There Is No Safer Football Helmet for Kids: Study

By Dennis Thompson
HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- High-tech helmets and custom mouth guards do not reduce concussion risk for high school football players any more effectively than low-cost helmets or off-the-shelf mouth guards, a new study says.

Neither specific brands nor higher-cost protective gear resulted in fewer concussions among more than 1,300 football players at 36 high schools during the 2012 season, according to a study scheduled for presentation Monday at an American Academy of Pediatrics (AAP) meeting in Orlando, Fla.

"We're certainly not saying that helmets and mouth guards aren't important. They do what they are supposed to do. Mouth guards prevent dental injuries, and helmets prevent skull fractures and scalp and face lacerations," said Dr. Margaret Alison Brooks, the study's lead co-investigator. "But I don't think the manufacturing companies have the data to support [the claim that] if a parent buys a specific model, their child will have a reduced risk of concussion."

About 40,000 sports-related concussions occur in United States high schools every year, the researchers said.

Many manufacturers of football helmets and mouth guards cite laboratory research that their pricey equipment will better cushion impact and reduce players' risk of concussion, said Brooks, an assistant professor of orthopedics and rehabilitation at the University of Wisconsin.

"We were interested in whether we can support the manufacturer claims that more expensive, newer, fancier football helmets really reduce the risk of concussion," she said.

Players involved in the study completed a preseason questionnaire listing their personal statistics and previous injuries. Athletic trainers took notes on all concussions that occurred throughout the year.

The players wore helmets manufactured by three companies: Riddell (52 percent), Schutt (35 percent) and Xenith (13 percent). About 75 percent of helmets were relatively new, having been purchased since 2009.

The study also noted which mouth guards players wore. About 60 percent of players wore generic models provided by schools, while the rest wore models custom-fitted by dental professionals or specifically marketed to reduce the risk of concussions.

During the 2012 season, 115 players sustained a concussion -- about 8.5 percent of all players in the study, the researchers said.

The concussion rate did not vary among players based on the type of helmet worn or the age of the helmet. The helmet brand also made no difference in the severity of concussions, which was measured by the number of days lost from play due to concussion.

"As long as the helmet their child is wearing is in good condition, is properly fit and is worn correctly, then the parent shouldn't feel bad if their child is not in a $400 or $500 helmet," Brooks said.

Players with custom-fitted mouth guards actually suffered a higher concussion rate than those who used generic models.

The realities of both physics and human anatomy make it unlikely that any helmet could better reduce the chances of concussion, Brooks said.

"There's a lot of debate regarding whether you can create a helmet that could reduce concussion risk, given the structure of the skull," she said. "The brain isn't attached to the skull. It's floating freely in spinal fluid. You can dissipate the force of something striking the skull, but you can't reduce the forces that make the brain bounce back and forth inside the skull following impact."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Dr. Margot Putukian, director of athletic medicine at Princeton University, said the new study adds further evidence to the questionable ability of helmets to prevent concussions.

"I think the companies are well-meaning and they are trying to develop technology that might reduce impact, but we're not seeing their efforts translate into a reduction in concussion," said Putukian, who was not involved with the study. "There is risk in sports that can't be completely negated by equipment."

Coaches and officials would have a better chance of reducing concussions if they limited contact during practice and taught athletes the proper technique for tackling, study author Brooks said.

"I personally don't have a problem with more emphasis on enforcing rules that limit contact with the head," she said. "You shouldn't be leading with your head. You shouldn't be tackling with your head. We should be teaching kids that the head should not be the leading point of contact."

On Sunday, the AAP released a new report with guidance for pediatricians caring for children and teens who suffer concussions.

The medical group outlined how long kids should stay home after concussions, depending on symptom severity, and recommended using a symptoms checklist. The AAP recommended a collaborative team approach, including the player's pediatrician, family members and certain school staff members.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Dr. Margaret Alison Brooks, assistant professor of orthopedics and rehabilitation, University of Wisconsin, Madison; Dr. Margot Putukian, director of athletic medicine, Princeton University, Princeton, N.J.; Oct. 27 and 28, 2013, presentations, American Academy of Pediatrics meeting, Orlando, Fla.

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Study of Male Birth Defect Lets Pesticides Off the Hook -- for Now

MONDAY, Oct. 28 (HealthDay News) -- Only a weak link exists between pesticide exposure and a common birth defect in baby boys, according to a new study.

Researchers examined the association between hundreds of chemicals used in commercial pesticides and a birth defect called hypospadias, in which the urethral opening on the penis is on the underside rather than on the tip.

This birth defect occurs in about five of every 1,000 male infants, and the cause is usually unknown. Some studies have suggested a slightly increased risk for infants whose parents work around pesticides, but many have found no such link.

"We didn't see many chemicals that suggested an increased risk, and of those that did, most of them were infrequently used," study lead author Suzan Carmichael, an associate professor of pediatrics at Stanford University, said in a university news release.

"It is good news that such exposures are rare, but at the same time, when exposures are rare, it makes studies harder to do," she said.

In the study, researchers compared data from 690 male infants born with hypospadias and nearly 2,200 male infants who did not have the birth defect. The infants were born in California's Central Valley, which has one of the highest rates of pesticide use in the nation, according to the study. The mothers of the children lived fairly close to where pesticides were used.

The researchers found that 15 chemicals used in pesticides had possible associations with hypospadias, but they said further research is needed, according to the study, which was published online Oct. 28 in the journal Pediatrics.

Study co-author Gary Shaw, a professor of pediatrics at Stanford, said the jury is still out on the possible association between pesticides and hypospadias.

"These results extend what we know, but at the end of the day they need to be replicated before we can really be sure whether there is or is not a real risk associated with these chemicals," Shaw said in the news release.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Stanford University, news release, Oct. 27, 2013

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Exercise May Make Life Better for Those With Arthritis

SATURDAY, Oct. 26 (HealthDay News) -- Regular exercise boosts quality of life and reduces health care costs for people with arthritis, a new study shows.

Researchers found that meeting national physical activity guidelines could add up to 20 days of good health in one year for these patients.

However, many Americans are not getting the recommended 150 minutes of moderate to vigorous activity a week, in bouts lasting at least 10 minutes each.

The findings were scheduled to be presented this week at the American College of Rheumatology annual meeting in San Diego.

"Regular physical activity improves health and reduces mortality in the general population. Furthermore, physical activity promotes arthritis-specific health benefits including improving symptoms, function and psychosocial outcomes, as well as reduced disability," study author Dr. Kai Sun, a medical resident and research trainee at Northwestern Feinberg School of Medicine in Chicago, said in a news release from the American College of Rheumatology.

"Despite these benefits," Sun noted, "the majority of adults in the U.S. do not attain the recommended amounts of physical activity."

One type of arthritis -- osteoarthritis -- which is most common among middle-aged or older adults, causes progressive damage to the cartilage, or cushioning at the end of long bones. This damage can lead to pain, swelling or limited movements around the joint.

Knee osteoarthritis is one form of the joint disease that may be worsened by excess weight. A person's age, certain injuries, stress on the joints and having a family history of the condition also increase people's risk for osteoarthritis.

Using results from a nationwide study sponsored by the U.S. National Institutes of Health, a team of researchers examined physical activity levels and the quality-adjusted life years (a standard measurement of quality of life and cost-effectiveness of medical treatment) of 4,700 adults diagnosed with or at risk for arthritis of the knee.

The researchers measured the physical activity levels of the participants for one week using a device called an accelerometer. They then divided the participants into three groups: One group included those who were meeting national physical activity guidelines; the second group included participants who were not active enough, but did engage in some moderate to vigorous activity; and the third group included those who were inactive.

The researchers measured the participants' physical activity level and quality-adjusted life years when the study began, and again two years later.

Over the course of the study period, the quality-adjusted life years of participants who met the guidelines for physical activity were higher than those who were somewhat active or inactive, the investigators found.

The difference translated into between 10 and 20 more days of good health in one year. The researchers noted that even if the national guidelines are not met, increasing physical activity in any way could enhance quality of life, add years of health and lower overall health care costs for people with arthritis.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American College of Rheumatology, news release, October 2013

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Certain Rheumatoid Arthritis Drugs May Also Protect Patients' Hearts, Studies Find

SATURDAY, Oct. 26 (HealthDay News) -- Drugs that people with rheumatoid arthritis use to help ease the symptoms of the disease might also help ward off heart trouble, two new studies find.

Researchers in Sweden found that so-called "biologic" drugs, known as tumor necrosis factor inhibitors, or anti-TNFs, slightly reduce the risk for acute coronary syndrome -- a condition that includes angina and heart attack in which blood supply to the heart muscle is suddenly blocked.

In another study, British scientists also found taking these drugs was associated with a lower risk for heart attack in patients with rheumatoid arthritis.

The findings were to be presented Saturday at the American College of Rheumatology's annual meeting in San Diego. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

The roughly 1.3 million Americans affected by the rheumatoid arthritis, a disease that occurs when the immune system mistakenly begins to attack the joints, often suffer from pain, stiffness, swelling, and have trouble moving and using many of their joints. The condition, which is twice as common among women, can also cause inflammation in the organs.

One expert said heart problems were also an issue for many patients.

"It has been known that patients with rheumatoid arthritis have a greater risk of developing heart disease than those without," said Dr. Kenneth Ong, acting chief of cardiology at The Brooklyn Hospital Center in New York City. "This risk seems to extend in many forms of cardiovascular disorders, among which the most notable is coronary artery disease, but also includes heart failure, peripheral artery disease and possibly stroke."

For the past decade, anti-TNF drugs have been used around the world to treat rheumatoid arthritis as well as other inflammatory conditions. These pricey medications -- prescribed under brand names such as Remicade, Enbrel, Humira, Cimzia and Simponi -- have been shown to reduce inflammation.

In the first study, the Swedish team compared rates of heart disease among patients with rheumatoid arthritis taking anti-TNFs with patients not using the drugs and people in the general population, to see if the medications could also cut the risk for heart issues.

The study involved a group of more than 7,700 patients in Sweden with rheumatoid arthritis who had never been diagnosed with heart disease. They began taking anti-TNFs between 2001 and 2010. Of this group, about 76 percent were women averaging about 57 years of age. The researchers compared these patients to a group of more than 23,000 similar people who also had rheumatoid arthritis but had never taken anti-TNFs, as well as a group of more than 38,500 similar people randomly selected from the general population in Sweden.

The researchers classified exposure to the drugs into three categories: those who were "actively" on the drugs; those with "short-term exposure" who took the medication for up to two years; and those who had "ever" taken the medication at some point.

The study revealed the prevalence of heart events was slightly lower among patients with rheumatoid arthritis who were actively taking anti-TNFs than people with rheumatoid arthritis who had never taken this type of medication. Patients actively taking anti-TNFs were 50 percent more likely to have angina or heart attacks than the general population, while patients who had never taken these medications were more than twice as likely to have these heart events.

After taking other factors into account, such as how long the patients had rheumatoid arthritis, other diseases affecting the patients and socio-economic status, the researchers found that patients actively on the drugs had a 27 percent lower risk for angina/heart attack than patients who had never taken such a drug.

"This nationwide study adds to the evidence that use of TNF inhibitors for rheumatoid arthritis also has an impact on cardiovascular [illness]," study author Dr. Lotta Ljung, a senior consultant in rheumatology at Umea University Hospital, said in a news release issued by the meeting organizers.

However, she stressed that it's not clear whether the drugs themselves caused the lowering of heart risks, or whether an easing of rheumatoid arthritis was the underlying cause of better heart health.

A second study conducted by researchers in the UK examined the effects of anti-TNF drugs on patients' risk for heart attacks. The researchers compared use of these drugs among patients with rheumatoid arthritis to patients taking more traditional drugs, known as non-biologic disease-modifying antirheumatic drugs (DMARDs).

Using The British Society for Rheumatology Biologics Register, which contains information compiled between 2001 and 2008 on more than 20,000 patients in the UK, the researchers examined the rate of heart attacks among nearly 14,300 people with rheumatoid arthritis. They also considered whether the severity of heart attacks was in any way affected by treatment with TNF inhibitors.

The researchers also used data from two previous British studies. One examined the safety of biologic drugs, the other examined heart attack-related hospitalizations in England and Wales.

"Better control of inflammation with biologic therapy might reduce not only the rate of heart attacks, but potentially also affect the size of [heart attacks]," reasoned study co-author Dr. William Dixon a rheumatologist with Arthritis Research UK's Epidemiology Unit at the University of Manchester.

The study showed that patients taking anti-TNF drugs were at lower risk for heart attack than patients taking traditional DMARDs. However, use of the biologic drugs did not affect the severity of heart attacks, the British team found.

In the news release, Dixon said that "rheumatologists can be reassured that treatment of active rheumatoid arthritis with anti-TNF therapy may lead not just to an improvement in joint symptoms, but also a reduction in the rate of [heart attacks] in the medium term."

His team pointed out, however, that patients with rheumatoid arthritis generally have an increased risk of heart attacks. So, even though anti-TNFs may help curb the risk for heart attacks they do not eliminate it. The U.K. group conclude that patients with rheumatoid arthritis who taking biologic drugs still need to take steps to cut their risk for heart disease.

One expert not connected to the studies agreed.

"Given that these studies demonstrate the increased risk of cardiovascular disease in rheumatoid arthritis, patients should try to mitigate other known cardiovascular risk factors by not smoking and maintaining a healthy diet and weight," said Dr. Diane Horowitz, a rheumatologist at North Shore University Hospital in Manhasset, N.Y., and Long Island Jewish Medical Center in New Hyde Park, N.Y.

For his part, Ong said it makes "sense that drugs that reduce inflammation in rheumatoid arthritis could reduce some of the risk of developing heart disease in these same patients."

But he added that the studies also raise intriguing questions, such as whether or not the heart-healthy benefits of anti-TNFs last beyond the time of treatment, whether the benefit extends equally to men and women and whether these results extend to patients who do not require hospitalization for heart issues.

Cost was another issue, Ong said. "Anti-TNF drugs are among the most expensive medications developed for the treatment of rheumatoid arthritis," he said. "I understand that it is not the first line of treatment for rheumatoid arthritis [but] if these initial results are verified by subsequent studies, the cost of treating rheumatoid arthritis may skyrocket."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Kenneth Ong, M.D, acting chief, cardiology, The Brooklyn Hospital Center, New York City; Diane Horowitz, M.D., rheumatologist, North Shore University Hospital, Manhasset, N.Y., and Long Island Jewish Medical Center, New Hyde Park, N.Y.; American College of Rheumatology, news release, 2013

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Study Links Americans' Low Fiber Intake to Higher Heart Risk

FRIDAY, Oct. 25 (HealthDay News) -- People who don't eat enough fiber seem at increased risk for heart problems, and too few Americans are consuming enough fiber, a new study says.

Researchers analyzed data collected from more than 23,000 U.S. adults between 1999 and 2010 and found that low fiber intake was strongly associated with heart disease risk factors such as obesity, inflammation and metabolic syndrome. The syndrome is a group of symptoms that puts people at increased risk for diabetes and heart disease.

Previous studies have found that dietary fiber may help lower blood pressure, cholesterol levels and inflammation. Despite those findings, this new study found that Americans don't have enough fiber in their diets.

Fiber-rich foods include fruits, vegetables, legumes and grains.

The Institute of Medicine -- an independent nonprofit organization that advises the U.S. government on health issues -- recommends 38 grams of fiber a day for men aged 19 to 50 and 30 grams a day for men over 50. The IOM recommends 25 grams a day for women aged 19 to 50 and 21 grams a day for women over 50.

But the average dietary fiber intake among the study participants was only about 16 grams per day, according to the study, which was published in the December issue of the American Journal of Medicine.

The new findings show the need to develop new strategies and polices to increase Americans' dietary fiber intake, study senior investigator Dr. Cheryl Clark, of the Center for Community Health and Health Equity at Brigham and Women's Hospital and Harvard Medical School, said in a journal news release.

The researchers also found racial and ethnic differences. Compared to whites, Mexican-Americans had higher levels of fiber in their diet, while blacks had lower levels.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: The American Journal of Medicine, Oct. 18, 2013

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Fibromyalgia Might Be Harder on Younger Patients, Study Finds

SATURDAY, Oct. 26 (HealthDay News) -- Young and middle-aged fibromyalgia patients report worse symptoms and poorer quality of life than older patients, a new study reveals.

Fibromyalgia is characterized by symptoms such as musculoskeletal pain and tenderness, fatigue, and sleep and memory problems. The disorder, which most often affects women, has no known causes and few effective treatments.

The study included 978 fibromyalgia patients who were divided into three age groups: 39 and younger, 50 to 59, and 60 and older. The younger and middle-aged patients were more likely to be employed, unmarried, smokers, have a higher education level and lower body-mass index (BMI), a measure of body fat that takes height and weight into account.

They were also more likely to have a history of abuse and to have had fibromyalgia symptoms for a shorter length of time than older patients, the study authors said.

"Among the three age groups of young, middle-aged and older, symptom severity and quality of life differs," study senior author Dr. Terry Oh, a physical medicine and rehabilitation physician at the Mayo Clinic in Rochester, Minn., said in a clinic news release.

The findings were surprising, because older people generally have poorer quality of life and physical health than younger people, Oh said.

The researcher noted that female fibromyalgia patients in all three age groups reported a lower quality of life than average U.S. women, and that the difference between their physical health and that of the average woman was more significant than mental health differences, particularly in young patients.

The study was to be presented this week at the American College of Rheumatology annual meeting, in San Diego.

In other Mayo studies presented at the meeting, researchers found that about 7 percent of fibromyalgia patients have inflammatory rheumatic conditions and that these patients don't respond as well to treatment as those without rheumatic diseases, and that fibromyalgia patients may also have skin-related symptoms such as excessive sweating, burning and other sensations.

Because the studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Mayo Clinic, news release, Oct. 26, 2013

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Good News for Caregivers: You May Live Longer

By Maureen Salamon
HealthDay Reporter

FRIDAY, Oct. 25 (HealthDay News) -- Conflicting with mounds of previous findings, new research suggests that family caregivers actually live slightly longer than non-caregivers.

The study found that caregivers assisting chronically ill or disabled family members had an 18 percent lower death rate than similar people who were non-caregivers, which translated to a nine-month extension in life expectancy over the six-year study period.

However, the research did not delve into the types of tasks caregivers provided, and the study authors said the analysis could not rule out the possibility that some groups of caregivers -- especially those immersed in highly stressful caregiving scenarios -- might be more vulnerable to higher death risks.

"People should feel encouraged and empowered to be caregivers for their families," said study first author David Roth, director of the Johns Hopkins University Center on Aging and Health, in Baltimore. "Some previous [research] literature may have oversold the scary or stressful aspects of it. Other studies suggest that it's not so much the caregiving [that is linked to earlier death], but the distress caregivers feel when they have a loved one who is ill or in pain."

The study, funded by the U.S. National Institute of Neurological Disorders and Stroke and the U.S. Department of Health and Human Services, was published online recently in the American Journal of Epidemiology.

More than 34 million unpaid caregivers provide care to an adult who is ill or has a disability, according to the U.S. Centers for Disease Control and Prevention. About 83 percent are family caregivers, unpaid individuals providing care for a relative.

Roth and his team analyzed information originally gathered for a larger study on the excess stroke risk among black people aged 45 and up living in the nation's "stroke belt" in the Southeast. Roth and his colleagues examined whether 3,500 family caregivers from that study exhibited differences in death rates over six years compared to the same number of non-caregivers who were matched on demographics, health history, health behavior and a dozen other common variables.

The survival benefit found among caregivers was consistent among all subgroups -- even spouse caregivers, who have been particularly singled out in prior research as having elevated death risks.

Roth said that the notion of caregiving conferring health benefits is logical when caregiving is done willingly and at manageable levels for individuals who are capable of expressing gratitude for the care.

"I think most of the [scientific] literature that finds caregiving to be very bad for health is for dementia patients, and a lot of times, spouses," he said, adding that his research was population-based instead of focusing on specific groups. While Roth's study linked caregiving to lower death rates, it did not prove a cause-and-effect relationship.

Kathleen Kelly, executive director of the National Center on Caregiving and the Family Caregiver Alliance, said she agrees that many positive aspects of caregiving can translate into health effects.

"I'm not surprised by the findings on the positive side of the ledger, so to speak, because I do think there's satisfaction for caregivers who provide assistance to their relatives," she said. "It ties into reciprocity and responsibility. Also, depending on the age of the caregiver, they may have a high degree of purpose and connectedness in their activities. All of this could lead to a higher degree of health because you're active and engaged."

Kelly cautioned, however, that the health effects of caregiving may change drastically when the person being cared for has a condition requiring constant care, such as dementia, and cannot express gratitude to caregivers.

"The role is really murky once you're providing personal care, like in the bathroom," she said. "When you're talking about heavy-duty medical care, it really does change. The study makes a lot of really interesting points, but we also need to take into consideration folks dealing with very difficult and demanding 24/7 kinds of scenarios."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: David L. Roth, Ph.D., director, Johns Hopkins Center on Aging and Health, Baltimore; Kathleen Kelly, executive director, National Center on Caregiving, Family Caregiver Alliance, San Francisco,; Oct. 3, 2013, American Journal of Epidemiology, online

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Are Today's Artsy Kids Tomorrow's Business Leaders?

FRIDAY, Oct. 25 (HealthDay News) -- Children who participate in arts and crafts seem more likely to be inventors or start businesses when they're adults, according to a new study.

Michigan State University researchers looked at the university's Honors College graduates from 1990 to 1995 who majored in science, technology, engineering or mathematics and found that those who owned businesses or patents received up to eight times more exposure to the arts during childhood (until age 14) than people in the general public.

"The most interesting finding was the importance of sustained participation in those activities," Rex LaMore, director of MSU's Center for Community and Economic Development, said in a university news release. "If you started as a young child and continued in your adult years, you're more likely to be an inventor as measured by the number of patents generated, businesses formed or articles published. And that was something we were surprised to discover."

Music training appeared especially important. The researchers found that 93 percent of the graduates in the study reported musical training at some point in their lives, compared with 34 percent of adults in the general population. The graduates also had higher-than-average involvement in the visual arts, acting, dance and creative writing, according to the study recently published in the Economic Development Quarterly.

The researchers also found that those who were exposed to metal work and electronics during childhood were 42 percent more likely to own a patent, while those exposed to photography during childhood were 30 percent more likely to have a patent. Those exposed to architecture during childhood were 87.5 percent more likely to form a company.

An arts and crafts background can stimulate creative thinking that can help solve complex problems, according to the researchers, who said their findings could prove valuable in helping to rebuild the U.S. economy.

"Inventors are more likely to create high-growth, high-paying jobs in our state, and that's the kind of target we think we should be looking for," LaMore said. "So we better think about how we support artistic capacity, as well as science and math activity, so that we have these outcomes."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Michigan State University, news release, Oct. 23, 2013

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Antibiotic-Resistant Infections Up Among Hospitalized Kids: Study

SATURDAY, Oct. 26 (HealthDay News) -- Hospitalized children are developing antibiotic-resistant staph infections of their musculoskeletal systems in rising numbers, resulting in longer hospital stays, more surgeries and other related complications, a new study finds.

The researchers looked at the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) musculoskeletal infections at a large U.S. children's hospital between 2001 and 2010.

"Methicillin-sensitive" means an infection does respond to treatment by the antibiotic.

During the study decade, there were 111 MSSA and 37 MRSA cases. The proportion of MRSA cases rose from 9 percent in 2001 to 29 percent in 2010, a threefold increase. Compared to those with MSSA, kids with MRSA had longer hospital stays (13 days versus 8 days) and were more likely to have multiple surgeries (38 percent versus 15 percent).

Children with the antibiotic-resistant infections were also more likely to have complications such as blood clots, septic shock, recurrent infection and cell death (22 percent versus 6 percent), according to the study presented Saturday at the American Academy of Pediatrics national conference, in Orlando, Fla.

"As MRSA infections rise, prompt recognition and aggressive treatment of MRSA musculoskeletal infections are critical to avoiding life-threatening complications, and improving patient outcomes," study lead author Eric Sarkissian said in an academy news release.

"Our findings support prior concern about the increased virulence of MRSA compared to MSSA infections," Sarkissian said. "Optimizing patient outcomes will require increased health-care provider vigilance, early broad-spectrum antibiotic administration and aggressive surgical management."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Academy of Pediatrics, news release, Oct. 26, 2013

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Current Colon Cancer Screening Guidelines Might Miss Some Patients

FRIDAY, Oct. 25 (HealthDay News) -- Current U.S. colon cancer screening guidelines may result in 10 percent of colon cancers being missed in people with a family history of colon polyps that can lead to cancer, a new study suggests.

"The biggest surprise was the percentage of missed cancers under the current guidelines. We figured there would be a few percent, but 10 percent is a large number," study author Dr. N. Jewel Samadder, of the Huntsman Cancer Institute at the University of Utah, said in a university news release.

Colorectal cancer is the third most common cancer in the United States and the second deadliest.

Samadder's team looked at data from nearly 127,000 people, aged 50- to 80, who underwent colonoscopy in Utah between 1995 and 2009. They found that first-degree relatives -- parents, siblings, children -- of people with adenomas (polyps linked to cancer) or advanced adenomas had a 35 percent to 70 percent increased risk of developing colon cancer than relatives of patients without these growths.

Second-degree relatives (aunts, uncles, grandparents) and third-degree relatives (cousins, nieces, nephews, great-grandparents) of people with adenomas were also at increased risk for colon cancer, according to the study published online Oct. 25 in the journal Cancer.

"We expected to see increased risk in first-degree relatives, but we weren't sure the risk would also be higher for more distant relatives in multiple generations," Samadder said.

Current national guidelines for colon cancer screening recommend colonoscopy every 10 years starting at age 50 for the general population. But first-degree relatives of people diagnosed with either colorectal cancer or advanced adenomas before age 60 should have a colonoscopy every five years beginning at age 40, according to the guidelines.

However, screening recommendations for second- and third-degree relatives of people diagnosed before age 60 are the same as for the general public.

So, the new findings "raise the issue of whether some level of more aggressive screening should be considered, not only for first-degree relatives of patients with polyps diagnosed at or below age 60, but also for those first-degree relatives of patients diagnosed above age 60," Samadder said.

One expert not connected to the study said the findings may be important, but it's often difficult to assess a patient's family history when it comes to colon cancer.

"This information is important not only to specialists who treat colon and rectal and cancer but all primary care providers who recommend screening programs for their patients," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount KIsco, NY.

However, he added that, "It will be difficult to apply this information in everyday clinical practice. I regularly see patients who know their relatives have had surgery for cancer don't know the type. Finding out if their relatives have had adenomas or advanced adenomas will be very difficult. This will be further complicated as we seek information about second or third degree relatives."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jerald Wishner, M.D., director, colorectal surgery, Northern Westchester Hospital, Mount Kisco, N.Y; University of Utah, news release, Oct. 22, 2013

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Study Ties Y Chromosome Variations to Prostate Cancer Risk

FRIDAY, Oct. 25 (HealthDay News) -- Men with certain inherited variations in their Y chromosome may have a higher risk of prostate cancer, according to a large new study.

Researchers from the University of Utah School of Medicine said the identification of these genetic mutations could help scientists develop tests to determine men's risk for developing the disease and also improve prostate cancer treatments.

In conducting the study, the researchers used the Utah Population Database, which dates back to the 1800s and identifies more than 6.5 million people, spanning 15 generations. The study was narrowed down to 1.25 million men who had at least two parents, four grandparents and six or eight great-grandparents also in the database.

All of the men who did not have a father in the database were labeled as "founders" and assigned a specific Y chromosome identification (YID). Founders' sons, grandsons and great-grandsons also were assigned the same YID. Of these groups, nearly 260,000 had at least two men sharing the same Y chromosome.

The men's genealogical and medical records also were linked to the Utah Cancer Registry, enabling the researchers to determine which of the men developed prostate cancer.

The researchers said that since most of the Y chromosome does not recombine during cell division, it is passed almost entirely unchanged from father to son.

"As a result, each male resident of Utah shares the Y chromosome of his father and his father's father and so on," study leader Lisa Cannon-Albright said in a news release from the American Society of Human Genetics.

"This provided the ability to estimate the risk for prostate cancer in independent Y chromosomes represented in Utah," said Cannon-Albright, chief of the genetic epidemiology division at the University of Utah School of Medicine.

Once the researchers estimated the number of prostate cancer cases expected to occur in each YID group, they compared this estimate to the actual number of prostate cancers.

Focusing on 1,000 YID groups that included between about 200 and 2,300 men, the study revealed the prostate cancer incidence was significantly higher than expected in 73 specific Y chromosome groups.

The researchers said that in one YID group of nearly 9,800 men, they predicted that about 45 prostate cancer cases would have occurred. When they compared their estimate to the state's cancer registry, they found that 65 men in the group had actually been diagnosed with prostate cancer.

A separate group of about 500 men revealed that 26 had prostate cancer. The researchers had estimated, however, that about 10 cases would develop among this group.

Among the men who did not share the Y chromosome of the founder, 39 developed prostate cancer. This rate was not statistically different from the 36 cases of the disease predicted by the researchers, who concluded that there is a Y chromosome-linked risk for prostate cancer that is not seen among men who do not share a common Y chromosome.

The study findings were scheduled for presentation Friday at the American Society of Human Genetics meeting, in Boston. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Society of Human Genetics, news release, Oct. 25, 2013

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Flu Can Kill Even Healthy Children, Study Finds

By Steven Reinberg
HealthDay Reporter

MONDAY, Oct. 28 (HealthDay News) -- Children, even those without severe medical conditions, can die from the flu in as little as three days after symptoms appear, U.S. health officials warn.

Between 2004 and 2012, flu complications killed 830 children in the United States, many of whom were otherwise healthy, according to the U.S. Centers for Disease Control and Prevention.

Most striking is that 35 percent of these children died before being hospitalized or within the first three days of developing symptoms, according to the report published online Oct. 28 in Pediatrics.

"We found these influenza-related deaths can occur in children with and without medical conditions and in children of all ages, and that very few of these children have been vaccinated," said lead author Dr. Karen Wong, a CDC medical epidemiologist.

Researchers who reviewed those deaths found that only 22 percent with a high-risk medical condition and just 9 percent without a significant medical condition had been vaccinated.

Wong doesn't know why so many children die so fast. "About a third of these children die within the first three days of their first reported symptoms," she said.

One expert wasn't surprised that many otherwise healthy children who died did so before being admitted to the hospital.

"First, parents don't realize that flu can be fatal," said Dr. Marcelo Laufer, a pediatric infectious diseases specialist at Miami Children's Hospital.

Second, parents of children with chronic diseases "know the system better, so they come earlier than healthy patients," he said.

Because flu can progress so quickly, prevention is really the best strategy, Wong said. "And that's why we recommend every child 6 months or older get vaccinated every year," she said.

Because an infant under 6 months of age can't be given flu vaccine, Wong said it is vital that pregnant women get a flu shot to help protect their newborn, and that everyone likely to be near the baby also be vaccinated so they can't pass flu to the infant.

Wong said children who get the flu need to be watched carefully. She recommends getting in touch with the child's doctor when symptoms start.

"That's especially true for kids with high-risk medical conditions and for very young children," she explained. "These children are at especially high risk for flu complications."

Laufer, however, said a phone call to the doctor isn't enough. "It's very difficult for a pediatrician on the other side of the phone to understand how sick the child really is," he said.

Parents should take their child to the doctor or emergency department if they're sicker than what one would expect with a common cold, he said.

"Parents should realize that influenza is much more than sniffles," Laufer added. "A kid with influenza is a kid who is very sick, is a kid who is lethargic, has decreased appetite, is not drinking as much and not urinating as much in addition to other flu symptoms," he said.

Wong added that early antiviral treatment is recommended for high-risk children who develop symptoms of influenza. "That's another thing they can talk to their health care provider about," Wong added.

Antiviral drugs include Tamiflu, Relenza, Symmetrel and Flumadine.

In the study, Wong's group found that of the 794 children whose medical history was known, 43 percent had no medical condition that put them at high risk of dying from flu.

As for children with high-risk medical conditions who died, 33 percent had neurological conditions such as cerebral palsy or seizure disorder, and 12 percent had a genetic condition that put them at risk for flu complications.

Asthma, lung disease, heart disease and cancer can also increase a child's odds of dying from flu, the researchers noted.

Each year in the United States, flu causes an estimated 54,000 to 430,000 hospitalizations and 3,000 to 49,000 deaths, with infection rates highest among children, according to the CDC.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Karen Wong, M.D., M.P.H., medical epidemiologist, U.S. Centers for Disease Control and Prevention; Marcelo Laufer, M.D., pediatric infectious diseases specialist, Miami Children's Hospital; November 2013, Pediatrics

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Health Tip: Participating in Pulmonary Rehabilitation

(HealthDay News) -- Exercise is a challenge when you have difficulty breathing. Pulmonary rehabilitation -- rehab for your lungs -- can help you breathe a little easier.

The American Council on Exercise says most pulmonary rehabilitation programs involve:

Participating in cardiovascular, flexibility and strengthening exercises.Exercising under the supervision of trained professionals.Monitoring symptoms and medication changes to make sure you exercise safely and effectively.Learning about breathing techniques, managing symptoms and medications.Getting social support from others with lung conditions.

-- Diana Kohnle
Copyright © 2013 HealthDay. All rights reserved.

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Brain-Imaging Drug Approved for Alzheimer's Detection

FRIDAY, Oct. 25 (HealthDay News) -- Vizamyl (flutemetamol F 18 injection) has been approved by the U.S. Food and Drug Administration for use with positron emission tomography (PET) imaging of the brain to screen adults for signs of Alzheimer's disease and other forms of dementia.

Dementia -- characterized by deteriorating memory, judgment, language and motor skills -- has been associated with brain accumulation of a protein called beta amyloid. Vizamyl, combined with a PET scan, can help doctors detect this protein, the FDA said Friday in a news release.

Vizamel, the second diagnostic drug approved for this purpose, was evaluated in clinical studies of 761 people. The injected drug is not meant to predict whether a person will go on to develop Alzheimer's or other types of dementia, or to evaluate how people may respond to dementia therapies, the FDA warned.

Potential side effects of the drug include allergic-like reaction, becoming flushed, headache, a rise in blood pressure, nausea and dizziness, the agency said.

Vizamyl is produced for GE Healthcare by Medi-Physics Inc., based in Arlington Heights, Ill.

-- Scott Roberts
Copyright © 2013 HealthDay. All rights reserved.

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After Breast Cancer Surgery, Patient Assistance Programs Can Help

FRIDAY, Oct. 25 (HealthDay News) -- Patient assistance programs make it more likely that breast cancer patients will get additional treatments after they have surgery, and receive other kinds of support, a new study finds.

These recommended additional -- or "adjuvant" -- therapies include radiation, chemotherapy and hormonal treatments.

"Doctors have been frustrated by data showing that perhaps as many as 20 percent of women with breast cancer -- especially black and Hispanic women -- do not take advantage of lifesaving adjuvant therapies," study author Dr. Nina Bickell, a professor of health evidence and policy and a professor of medicine at Mount Sinai Hospital, in New York City, said in a Mount Sinai news release.

"Some women lack critical information about the value of these treatments, while others need help dealing with the emotional aspects of breast cancer treatment, or with practical matters -- such as transportation, insurance or childcare -- before taking the next step," she said. "Fortunately, there are many high-quality patient assistance programs that can help women address these issues."

Bickell and her colleagues looked at 374 women with early stage breast cancer who had recently undergone surgery for their cancer. Nearly 80 percent of those who contacted a patient assistance program had some or all of their needs met, compared with 35 percent of those who did not connect with a program.

The programs were especially effective in meeting patients' needs for information about adjuvant treatment or counseling, according to the study recently published online in the Journal of Oncology Practice.

"We were delighted to discover that most of the women in our study who needed some type of assistance had a successful encounter with a patient assistance program and got the treatments they needed," Bickell said.

"Nevertheless, national statistics suggest that women in the U.S. continue to face economic and logistical barriers to getting adjuvant therapy for breast cancer," she added. "To ensure that patient assistance programs have the greatest impact on reducing national disparities in care, private philanthropies, which represent the biggest source of funding for these valuable programs, will be challenged to increase development in this area."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Mount Sinai Hospital, news release, Oct. 22, 2013

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Website Contractor to Lead HealthCare.gov Repair

By Karen Pallarito
HealthDay Reporter

FRIDAY, Oct. 25 (HealthDay News) -- The Obama administration on Friday said it has tapped one of its website contractors to manage the overall effort to fix HealthCare.gov., the new federal health insurance marketplace.

Quality Software Services Inc. (QSSI), a Columbia, Md.-based unit of UnitedHealth Group, will work through a "punch list" of problems identified in an assessment led by President Barack Obama's soon-to-be economic adviser Jeffrey Zients, according to the U.S. Centers for Medicare and Medicaid Services.

Zients, who is assisting in the effort to fix the troubled marketplace, said his team of private sector and government experts has identified a range of "performance problems" affecting the speed, response and reliability of HealthCare.gov, as well as "functional problems" resulting from bugs in the software.

Despite its troubled track record, "HealthCare.gov is fixable," Zients insisted during a Friday afternoon news conference.

The marketplaces -- or "exchanges" -- are the centerpiece of the Affordable Care Act, the Obama administration's controversial health care-reform package. The federal exchange is where uninsured Americans in 36 states may sign up for coverage.

In its new oversight role, QSSI will "prioritize the needed fixes and make sure they get done," Zients said.

"There will be a relentless focus on speed and execution to work through the punch list," he said. "Each week, the site will get better as we make the necessary fixes, and by the end of November HealthCare.gov will work smoothly for the vast majority of users."

QSSI is one of a number of vendors hired by the U.S. Centers for Medicaid and Medicaid Services to work on HealthCare.gov. Much of its work involved developing the so-called pipeline that transfers data between the marketplace and various data sources. The company also played a role in testing HealthCare.gov.

Terms of QSSI's new contract were not disclosed. Julie Bataille, director of the office of communications at the U.S. Centers for Medicare and Medicaid Services, said an existing contract with the company is currently being modified.

Nearly half of the 700,000 applications to state and federal marketplaces that have been filed to date have come through the federal marketplace, she said.

Separately, online data tracking service comScore reported on Thursday that traffic to HealthCare.gov "has steadily and dramatically declined" since a spike of 2.5 million unique visitors on Oct. 1.

Since Oct. 10, there have been no more than 500,000 unique visitors to the site each day, and the numbers continue to trend downward. However, the percentage of visitors to the site who successfully logged in jumped from 2 percent in the first week of open enrollment to 22 percent in the third week.

The company also noted an increase in the number of visitors successfully creating accounts and initiating applications.

"HealthCare.gov is allowing people now to complete the application and enrollment process," Bataille said. And as improvements are made each week, "People will be able to apply by December 15th in order to get coverage by January 1st."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Oct. 25, 2013, press briefing with Jeffrey Zients, special advisor, U.S. Department of Health and Human Services, and Julie Bataille, director, Office of Communications, Centers for Medicare and Medicaid Services; Oct. 24, 2013, web posting, comScore, Reston, Va.

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Many Lupus Patients Forgo Needed Medication, Study Finds

By Amy Norton
HealthDay Reporter

SATURDAY Oct. 26 (HealthDay News) -- Many poorer patients with the autoimmune disease lupus don't take their medications as prescribed, a new U.S. study suggests.

Researchers found that lupus patients on Medicaid -- the public health insurance program for the poor -- were often not sticking with their prescriptions. Over six months, patients picked up enough medication to cover only 31 percent to 57 percent of those days.

The findings are concerning, experts say, not only because lupus drugs can help send symptoms into remission, but because they may also stave off some of the long-term consequences of the disease.

"It's alarming," said lead researcher Dr. Jinoos Yazdany, of the University of California, San Francisco. "These medications have a proven track record of improving patients' outcomes."

The study used pharmacy claims data, so it's not possible to say why people were not taking their medication as prescribed, Yazdany said.

But money could be one factor. Medicaid covers the drugs, Yazdany noted, but even a small co-pay could be a barrier for low-income patients.

Drug side effects could be another issue, Yazdany said, as could a lack of education about the medications. "Some people may not be fully aware of the benefits of these drugs," she said.

Yazdany is scheduled to present the findings Saturday, at the American College of Rheumatology's annual meeting in San Diego.

The most common form of lupus is systemic lupus erythematosus (SLE). In SLE, the immune system attacks the body's own tissue, damaging the skin, joints, heart, lungs, kidneys and brain.

The disease mostly strikes women, usually starting in their 20s or 30s.

Lupus drugs include immune-system suppressors, such as cyclophosphamide (Cytoxan) and tacrolimus (Prograf), and anti-malaria drugs, such as hydroxychloroquine (Plaquenil), which can ease the fatigue, joint pain and skin rash seen in lupus.

Part of the goal is to control symptom flare-ups, including fatigue, fever, joint pain and skin rash. But the drugs can also reduce organ damage that can lead to kidney failure and heart disease.

The study included 23,187 Medicaid patients, mostly women, who were prescribed at least one drug for lupus. Yazdany's team used pharmacy claims to gauge whether patients were sticking with their prescribed regimen.

In general, patients lacked medication for a substantial proportion of the six months. But black, Hispanic and Native American patients were less compliant than white and Asian patients -- with only enough medication to cover a little more than half of the time period. And people living in the Midwest were less compliant than residents of other regions.

Overall, fewer than one-third of all patients had enough medication to cover at least 80 percent of the study period.

Dr. Cristina Drenkard, an assistant professor at Emory School of Medicine in Atlanta, said this finding is "very concerning."

Low-income minorities with lupus are known to fare worse than their white counterparts, and the reasons are probably many, noted Drenkard, whose research focuses on lupus. But it's likely that lesser adherence to drug regimens is one reason, she said.

Drenkard and her colleagues recently published a small study looking at whether a "self-management" program could help low-income black women with lupus. And they found that women who attended workshops at a public clinic were feeling better and doing a better job of taking their medication and generally managing their disease.

"We think self-management support like this is important for people with SLE," Drenkard said.

Still, a program like that would be only one part of the solution, these experts added.

"We need more research to understand what the barriers are to drug adherence, from the patient point of view," Yazdany said.

Another study to be reported at the same meeting underscores the importance of sticking with prescriptions. Researchers found that among more than 1,700 lupus patients in 11 countries, those taking anti-malaria drugs were less likely to show damage to their kidneys, heart or other organs over six years.

Do lupus patients with private insurance do a better job of sticking with their medications? It's not clear, said Yazdany. With Medicaid, there are state databases to comb through, but there is no similar way to study lupus patients with private insurance on a national level.

For now, Yazdany said it's important for all lupus patients to bring any medication concerns to their doctor. If side effects are an issue, she said, your doctor may be able to adjust the dose or switch the medication.

"We have more [drug] options available now than we used to," Yazdany said. "So there's a good chance that something else will work for you."

Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jinoos Yazdany, M.D., MPH, assistant professor, University of California, San Francisco; Cristina Drenkard, M.D., Ph.D., assistant professor, medicine, Emory School of Medicine, Atlanta; Oct. 26, 2013, presentation, American College of Rheumatology annual meeting, San Diego

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Moms With Lupus More Likely to Have Children With Autism, Study Suggests

By Serena Gordon
HealthDay Reporter

SATURDAY, Oct. 26 (HealthDay News) -- Women with lupus are twice as likely to have a child with autism compared to mothers without the autoimmune disease, new, preliminary research finds.

However, the overall risk is still low and the findings won't change the management of women with lupus, said one expert.

"I wouldn't tell my lupus patients not to get pregnant," Dr. Yousaf Ali, acting chief of rheumatology at Mount Sinai Hospital in New York City.

The study was undertaken to follow up on earlier, small reports that found that women with systemic lupus erythematosus (SLE) -- the most common form of the disease -- may have an excess risk of having children with an autism spectrum disorder, said lead investigator Dr. Evelyne Vinet, an assistant professor in the rheumatology department at McGill University Health Center in Montreal.

"We identified all women with systemic lupus erythematosus in a Quebec database and matched them to women who didn't have SLE, and we were able to see how many of their children were diagnosed with an autism spectrum disorder," Vinet said.

About 1.4 percent of children born to women with lupus were diagnosed with an autism spectrum disorder, compared to 0.6 percent of children born to women without lupus, the study found. It's important to note that while this study found an association between lupus in women and autism in their children, it wasn't designed to prove that the mother's lupus caused the autism.

Vinet is scheduled to present the findings Saturday at the American College of Rheumatology annual meeting in San Diego.

In lupus, as with other autoimmune disorders, the body's own immune system mistakenly attacks and destroys healthy cells, damaging the skin, joints and other organs. In some cases, the brain and nervous system are affected.

Autism spectrum disorders include a group of neurodevelopmental disabilities that can range from mild, as in Asperger's syndrome, to full-blown autism. Children with autism display social problems, communication difficulties and restricted, repetitive patterns of behavior.

Vinet said research done in mice has suggested that the rogue immune system cells that account for a mother's lupus may react with cells in the brains of her offspring.

The new study included 509 women with lupus who had 719 children and, for comparison, a group of nearly 5,900 women without lupus who had about 8,500 children.

In addition to finding that the incidence of autism disorders was doubled for children of women with lupus, the researchers also found that the autism diagnosis occurred earlier in children whose mothers had lupus. The average age was 3.8 years for children of women with lupus compared to 5.7 years for children of women without lupus.

Vinet said it's not clear why children of women with lupus would be diagnosed sooner. But the researchers hypothesize that the autism in these children may be more severe, or it may simply be that women with lupus are more vigilant about any changes in their children's health.

The researchers also controlled the data to see if pregnancy complications, such as preterm birth, gestational diabetes or being born small for gestational age, would affect the rate of autism in the children. After controlling for these factors, they found the risk of autism was slightly more than twofold for the children of women with lupus.

Ali said it would be important for these findings to be replicated in another study.

The findings shouldn't alarm women with lupus who want to become mothers, he noted.

"Lupus is a disease of young women of childbearing age, and the absolute risk of having children with an autism spectrum disorder is very small," Ali said.

Women who want to start a family should see their doctors ahead of time so they can switch medications before pregnancy if necessary (some aren't considered safe for pregnancy), Ali and Vinet said. They should also wait until their disease has been quiet for at least six months before conceiving, the doctors said.

Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Evelyne Vinet, M.D., assistant professor, McGill University Health Centre, Montreal; Yousaf Ali, M.D., acting chief, rheumatology, Mount Sinai Hospital, New York City; Oct. 26, 2013, presentation, American College of Rheumatology annual meeting, San Diego

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Ultrasound Device May Improve Emergency Stroke Care: Study

FRIDAY, Oct. 25 (HealthDay News) -- The use of a hands-free ultrasound device in combination with a clot-busting drug appears safe for patients with a common kind of stroke, a small, new study finds.

An ischemic stroke occurs when blood flow to the brain is blocked. When this happens, the hands-free ultrasound device is placed on the patient's head and delivers ultrasound to boost the effectiveness of the clot-busting medicine tPA (tissue plasminogen activator).

The new trial was funded by the U.S. National Institutes of Health and was published Oct. 24 in the journal Stroke.

"Our goal is to open up more arteries in the brain and help stroke patients recover," study author Dr. Andrew Barreto, an assistant professor of neurology in the Stroke Program at the University of Texas Health Science Center at Houston, said in a journal news release.

Unlike the traditional hand-held ultrasound device that's aimed at a blood clot, the hands-free version uses 18 separate probes and showers the deep areas of the brain where large blood clots cause severe strokes, the researchers said.

The new study included 12 men and eight women with an average age of 63. The patients had moderately severe ischemic strokes and received tPA within four and a half hours after the start of their stroke symptoms. They also received two hours of exposure to the hands-free ultrasound device.

Ninety days after the combined treatment, 65 percent of the patients had either returned home or were in post-stroke rehabilitation. A quarter of the patients had no stroke-related disability, and one patient had slight disability.

"This technology would have a significant impact on patients, families and society if we could improve outcomes by another 5 percent to 10 percent by adding ultrasound to patients who've already received tPA," Barreto said.

Barreto's team has launched an international study of the ultrasound approach combined with the clot buster, to be conducted in 830 ischemic stroke patients.

Two stroke experts not connected to the study said the device shows promise.

"The potential benefit of this technology is its simplicity and potential for widespread use within primary stroke centers that are the first to see the majority of ischemic stroke patients," said Dr. Jeffrey Katz, chief of vascular neurology at North Shore University Hospital in Manhasset, N.Y.

Katz said that if the data from trials continues to be positive, "we may finally have the first proven adjunct to intravenous tPA that has the potential for mass use because it does not rely on the availability of trained operators or expensive specialized facilities."

Dr. Sampson Davis, an emergency medicine physician at St. Michael's Medical Center in Newark, N.J., added: "Because I am the first doctor to encounter stroke patients, I'm excited about medical technology and thrilled to see such a timely study unfolding."

"Although more research steps are needed, including the aforementioned larger patient size, this project holds promise and is a step in the right direction in treating stroke," Davis said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jeffrey Katz, M.D., chief of vascular neurology, North Shore University Hospital, Manhasset, N.Y.; Sampson Davis, M.D., emergency medicine physician, St. Michaels Medical Center, Newark, N.J.; Stroke, news release, Oct. 24, 2013

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Too Few Kids Follow Bike Helmet Laws, Study Finds

SATURDAY, Oct. 26 (HealthDay News) -- Helmets are worn by only about one in 10 Los Angeles County children involved in bicycle accidents, despite a state law that requires helmets for riders under age 18, a new study finds.

The findings show the need for new education programs to increase the use of bike helmets, according to the study authors.

The researchers analyzed the medical records of more than 1,200 children, median age 13, who were treated for bicycle accident-related injuries in Los Angeles County between 2006 and 2011.

Overall, just over 11 percent of the children were wearing a helmet at the time of the accident, but there were significant racial/ethnic differences in helmet use. About 35 percent of white children wore helmets, compared to 7 percent of Asian children, 6 percent of black children and 4 percent of Hispanic children, the findings revealed.

The investigators also found that children over age 12 were less likely to wear a helmet and that helmet use was lower among children with public insurance than among those with private insurance (7.6 percent versus 15.2 percent), according to the study presented Oct. 26 at the national conference of the American Academy of Pediatrics (AAP) in Orlando, Fla.

Nearly 6 percent of the children in the study required emergency surgery and the death rate was 0.7 percent. Of the nine children who died, eight were not wearing a helmet.

"Our study highlights the need to target minority groups, older children and those with lower socioeconomic status when implementing bicycle safety programs in Los Angeles County," study author Dr. Veronica Sullins said in an AAP news release.

Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Each year in the United States, bicycle crashes and bicycle-related head injuries cause 150,000 emergency department visits and nearly 400 deaths, according to the U.S. Centers for Disease Control and Prevention.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Academy of Pediatrics, news release, Oct. 26, 2013

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Social Isolation Linked to More Pain After Hip Replacement

SATURDAY, Oct. 26 (HealthDay News) -- People without social support may experience more pain years after surgery, a new study suggests.

Researchers surveyed 687 patients, average age 62, with rheumatoid arthritis or osteoarthritis who underwent total hip replacement surgery. Of those patients, 8.2 percent in the rheumatoid arthritis group and 7.8 percent in the osteoarthritis group were considered to be socially isolated.

This meant that they had few people who were close to them. For example, they were not married, had fewer than six friends or relatives, or did not belong to any community or religious groups.

The socially isolated patients were almost three times more likely than those with good social support to have serious, ongoing pain two or more years after having hip replacement surgery, according to the researchers at the Hospital for Special Surgery in New York City.

The study is scheduled to be presented Tuesday at the annual meeting of the American College of Rheumatology in San Diego. Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

"We believe further prospective studies should be done to determine whether interventions to evaluate and improve patients' social ties before surgery could lead to a better pain outcome after hip replacement," study author Dr. Lisa Mandl said in a hospital news release.

"It could be a way to improve outcomes without medication or other costly interventions. I see no downside to helping patients get the social support they may need to improve their quality of life," Mandl said.

She noted that previous studies have shown that people with poor social ties are at higher risk for heart attack, stroke and death than those with the support of family, friends and the community.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Hospital for Special Surgery, news release, Oct. 26, 2013

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Can't Settle on a Menu Selection? Listen to Your Tablemates

FRIDAY, Oct. 25 (HealthDay News) -- Your dinner companions may influence your food choices at a restaurant, according to a new study.

The study found that when a group of people go to a restaurant, they tend to select items from the same menu categories.

"My conclusion from the research is that people want to be different, but not that different," study author Brenna Ellison, a food economist at the University of Illinois, said in a university news release. "We want to fit in with the people we're dining with. It goes against the expectation that people will exhibit variety-seeking behavior; we don't want to be that different from others."

Ellison analyzed three months' worth of lunch receipts from a restaurant in Stillwater, Okla. In one section of the restaurant, guests received menus with items and prices only. Customers in another section received menus with calorie counts for each entree. Those in a third section received menus with the calorie count and a traffic-light symbol that indicated the calorie ranges of food items: green-light items had 400 calories or less, yellow-light items had 401 to 800 calories and red-light items had more than 800 calories.

"[Servers said] people talked about the traffic lights a lot," Ellison said. "And we did find that larger tables that received the traffic-light menus did order fewer calories, on average, which suggests there was some peer pressure to order lower-calorie items."

"The big takeaway from this research is that people were happier if they were making similar choices to those sitting around them," she said. "If my peers are ordering higher-calorie items or spending more money, then I am also happier -- or at least less unhappy -- if I order higher-calorie foods and spend more money."

"The most interesting thing we found was that no matter how someone felt about the category originally -- even if it was initially a source of unhappiness, such as the items in the salad category -- this unhappiness was offset when others had ordered within the same category," Ellison said. "Given this finding, we thought it would almost be better to nudge people toward healthier friends than healthier foods."

The study findings were presented at the recent annual meeting of the Agricultural and Applied Economics Association in Washington, D.C.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Illinois, news release, Oct. 23, 2013

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Migraines Tied to Raised Risk of Depression, Suicidal Thoughts

FRIDAY, Oct. 25 (HealthDay News) -- People who suffer from migraines are twice as likely to be depressed as others without the debilitating headaches, according to a new study.

And those who experience migraines, particularly people younger than 30, are also more likely to consider suicide, the Canadian researchers said.

Routine screenings and interventions are needed for those migraine sufferers at greatest risk for both depression and suicidal thoughts, the study authors contend.

"We are not sure why younger migraineurs have such a high likelihood of depression and suicidal ideation," study co-author Meghan Schrumm, a former graduate student at the University of Toronto, said in a university news release.

"It may be that younger people with migraines have not yet managed to find adequate treatment or develop coping mechanisms to minimize pain and the impact of this chronic illness on the rest of their lives," Schrumm suggested.

The study, published online recently in the journal Depression Research and Treatment, involved more than 6,000 Canadians who said they had been diagnosed with migraines. The researchers compared them to a much larger group who did not report having migraines.

As in previous studies, migraines were much more common among women, with one in every seven women reporting having migraines, compared with one in every 16 men.

Of study participants, more than 8 percent of men and 12 percent of women who experienced migraines also suffered from depression, compared to just above 3 percent of men and about 6 percent of women who did not have migraines.

Younger people with migraines were much more likely than older patients to develop symptoms of depression. Women younger than 30 who suffered from migraines had six times the odds of being depressed than adults aged 65 and older. Migraine sufferers who were single or had trouble with daily activities were also at increased risk for depression.

Men and women with migraines were also much more likely than those without the headaches to have seriously considered committing suicide. Although nearly 16 percent of men and 18 percent of women with migraines said they thought about taking their own life, about 8 percent of men and 9 percent of women who didn't have migraines said the same.

Although the study found associations between having migraines, depression and suicidal thoughts, it did not establish a cause-and-effect relationship.

Based on the findings, study lead author Esme Fuller-Thomson, chair of the University of Toronto's Factor-Inwentash Faculty of Social Work, concluded there is a need for routine screening and interventions for depression and suicidal thoughts among young and unmarried people who suffer from migraines as well as those who are limited in their daily activities.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Toronto, news release, Oct. 17, 2013

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'Super-Magnets' Pose Rising Threat to Kids, Study Finds

By Kathleen Doheny
HealthDay Reporter

SUNDAY, Oct. 27 (HealthDay News) -- Powerful "super-magnets" found in adult desk toys and other novelty items still trigger many emergency-room visits after children swallow them, according to a new report, even though some products with these magnets have been recalled.

"These ingestions have increased over the past three to five years," said study researcher Dr. Daniel Rosenfield, a pediatric resident at the University of Toronto and the Hospital for Sick Children, in Canada.

At the hospital, Rosenfield's team looked back at the records involving about 2,700 ingestion incidents from 2001 through 2012. They found that 94 involved magnets, with ingestion of multiple magnets increasing the most in the last three years of the study.

These neodymium-iron-boron magnets became popular about that time, sold in toys, jewelry and other novelty items, including desk toys used for fun and stress relief by adults. These desk toys include magnetic marbles and magnetic sculpting balls.

Rosenfield is scheduled to report the findings Sunday at an American Academy of Pediatrics meeting in Orlando, Fla.

Although recalls are in place for some of these products in both the United States and Canada, many of the items are still in circulation or available online, Rosenfield said. Many parents, as well as teachers and others, remain unaware of the dangers of these magnets, he said.

"The problems with these multiple magnets is, if you ingest more than one at a different point in time, they can attract [each other] across loops of the gut, causing pressure to build up," Rosenfield said.

In the study, the children ranged in age from 7 months to 13 years, but the average age was about 4 years.

In the case of the 13-year-old, Rosenfield said, the teen was trying to mimic a tongue piercing with a stud, and swallowed three magnets.

Six children had to be taken to the operating room to remove the magnets and others had to have them removed by way of an endoscope or tube, according to the study. Others were given laxatives or were observed to see if the magnet passed. No deaths occurred.

Children often ingest the magnets without a parent knowing, Rosenfield said, so parents and doctors should be alert to the possibility of magnet ingestion if a child complains of stomachache without apparent causes. With an abdominal X-ray, he said, ingestion can be detected fairly quickly.

The problem of magnet ingestion is ongoing, said Dr. Cathy Burnweit, chief of pediatric surgery at Miami Children's Hospital. Burnweit reviewed the study but did not participate in it. She said she has often treated children who have swallowed magnets, although coins are what she fishes out most often.

"Sometimes magnets get stuck in the lower throat," Burnweit said. "If they get through there, a solitary item will usually pass into the stool." But the scenario described by Rosenfield also occurs, she said. "If there are two magnets and they are in different places, the loops of bowel will be drawn together and can rupture the intestines," she said. "This can happen within hours to days."

Parents are busy, she said, but more awareness is key. "Be very cognizant of toys, coins and little objects, particularly in the toddler age group," she said. If an object can fit down the diameter of a toilet paper roll, she said, "children have been known to swallow it."

The U.S. Consumer Product Safety Commission held a hearing earlier this month, asking experts to comment on its proposed new rule to prohibit sales of the super-magnet products.

Because the new study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Daniel Rosenfield, M.D., pediatric resident, University of Toronto and the Hospital for Sick Children, Toronto; Cathy Burnweit, chief of pediatric surgery, Miami Children's Hospital, Florida; Oct. 27, 2013, presentation, American Academy of Pediatrics meeting, Orlando, Fla.

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Treating Rheumatoid Arthritis Early May Cut Damaging Effects

SATURDAY, Oct. 26 (HealthDay News) -- Immediate and effective treatment for rheumatoid arthritis reduces the risk that patients will have joint damage and disability within a few years, a new study suggests.

The findings show the need for doctors to discourage patients from delaying treatment, according to the researchers at the Hospital for Special Surgery in New York City.

"We need to educate people diagnosed with rheumatoid arthritis about this. Some want to delay treatment because they are afraid. They haven't wrapped their heads around the fact that they have this disease, or they are reluctant to start taking medication. Some resort to non-medicinal approaches, many of which have limited effect," study lead investigator and rheumatologist Dr. Vivian Bykerk said in a hospital news release.

"Unfortunately, I have seen too many people delay effective treatment approaches and they come back a year later very disappointed, often with joint damage that could have been prevented. The longer you have inflammation in the joints, the more likely you are to have joint damage, and it is going to impact how you function down the road," she added.

The study included 833 patients with early rheumatoid arthritis -- defined as having symptoms for a year or less. Six months into the study, the patients were classified as having achieved low disease activity or not. Low disease activity means that joint pain, swelling and other signs of inflammation are significantly reduced.

The 56 percent of patients who achieved low disease activity at six months were much less likely to have joint damage and disability at two years, according to the findings to be presented Monday at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals in San Diego.

"We believe there is a window in which people have a much better chance of getting rheumatoid arthritis under good control, often with less intense therapy, and the window is within the first three months of developing joint inflammation," Bykerk said.

These findings show the need for doctors to warn patients about the hazards of delaying therapy and to follow patients more often in the early stages of treatment, she added.

Research presented at medical meetings is considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Hospital for Special Surgery, news release, Oct. 26, 2013

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FDA OKs New Hydrocodone Painkiller

FRIDAY, Oct. 25 (HealthDay News) -- A new painkiller that contains the powerful narcotic hydrocodone was approved Friday by the U.S. Food and Drug Administration.

The approval comes one day after an FDA move to tighten controls on prescriptions for painkillers that contain hydrocodone, such as Vicodin and Lortab.

The new drug -- Zohydro ER (hydrocodone bitartrate extended-release capsules) -- was approved for patients with pain severe enough to require daily, 24-hour, long-term treatment and for which other pain treatments are inadequate.

It is not approved for as-needed pain relief.

The approval is based on safety findings from studies of more than 1,100 people with chronic pain and efficacy findings from a study of more than 500 patients with chronic low back pain. That study found that those who took the drug had significant improvements in pain compared to those who took a placebo, according to the FDA.

The most common side effects of Zohydro ER are constipation, nausea, drowsiness, fatigue, headache, dizziness, dry mouth, vomiting and itching.

The drug, made by San Diego-based Zogenix Inc., is the first FDA-approved "single-entity" (not combined with an analgesic such as acetaminophen) and extended-release hydrocodone product.

Zohydro ER is classed as a "Schedule II" medication, which means it will be subject to the same type of strict controls as other narcotics with the highest potential for abuse, including OxyContin, methadone, fentanyl, Adderall and Ritalin.

One physician who is experienced with pain medication believes the new drug should not have been approved, however.

"This product was specifically turned down by the FDA Advisory Committee due to the risks of misuse, abuse, overdose and death, particularly given the limited data supporting the benefits of this medication for chronic pain," said Dr. Lewis Nelson, a professor in the department of emergency medicine in the division of medical toxicology at NYU School of Medicine, in New York City.

He said that, "other similar products already exist that come in safer formulations. The new [risk-limiting] requirements will have an undefined impact on the safety of this very dangerous medication. This is not necessarily an improvement in existing therapy and will likely result in increased use and increased cost to patients with chronic pain."

Under the new approval, the drug maker will have to conduct ongoing studies of Zohydro ER to assess the known serious risks of misuse, abuse, increased sensitivity to pain, addiction, overdose and death associated with long-term use beyond 12 weeks. These studies will also be required for other extended-release/long-acting (ER/LA) painkillers, the FDA said.

The agency also noted that Zohydro ER will be part of the ER/LA Opioid Analgesics Risk Evaluation and Mitigation Strategy. That program requires drug companies to offer health care professionals educational programs on how to safely prescribe extended-release/long-acting opioid painkillers. The companies must also provide medication guides and patient counseling documents with information on the safe use, storage and disposal of extended-release/long-acting opioids.

On Thursday, the FDA proposed tighter controls on prescriptions for painkillers that contain hydrocodone. The changes would cut in half the number of refills that patients can get before seeing their doctor to get a new prescription. Patients would also have to take their prescription to a pharmacy to have it filled, rather than have their doctor call it in.

The FDA added that it will ask in mid-December that all prescription drugs containing hydrocodone be reclassified as "Schedule II" medications.

The agency said the changes are meant to reduce the epidemic levels of prescription drug abuse in the United States.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Lewis Nelson, M.D., professor, department of emergency medicine in the division of medical toxicology, NYU School of Medicine, New York City; U.S. Food and Drug Administration, news release, Oct. 25, 2013

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