Posts
Title: CPR Training Should Focus on High-Risk Neighborhoods: Experts
Category: Health News
Created: 2/25/2013 4:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM
Thursday, April 25, 2013
Pediatrics Group Issues New Ear Infection Guidelines
By Serena Gordon
HealthDay Reporter
MONDAY, Feb. 25 (HealthDay News) -- The American Academy of Pediatrics has issued new guidelines for identifying and treating a common childhood ailment that can cause a lot of misery -- the ear infection.
In the guidelines released Monday, the pediatrics group more clearly defines the signs and symptoms that indicate an infection that might need treatment. They also encourage observation with close follow-up instead of antibiotic treatment for many children, including some under the age of 2 years. And, for parents of children with recurrent infections, the new guidelines advise physicians and parents when it's time to see a specialist.
"Between a more accurate diagnosis and the use of observation, we think we can greatly decrease the use of antibiotics," said the lead author of the new guidelines, Dr. Allan Lieberthal, a pediatrician at Kaiser Permanente Panorama City, in Los Angeles, and a clinical professor of pediatrics at the Keck School of Medicine at the University of Southern California.
The last set of guidelines was issued in 2004. Lieberthal said those stimulated a lot of new research, which provided additional evidence for the current American Academy of Pediatrics (AAP) guidelines appearing in the March issue of Pediatrics.
Lieberthal said the biggest change in the new document is the definition of the diagnosis itself.
Pediatrician Dr. Roya Samuels, who has reviewed the new guidelines, agreed. "The definition is more clear-cut, more precise," she said. But, she added, "There's still no gold standard for diagnosis. There are different stages of [ear infections], and making the diagnosis can be tricky."
Because the diagnosis isn't always easy to make, the AAP offers detailed treatment suggestions, encouraging observation with close follow-up, but also leaves it up to the discretion of the doctor whether or not to prescribe antibiotics. If children who are being observed don't improve within 48 to 72 hours from when symptoms first began, the guidelines recommend beginning antibiotic therapy.
Previous guidelines recommended giving antibiotics for ear infections in children age 2 and under. The new guidelines suggest that children aged between 6 months and 23 months can be observed with close follow-up as long as they don't have severe symptoms.
Another key component of the new guidelines is pain management. "Antibiotics take 24 to 48 hours before they start to improve signs and symptoms, so if a child has fever or pain, it's important to place them on [pain-relieving or fever-reducing medications]," Samuels said.
The guidelines also confirm that amoxicillin should be the antibiotic of choice unless the child is allergic to penicillin, or if the child has been treated with amoxicillin during the past month.
The new guidance from the AAP also states that children, even those with recurrent infections, shouldn't be on long-term daily antibiotics to try to prevent infections from occurring.
Scientists Pinpoint How Deep Brain Stimulation Eases OCD
By Amanda Gardner
HealthDay ReporterSUNDAY, Feb. 24 (HealthDay News) -- Deep brain stimulation has helped people with severe obsessive-compulsive disorder, and new research begins to explain why.
A Dutch study appearing in the Feb. 24 online issue of the journal Nature Neuroscience found the procedure essentially restored normal function in a part of the brain called the nucleus accumbens.
The nucleus accumbens "is part of a greater brain network," explained study author Dr. Martijn Figee. "This network is involved in motivation and the processing of rewards, and its activity is disturbed in [obsessive-compulsive disorder], probably explaining why [patients] are stuck in pathological behaviors at the cost of healthy ones."
So, obsessive-compulsive disorder (OCD) is essentially the result of faulty wiring in the brain.
It's not so much a disorder of a specific part of the brain than it is a "disorder of neurocircuitry," explained Dr. Brian Snyder, director of functional and restorative neurosurgery at Winthrop University Hospital in Mineola, N.Y.
About 1 percent of U.S. adults suffer from the condition, which involves unwanted, intrusive thoughts or obsessions that then spur compulsive behavior.
While a person without OCD might momentarily worry that he or she has forgotten to lock the door, that thought is quickly balanced by the realization that, yes, the door has indeed been locked.
For a person with OCD, on the other hand, the thought that the door is unlocked will recur and fall into a repetitive pattern of thinking (obsession) and checking to make sure the door is locked (compulsion).
Dr. Wayne Goodman, professor and chair of psychiatry at Mount Sinai Hospital in New York City described OCD as a kind of "reverberating circuit."
Deep brain stimulation (DBS), which is widely used for severe Parkinson's and experimentally to treat major depression, has limited approval in the United States to treat OCD that hasn't responded to other treatments.
But experts haven't been sure why the procedure worked.
This study involved 16 patients with OCD and 13 healthy controls, all of whom had electrodes implanted in the nucleus accumbens area of the brain. They then underwent functional MRI brain scans while performing a task that involved the anticipation of reward (the type of activity that might trigger OCD).
OCD symptoms improved an average of 50 percent while brain activity -- not only in the nucleus accumbens but also in a larger brain network -- was normalized, said Figee, who is a psychiatrist with the DBS psychiatry department at Academic Medical Center in Amsterdam, the Netherlands.
"This may explain why patients with DBS experience very fast changes in a wide array of motivational and behavioral problems," he added. "This is clinically important because it indicates that DBS could also help for other disorders that have similar network disturbances, like addiction or eating disorders."
Sibling's Death May Boost Your Own Risk of Dying From Heart Attack: Study
By Steven Reinberg
HealthDay ReporterWEDNESDAY, Feb. 27 (HealthDay News) -- When a brother or sister dies -- especially from a heart attack -- the risk of a surviving sibling also dying from a heart attack increases sharply in the following years, a large new study from Sweden suggests.
Chronic stress or lifestyle choices like drinking, smoking, unhealthy diet and lack of exercise may follow the loss of a sibling, increasing the risk of a heart attack over time, the researchers said.
"Health care providers should follow bereaved siblings to help recognize signs of acute or chronic psychosocial stress mechanisms that could lead to heart attack," said lead researcher Mikael Rostila, an associate professor at Stockholm University and the Karolinska Institute.
"We might be able to prevent heart attacks and other heart-related conditions by treating these siblings early on and recommending stress management," he added.
Reasons for the association between a sibling's death and the death of a brother or sister years later aren't clear, Rostila noted. And although the study showed an association between a sibling's heart attack death and heightened death risk, it did not establish a cause-and-effect relationship.
"More detailed information from medical records, shared childhood social environment and family characteristics, and data on personal and relational characteristics is needed to uncover the mechanisms causing the association between sibling death and heart attack," Rostila said.
The report was published in the Feb. 27 issue of the Journal of the American Heart Association.
To see the effect of a sibling's death on their other siblings, Rostila's team collected data on more than 1.6 million people in Sweden, aged 40 to 69.
They found the risk of dying from a heart attack increased 25 percent among surviving sisters and 15 percent among surviving brothers compared to people who had not lost a sibling. If their brother or sister died of a heart attack, risk of also dying from a heart attack in the following years increased by 62 percent among women and 98 percent among men, Rostila's team found.
Death from a heart attack was not likely to happen immediately after siblings died, the researchers said. Rather, the risk rose in the four to six years after a sibling's death among women and in the two to six years afterward among men, they found.
"This is a red flag for families," said Dr. Stephen Green, associate chairman of the department of cardiology at North Shore University Hospital, in Manhasset, N.Y. "We know that heart disease is genetic and environmental and typically siblings and family members share the same gene pool, but also share the same bad habits."
Many siblings whose brother or sister died from a heart attack have undiagnosed heart disease, Green said.
If you -- or someone you know -- has a family member with a history of heart disease or heart attack, or a family member who died from heart disease, it is important to talk with your primary care doctor or a cardiologist to make sure it doesn't happen to you, Green said.
More information
To learn more about heart attacks, visit the American Heart Association.
Healthy Older Women Advised Against Taking Calcium
By Barbara Bronson Gray
HealthDay ReporterMONDAY, Feb. 25 (HealthDay News) -- Healthy older women should not take calcium and vitamin D supplements to prevent fractures, according to a final recommendation issued Monday by the U.S. Preventive Services Task Force.
In healthy adults, lower doses of calcium and vitamin D seem to be ineffective. As for higher doses, it's still up in the air, the government group said.
The new recommendations do not apply to people who are known to be vitamin D-deficient or who already have osteoporosis, the U.S. Preventive Services Task Force (USPSTF) noted.
Every year about 1.5 million fractures in the United States are attributed to osteoporosis, which is caused by a decrease in bone mass and density that makes bones fragile and more susceptible to a break. Almost half of all women older than 50 will have an osteoporosis-related fracture in their lifetime, according to the USPSTF.
Calcium is one of the main building blocks of bone growth, and vitamin D (sourced via sunlight's action on the skin, or through diet) helps bones absorb calcium. But at issue is whether people receive enough of these nutrients in their daily diet, or if supplements would help protect them.
Dr. Virginia Moyer, chair of the USPSTF, and a professor of pediatrics at Baylor College of Medicine, said experts know that a "medium dose" of supplements -- less than 400 international units (IU) of vitamin D and less than 1,000 milligrams (mg) of calcium -- does not work.
As for higher doses? "We simply don't know. There are reasons to think they could work, but unfortunately, even though there are a bunch of studies, there are problems with them," Moyer said.
"We know these recommendations will be very frustrating to both physicians and patients, but it's a call to action to the research community," she added.
The USPSTF analyzed a wide range of studies on the effects of supplementation of vitamin D and calcium levels for bone health and the adverse effects of supplementation. The report, published online Feb. 26 in the Annals of Internal Medicine, makes these points about preventing fractures:
Don't take low doses of daily supplements: Less than 400 IU of vitamin D and less than 1,000 mg of calcium after menopause have no benefit.For higher doses: The task force doesn't have sufficient evidence to make a recommendation on daily supplements.For men and women younger than 50: The task force also doesn't have enough evidence to make a recommendation on vitamin D and calcium supplements.The report notes a downside to low-dose supplementation: Taking 400 IU or less of vitamin D and 1,000 mg or less of calcium increases the risk of kidney stones, which can be painful and may require hospitalization.
Should I Get Allergy Shots?
Allergy shots don't cure allergies, but they should reduce your symptoms noticeably.
They are best if you have severe allergy symptoms or symptoms that last more than three months every year, says Michael Land, MD. They can also help people who can't take allergy medicines because of side effects or interactions with other medications.
The shots are a form immunotherapy, which retrains your immune system not to overreact to your allergy trigger. Each shot contains a little bit of your allergy trigger, and over time, the dose gets bigger, so that you slowly and safely become less sensitive to that trigger.
In the buildup phase, you'll get the shots once or twice a week for several months. Some people start to feel relief within the first few weeks, though it may take several months.
When you reach your maintenance dose, you'll get a shot every 2 to 4 weeks for 3 to 5 years. Eventually, you may not need the shots at all, unless you move to an area where the pollen is different.
In most cases, allergy shots don't cause side effects, other than redness and slight swelling near the injection site. Because there's a small chance that you could have an allergic reaction, you get allergy shots at a doctor's office and stay there for about 30 minutes afterward.
Newest Diabetes Drugs Linked to Higher Pancreatitis Risk
Title: Newest Diabetes Drugs Linked to Higher Pancreatitis Risk
Category: Health News
Created: 2/25/2013 4:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM
Category: Health News
Created: 2/25/2013 4:36:00 PM
Last Editorial Review: 2/26/2013 12:00:00 AM
Heart Failure Drug May Only Help Heart's Function, Not Symptoms
By Amy Norton
HealthDay ReporterTUESDAY, Feb. 26 (HealthDay News) -- A drug often used to treat chronic heart failure may not ease symptoms in people with one form of the disease, a new study suggests.
The medication, called spironolactone (Aldactone), failed to improve symptoms or quality of life among 422 patients with diastolic heart failure -- a form of the disease that affects about half of all people with heart failure.
The drug did, however, benefit the structure and function of patients' hearts. And experts said it's too early to know what to make of the results, which appear in the Feb. 27 issue of the Journal of the American Medical Association.
"It would be premature to say this is not beneficial," said Dr. Sanjiv Shah, a cardiologist at Northwestern University Feinberg School of Medicine, in Chicago, who was not involved in the study.
Shah is involved in an ongoing study of spironolactone's effects in people with diastolic heart failure. And that trial is focusing on the big questions: Can the drug prevent or delay hospitalizations, or prolong people's lives?
Spironolactone is in a class of drugs called aldosterone receptor antagonists. They cause the kidneys to eliminate excess water and sodium from the body, so they can lower blood pressure and get rid of fluid build-up in some people with heart failure.
And studies have shown that spironolactone can extend the lives of some heart failure patients -- namely, those with a low "ejection fraction." That means the percentage of blood pushed out by the heart with each contraction is abnormally low.
The problem is that heart failure is "heterogeneous," according to Shah, who described it as a "syndrome" -- or a collection of signs and symptoms -- rather than a disease. So a treatment that works for some patients may not work as well for others.
In general, heart failure is a chronic condition where the heart does not pump blood efficiently enough to meet the body's needs. That causes symptoms such as fatigue, breathlessness and fluid build-up in the legs and feet.
In systolic heart failure, the heart's left ventricle (the main pumping chamber) cannot contract strongly enough, and many people with this form of heart failure have a reduced ejection fraction.
In the diastolic form, the left ventricle doesn't relax enough between contractions, which means it cannot fill up with as much blood as it should. But the heart's ejection fraction is actually normal.
Diastolic heart failure is trickier to diagnose, and doctors know less about how to best treat it, said Dr. John Cleland, a cardiologist at Hull York Medical School in Kingston-upon-Hull, England, who co-wrote an editorial published with the study.
He agreed that it's too soon to draw conclusions from the current findings, and that doctors will know more when Shah's study results are in.
Subscribe to:
Posts (Atom)