical School, analyzed how weight-loss surgery affected obese teens' ability to walk up to two years after their procedure.



The study involved 242 significantly obese teens who were 19 years old or younger and had weight-loss surgery between 2007 and 2012 at five U.S. bariatric surgery centers.



Gastric bypass (where a portion of the stomach is rerouted) was performed on 161 of the teens. The rest had either gastrectomy (removal of part of the stomach) or LAGB (laparoscopic adjustable gastric band), a procedure in which a band is placed around a portion of the stomach to make it smaller.



The researchers timed the teens as they walked roughly a quarter-mile before their surgery. They repeated the walking test six months, one year and two years after their weight-loss procedure.



Before and after each test, the researchers measured the teens' heart rates. The young people reported how much pain they felt while walking.



Just six months after surgery, the teens were able to walk faster and with less pain. Before surgery, they did the walk in 6.3 minutes, on average. Six months later, their average time dropped to 5.8 minutes. Their pre-walk resting heart rate also improved over that period from an average of 84 beats per minute to 74 beats per minute. Their post-walk heart rate dropped from an average of 128 beats per minute to 113 beats per minute, according to the study.



These improvements were also seen at one year and two years after surgery, the study published online July 18 in JAMA Pediatrics showed.



The study did not include a comparison group of teens who didn't have weight-loss surgery. Researchers said more study is needed to determine if the benefits of weight-loss surgery continue long-term and lead to additional health improvements.



More information



The U.S. The National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.




1 in 5 Americans Uses a Tobacco Product



THURSDAY, July 14, 2016 (HealthDay News) -- Despite decades of declines in smoking rates in the United States, one in five Americans still smokes or uses hookahs, e-cigarettes or other tobacco products, U.S. health officials reported Thursday.



Cigarettes remain the most popular, but the emergence of hookah and e-cigarette use, especially among younger adults, is cause for concern, the U.S. Centers for Disease Control and Prevention report said.



Findings from the 2013-2014 survey underscore the need "to educate the public about the potential harms of all tobacco product use, including risks associated with occasional use," CDC researcher Dr. Sean Hu and colleagues wrote.



Noting that e-cigarettes were used most often by 18- to 24-year-olds, the study authors suggested advertising and misleading marketing claims are to blame.



Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y., agreed.



"There is a misperception, fostered by e-cigarette and hookah pipe industry advertising, that these products are not harmful," Folan said. "These products contain nicotine and other hazardous chemicals."



Because they're perceived as a healthier alternative to smoking, Folan said e-cigarettes and hookahs have the potential to dissuade smokers from quitting.



For the report, researchers from the CDC and the U.S. Food and Drug Administration analyzed data from the 2013-2014 National Adult Tobacco Survey.



More than 49 million Americans (21 percent) reported using a tobacco product every day or some days. And more than one-quarter said they used a tobacco product daily, some days, or rarely, the researchers found.



Cigarettes were smoked by 17 percent of Americans; cigars and pipes by about 2 percent. More than 3 percent reported e-cigarette use, while almost 1 percent had tried hookahs (water pipes). And close to 6 million adults reported using smokeless tobacco, the findings showed.



Among the other findings:



  • Males and adults up to age 44 were most likely to use a tobacco product.


  • Midwesterners and southerners were more likely to use tobacco products than residents of other regions. So were people with less education; singles, including divorced and widowed individuals; poor people; and lesbians, gays and bisexuals.


  • Asians and Hispanics were less likely than whites or blacks to use tobacco products.


Progress has been made over the past five decades to curb smoking, but more work is needed, the researchers said.



What will help?



"A combination of comprehensive smoke-free laws, high-impact media campaigns, tobacco price increases, and easy access to quitting assistance," the study authors suggested.



Such strategies could help reduce tobacco-related disease, which causes smokers to die 10 years earlier than nonsmokers, the CDC said. Cigarettes alone lead to more than 480,000 deaths a year in the United States, including nearly 42,000 deaths from secondhand smoke exposure.



The FDA, which recently gained authority over all tobacco products, intends to ban sales of e-cigarettes and all other tobacco products to minors starting next month.



Hoping to prevent another surge of nicotine addiction, the agency will also require manufacturers to report ingredients and submit new or altered products for approval before bringing them to market.



Folan applauded the new rules.



Hopefully, with the FDA now having the authority to regulate these products, information about ingredients and manufacturing processes will be available to consumers," she said.



The findings were published in the July 15 issue of the CDC's Morbidity and Mortality Weekly Report.



More information



The U.S. Department of Health and Human Services tells how smoking hurts your health.



Early Bedtime for Preschoolers, Healthier Weight Later?



THURSDAY, July 14, 2016 (HealthDay News) -- Sending preschoolers off to bed early may bring them an unexpected benefit: less chance of obesity when they are teens.



So suggests research that compared preschoolers who went to bed at 8 p.m. with same-age kids who had later bedtimes. A team at the Ohio State University College of Public Health found that a bedtime just one hour later seemed to double the likelihood that young children will be obese teens.



"For parents, this reinforces the importance of establishing a bedtime routine," said the study's lead author, Sarah Anderson, an associate professor of epidemiology. "It's something concrete that families can do to lower their child's risk."



She added that the earlier bedtime is also likely to benefit youngsters' social and emotional development as well as their brain development.



The study reviewed data on nearly 1,000 children who were part of a study that followed healthy babies born in 1991 at 10 U.S. locations.



When the children were about 4 years old, they were divided into three groups: those who went to bed by 8 p.m.; those whose bedtime was between 8 p.m. and 9 p.m., and those went to bed later.



Half of the youngsters went to bed between 8 p.m. and 9 p.m. The rest were evenly divided between early and late bedtimes, according to the study published July 14 in the Journal of Pediatrics.



Researchers then looked at the kids' weight at an average age of 15. They found that only 10 percent of kids with the earliest bedtimes were obese teens. That compared to 16 percent of the children with bedtimes between 8 p.m. and 9 p.m., and 23 percent of those who went to bed after 9 p.m.



Most likely to become obese were kids who went to bed latest and whose mothers' interactions with them were observed to be less supportive and more hostile, the researchers found. They said later bedtimes were more common among non-white children who had less-educated mothers and lived in lower-income households.



However, only an association was seen between bedtimes and obesity risk, rather than a cause-and-effect link.



"It's important to recognize that having an early bedtime may be more challenging for some families than for others," Anderson said in a university news release. "Families have many competing demands and there are tradeoffs that get made. For example, if you work late, that can push bedtimes later in the evening."



The study authors said their findings suggest that household routines for preschoolers are important.



More information



The U.S. National Heart, Lung, and Blood Institute provides more information on the importance of sleep.


How to Spot the Warning Signs of Heat Stroke



WEDNESDAY, July 13, 2016 (HealthDay News) -- As people age, they are at added risk for heat stroke and other heat-related illnesses, according to the U.S. National Institute on Aging (NIA).



This is particularly true for those with chronic health issues, the agency cautions.



Heat fatigue, heat-related dizziness, heat cramps, heat exhaustion and heat stroke are all forms of hyperthermia. The condition occurs when the body is overwhelmed by heat and is unable to control its temperature, the NIA explains.



Those who lack access to air conditioning or transportation, who can't move around, wear too much clothing or visit crowded places may be more vulnerable, the agency notes.



Other factors that increase hyperthermia risk include:


  • Dehydration,

  • Poor blood circulation,

  • Less sweat production due to aging,

  • Use of multiple medications,

  • High blood pressure or other health conditions that require a reduced-salt diet,

  • Heart, lung and kidney diseases, or other conditions that cause general weakness or fever,

  • Being very overweight or underweight,

  • Drinking alcohol.



When temperatures, air pollution and humidity spike, older people with chronic health issues like heart disease and diabetes should stay indoors, the NIA advises. Those who don't have air conditioning should go to a mall, senior center, library or other cool location.



Heat-related illnesses require immediate medical attention. The NIA says it's essential to recognize the warning signs, including:



  • Fever (generally above 104 degrees Fahrenheit),

  • Confusion or combativeness,

  • Strong, rapid pulse,

  • Dry, flushed skin,

  • Lack of sweating,

  • Feeling faint,

  • Staggering,

  • Coma.



Anyone who may be suffering from a heat-related illness should be taken to a shady or air-conditioned spot and told to lie down. A cold, wet cloth should be applied to the wrists, neck, armpits and groin to help cool the blood. If the person can swallow, he or she should be given nonalcoholic fluids, like water or apple juice, according to the NIA.



More information



The U.S. Centers for Disease Control and Prevention provides more information on older people and heat-related illness.



Headed to the Pool? Protect Yourself From the Poop



SATURDAY, July 9, 2016 (HealthDay News) -- Swimming is a great way to cool off on a hot day, but beware of fecal contamination that can make you sick, an expert says.



"The most common problems people get while swimming are intestinal infections, either bacterial or viral," said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University Medical Center, in Nashville.



Symptoms include diarrhea, nausea, vomiting and sometimes fever. These symptoms occur several hours after infection, so people often don't realize they were infected while swimming.



There are a number of ways to reduce the risk of such infections.



Check the pool before you or your children get in. "Does it have clear and clean water? If not, you should reconsider getting in," Schaffner said in a medical center news release.



Before going into a pool, always take a shower. Anyone who has had stomach problems in the previous 24 hours should stay out of the pool.



Parents should check every 30 to 60 minutes that their toddlers haven't soiled their diapers (even plastic swim diapers) or their swimsuits. Change diapers away from poolside and wash your hands afterward.



If a child has an accident in a public pool, alert staffers so they can take steps to clean the water and make it safe again, Schaffner said.



Urine in the pool is not a major concern, he said, because it is sterile, dilutes quickly and poses little health risk to other swimmers.



"None of this should dampen anyone's enthusiasm for the pool. With a few simple precautions, playing in the water can be safe and fun for everybody," Schaffner concluded.



More information



The U.S. Centers for Disease Control and Prevention has more on swimming hygiene.




Many Men Ignore Testicular Cancer Symptoms for Months



TUESDAY, July 5, 2016 (HealthDay News) -- Early detection and treatment of testicular cancer is key to beating the disease, a urology specialist says.



Yet many men who feel something abnormal in a testicle wait a few months before seeing a doctor.



But, when diagnosed while still confined to the testicle, the five-year survival rate for testicular cancer is 99 percent, Dr. Jay Raman, chief of urology at Penn State Medical Center said in a university news release.



"I think part of it is the macho man complex -- that everything is fine. Then you add on top of that the fact that it is a sensitive area, and they may have some embarrassment about it," Raman said.



Men who know about testicular cancer may also be concerned that surgical removal of the testicle is the best way to cure the disease.



"So they wait to see if it gets better on its own. But sometimes they wait and wait, until they've waited too long," Raman said.



About 9,000 new cases of testicular cancer are diagnosed each year in the United States, according to Raman. Risk factors include being white and having a testicle that didn't descend when younger. Since these risk factors are not preventable, the best thing to do is be aware of the risk and know the symptoms of cancer.



All men should do a testicular self-exam at least every six months, Raman advised.



"What you are feeling for is that both testicles have the same contours -- relatively smooth and soft, kind of the consistency of a hard-boiled egg or the palm of your hand," he said. "If you notice anything firm, or lumps or bumps -- something that is different on one side than the other -- you should seek medical attention right away."



Surgery to remove the testicle is the most common treatment. If the cancer is confined to the testicle, exams and blood work may be the only follow-up patients require. If the cancer has spread beyond the testicle, chemotherapy and radiation may be necessary, he explained.



"The most important thing to know is that cure rates are directly tied to how early you find it," Raman said.



More information



The U.S. National Cancer Institute has more on testicular cancer.