2014

With chilly weather settling in and darkness arriving before most people’s workdays end, many of us are shifting our workouts indoors, a practice that is much better for us than abandoning exercise for the winter. But a new study of air quality in gyms raises some interesting questions about whether the places in which we work out are as healthy as they should be.

Science and common sense tell us that exercising in polluted air is undesirable. People who frequently run alongside heavily trafficked freeways and breathe great lungfuls of exhaust have been shown to have an increased risk of heart disease, even if they are otherwise in admirably good shape. But few studies systematically have examined the air quality inside gyms.

Therefore, from the journal Building and Environment, researchers at the University of Lisbon in Portugal and the Technical University of Delft in Holland decided that they would place air-quality monitoring equipment in gyms throughout Lisbon. … Their findings were disquieting. In general, the gyms showed high levels of airborne dust, formaldehyde and carbon dioxide. The concentrations of these substances generally exceeded most accepted standards for indoor air quality. (No government agency in the United States formally monitors air quality in gyms.) The levels were especially high during evening aerobics classes, when many people were packed into small studios, stirring up dust and fumes and puffing heavily, producing carbon dioxide with every breath. … In sufficient concentrations, these substances can contribute to asthma and other respiratory problems, she said. Almost all of the gyms in the study had levels of these substances that significantly exceed European standards for healthy indoor air standards.

Source: New York Times

At present, influenza activity is low in the United States but we expect activity to increase in the coming weeks as the U.S. typically experiences peak influenza activity between December and February. Based on our surveillance data we also expect an increase in norovirus in the very near future. In addition to vaccinations, it is also important to emphasize the early use of antivirals in the treatment of influenza. Antivirals are an important second line of defense, particularly for those at high-risk for complications from influenza. Two neuraminidase inhibitor antiviral medications are recommended for use in the United States—oseltamivir (Tamiflu®) and zanamivir (Relenza®). Current national surveillance data has not revealed significant resistance to oseltamivir and zanamivir to date.

Treatment works best when started within the first 48 hours of illness and can shorten the duration of symptoms and reduce the risk of severe complications and death. Treatment with antiviral medications is recommended for patients with influenza who are hospitalized; have severe, complicated or progressive illness; or are at higher risk for influenza complications. Antiviral treatment may also be considered in other populations, if treatment can be initiated within 48 hours of illness onset. Use of antivirals for the prevention of influenza should be considered for institutional outbreaks (such as in nursing homes or other closed populations) or for those who have contraindications to influenza vaccination. Other preventive health practices that may help decrease the spread of influenza and other common winter illnesses (such as norovirus), include staying home from work and school when ill, staying away from people who are sick, increasing hand washing, and using cough etiquette and respiratory hygiene practices.

Source: CDC

“The Center has plenty of Quadrivalent Influenza vaccine available.”

Despite the recent Advisory below, it is still important to get vaccinated against Influenza this year. We offer the Quadrivalent Influenza vaccine which protects against 4 Influenza viruses including partial protection against the H3N2 virus.

Influenza activity is currently low in the United States as a whole, but is increasing in some parts of the country. This season, influenza A (H3N2) viruses have been reported most frequently and have been detected in almost all states.

During past seasons when influenza A (H3N2) viruses have predominated, higher overall and age-specific hospitalization rates and more mortality have been observed, especially among older people, very young children, and persons with certain chronic medical conditions compared with seasons during which influenza A (H1N1) or influenza B viruses have predominated.

Influenza viral characterization data indicates that 48% of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically “like” the 2014–2015 influenza A (H3N2) vaccine component, but that 52% were antigenically different (drifted) from the H3N2 vaccine virus. In past seasons during which predominant circulating influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protection against drifted viruses. Though reduced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition, vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses).

Because of the detection of these drifted influenza A (H3N2) viruses, this CDC Health Advisory is being issued to re-emphasize the importance of the use of neuraminidase inhibitor antiviral medications when indicated for treatment and prevention of influenza, as an adjunct to vaccination.

The two prescription antiviral medications recommended for treatment or prevention of influenza are oseltamivir (Tamiflu) and zanamivir (Relenza). Evidence from past influenza seasons and the 2009 H1N1 pandemic has shown that treatment with neuraminidase inhibitors has clinical and public health benefit in reducing severe outcomes of influenza and, when indicated, should be initiated as soon as possible after illness onset. Clinical trials and observational data show that early antiviral treatment can:

• shorten the duration of fever and illness symptoms;
• reduce the risk of complications from influenza (e.g., otitis media in young children and pneumonia requiring antibiotics in adults); and
• reduce the risk of death among hospitalized patients.

Source: CDC

Exposure to bisphenol A (BPA) through consumption of canned beverages is associated with increases in systolic blood pressure, according to a randomized crossover trial in Hypertension. BPA is a chemical found in many plastic bottles, food containers, and the linings of cans.  Sixty older adults (mostly women) had three study visits, during which they consumed two servings of soy milk provided one of three ways: in two glass bottles (least amount of BPA exposure), two cans (most BPA), or one glass bottle and one can. The sequence of serving containers was randomized.  Urinary BPA concentrations were significantly higher 2 hours after participants drank from two cans versus two glass bottles. Furthermore, systolic BP was roughly 4.5 mm Hg higher after two cans versus two glass bottles. The authors write that the observed increase in systolic BP “may cause a clinically significant increase of risk of cardiovascular disorders, such as heart diseases and peripheral arterial diseases.”  Bisphenol A (BPA) is produced in high volumes worldwide. It is used in the manufacture of polycarbonate plastics and epoxy resin, which are used in the linings of food or beverage cans, water bottles, and dental fillings. BPA has been detected in 95% of the population of the United States.

BPA is considered to be an endocrine-disrupting chemical, and it shows affinity for estrogen receptors. It was initially considered to be a weak xenoestrogen, but subsequent studies showed that BPA can have effects even at low concentrations.  In addition, pathways other than binding to estrogen receptors have been proposed. These include the thyroid hormone pathway, binding to glucocorticoid receptors and androgen receptors, or interfering with the central nervous system and immune system. Epidemiological studies have suggested that BPA could have adverse effects on human health.  Specifically, BPA exposure has been shown to be associated with increased production of liver enzymes, recurrent miscarriages, premature delivery of fetuses, inflammation and oxidative stress, decreased quality of semen, and male sexual dysfunction.

Source: NEJM Journal Watch

The Mediterranean diet consistently has been linked with an array of health benefits, including decreased risk of chronic disease and cancer. Until now, however, no studies had associated the diet with longer telomeres, one of the biomarkers of aging.

In a study published Tuesday online in The BMJ, researchers at Harvard-affiliated Brigham and Women’s Hospital (BWH) found that greater adherence to the Mediterranean diet correlated with longer telomeres.

Telomeres are repetitive DNA sequences at the ends of chromosomes that get shorter every time a cell divides. Shorter telomeres have been associated with decreased life expectancy and increased risk of aging-related disease, while longer telomeres have been linked to longevity. Telomere shortening is accelerated by stress and inflammation, and scientists have speculated that adherence to the Mediterranean diet may help protect against that effect.

“To our knowledge this is the largest population-based study specifically addressing the association between Mediterranean diet adherence and telomere length in healthy, middle-aged women,” explained Immaculata De Vivo, an associate professor in the Channing Division of Network Medicine at BWH and the Harvard T.H. Chan School of Public Health, the senior author of this study. “Our results further support the benefits of adherence to this diet to promote health and longevity.”

The researchers analyzed 4,676 disease-free women from the Nurses’ Health Study who had completed the food-frequency questionnaire and whose telomere lengths had been measured. They found that a greater adherence to the Mediterranean diet was associated with longer telomeres, and that even small changes in diet made a difference.

“Our findings showed that healthy eating, overall, was associated with longer telomeres. However, the strongest association was observed among women who adhered to the Mediterranean diet,” explained Marta Crous Bou, a postdoctoral fellow in the Channing Division of Network Medicine and the first author of the study.

De Vivo notes that future research should be aimed at determining which components of the Mediterranean diet drive this association. This would allow researchers to gain insight into the biological mechanism, as well as provide a basis for increased public education for informed lifestyle choices.

Source: Harvard Gazette

“The Presidential Healthcare Center Provides Nutritional Assessments.”  

Cardiovascular screenings are a cost-effective way to identify middle-aged athletes who may risk heart attacks or strokes by participating in high-intensity sports, a new study suggests.

“I would suggest that all middle-aged athletes should be screened at least once, particularly men over 40 and women over 50,” said the study’s lead author, Dr. Andrea Menafoglio, a cardiologist at Ospedale San Giovanni in Bellinzona, Switzerland.

While the benefits of regular exercise are well known, vigorous physical exertion can be life-threatening for older athletes who may not realize that they have an underlying heart condition. Guidelines in Europe and the U.S. urge cardiovascular risk evaluations for middle-aged athletes, but researchers say the recommendations aren’t universally followed because widespread implementation hasn’t proved effective or affordable.

To see if widespread screening could detect hidden symptoms and risks for heart disease at a reasonable price, Menafoglio and colleagues at three hospitals in Switzerland evaluated 785 athletes between the ages of 35 and 65.

Each of the athletes reported spending at least two hours a week participating in high-intensity sports such as running, cycling, triathlon, football, swimming, tennis, climbing, or cross-country skiing.

The initial evaluation included a personal and family history, a physical exam, and a resting electrocardiogram, or ECG. For each participant, the researchers also estimated the risk of death from cardiovascular disease within the next 10 years based on gender, age, cholesterol level, blood pressure, and smoking habits.

Overall, the cost of screening averaged $199 per athlete (about 160 euros), because most athletes didn’t need any testing beyond the initial evaluation.

About one in seven athletes needed additional screening. Extra tests found some cases of previously unimagined diabetes, hypertension, high cholesterol, and mild heart valve disease.

Overall, the screenings caught previously undetected cardiovascular abnormalities in about 3 percent of participants and a high cardiovascular risk profile in about 4 percent.

Just three athletes had abnormalities that made it too dangerous for them to continue their exercise routines.

Source: Reuters Health

“The Presidential Healthcare Center can design a personalized exercise prescription for you.”

Almost a century after the discovery that sleep helps us remember things, scientists are beginning to understand why.

During sleep, the brain produces chemicals that are important to memory and relives events we want to remember, scientists reported this week at the Society for Neuroscience meeting in Washington D.C.

“One of the most profound effects of a night of sleep is the improvement in our ability to remember things,” says Ravi Allada, a sleep researcher at Northwestern University. Yet this connection hasn’t been well-understood, he says.

That’s changing, thanks to recent research from scientists including Jennifer Choi Tudor from the University of Pennsylvania. At the meeting, Tudor presented a study involving a brain chemical (known as 4EBP2) that is produced during sleep and is thought to play a role in remembering new information.

Previous experiments have shown that sleep-deprived mice have memory problems and lower levels of this chemical. So the team tried injecting the chemical into the brains of mice, then deprived them of sleep. “With the injection, their memory is normal,” Tudor says.

Sleep is also a time when old memories can be modified and new memories can be formed, says Karim Benchenane from the National Center for Scientific Research in Paris. Benchenane was part of a team that studied the brains of rats while the rats were awake, as well as during sleep.

When the animals were awake and traveling around their cages, the scientists identified brain cells that became active only when the rats were in a specific location. During sleep, these same cells became active in the same order, indicating that the rats were reliving their travels and presumably strengthening their memories of places they’d been.

Source: NPR

Exposure to secondhand smoke and roadway traffic may be tied to increased body mass index in children and adolescents, a new study suggests.

Researchers studied 3,318 children in 12 Southern California communities beginning at an average age of 10, and then followed them through age 18. They used parental questionnaires to establish exposure to smoking, and data on traffic volume and levels of nitrogen dioxide, ozone and particulates to track pollution.

The study, in Environmental Health Perspectives, controlled for many other factors: sex, initial B.M.I., asthma, physical activity, insurance status, parental education and income, acres of parks and open space nearby, percentage of people living in poverty in each community.

But even after accounting for these issues and more, they found that compared with children exposed to no secondhand smoke or near-roadway air pollution, B.M.I. was 0.80 higher in children exposed to pollution alone, 0.85 higher in those exposed to secondhand smoke alone, and 2.15 higher in those exposed to both.

A normal B.M.I. for adults is 18.5 to 24.9. Higher than 25 is considered overweight, and above 30 obese.

“It would be interesting to know more about the mechanism,” said the lead author, Dr. Rob McConnell, a professor of preventive medicine at the University of Southern California. “But the finding challenges the view that obesity is due solely to increased caloric intake and reduced physical activity. That’s not the whole story.”

Source: New York Times

The winter season is chock full of delicious dishes and treats, but no one likes the extra calories and added pounds that can come with the seasonal food. Use these smart tips on substitutions and choices to enjoy your favorite winter beverages and foods.

Eggnog

• Mix it up. Fill your glass with half- to three-quarter-parts of low-fat or skim milk and one part eggnog. You’ll still get the flavor without all the calories.
• Act like a kid. Take out the alcohol. This simple step will reduce the caloric content.
• Cut the fluff. Pass on that big dollop of whipped cream to avoid the extra sugar and saturated fat.

Hot Chocolate

• Skip the heavy stuff. If you order hot chocolate at a restaurant or coffee shop, ask that it be made with low-fat or skim milk, and without the whipped cream.
• Do some research. To make instant hot chocolate at home, look for product packets marked “low-fat/fat-free” or “low-sugar/sugar-free.” Be sure to add the mix to low-fat milk, skim milk or hot water.
• Go easy on the toppings. Use five to eight mini-marshmallows instead of large ones. If using whipped cream, look for low-fat versions and stick to less than one tablespoon. If you have hot chocolate regularly, try to limit the toppings to “once in a while treats” since they can pack a lot of calories and added sugars.

Apple Cider

• Read the labels. When buying cider at the store, check its added sugar content. Many products contain added sugars, which can increase your calorie intake and cause weight gain. Choose low-sugar and sugar-free options.
• Do it yourself. When making cider at home, use low-sugar apple juice and a variety of spices (like cinnamon sticks, cloves, nutmeg and whole cranberries). You’ll keep the flavor while cutting calories.

Cocktails and Other Alcoholic Beverages

• Enjoy cocktails. Serve non-alcoholic versions of your favorite cocktails to lower the calories. Be sure to check the nutrition label, because sometimes products that are alcohol-free have more added sugar.
• Break it up. To reduce the amount of calorie-laden drinks you consume during a holiday gathering, drink a glass of water or sparkling water between each beverage. This will help fill your stomach, leaving less room to overindulge.

Sodium

• Limit your sodium. Did you know that many of your favorite holiday dishes may be packed with sodium? Breads and rolls, poultry, and canned soups are three common foods that can add sodium to your diet. When shopping for ingredients to prepare your holiday meal, compare the labels to find lower sodium varieties.
• Savor the flavor. Use herbs and spices, like rosemary and cloves, to flavor dishes instead of salt or butter.
• Go fresh. Choose fresh fruits and vegetables to use in your dishes. If using canned products, rinse with water in a colander before cooking and serving.

Turkey

• Outsmart the bird. Reach for the lighter pieces of meat; they have fewer calories and less fat than the darker ones. Another way to cut calories is to take off the skin.
• Keep portions in check. A serving size of meat is 3 oz., about the size of a deck of cards. So, be conscious of how much you put on your plate, and pass on that second helping. If you’re also having another meat, like ham or lamb, take smaller portions of each.
• Watch out for the gravy train. Turkey usually comes with gravy, which can add excess fat, calories and sodium. Limit gravy to a tablespoon, and keep it off other items, like the dressing.

Dressing

• Call it what it is. Dressing is intended to be a complement to your meal, not an entrée. To keep calories and excess fat in check, aim for ¼ cup (or about half a scoop with a serving spoon).
• Judge it by its cover. If the dressing is filled with fatty meats like sausage and pork, looks greasy or buttery, and is made with white bread or sweet rolls, it may be best to pass. Better options would be dressings that have whole grain or cornbread, lean meat (or no meat), nuts (like almonds or walnuts), and lots of veggies and fruits.

Desserts

• Treat yourself right. The best way to enjoy an occasional sweet without losing control is by sampling a selection or two, rather than having full servings. For example, have one bite of pie, half a cookie or one small square of fudge. Find a friend or family member who will stick to the sampling rule with you.

Source: American Heart Association

The sixth annual World Pneumonia Day was observed this week to raise awareness about pneumonia’s toll and to promote interventions to protect against, treat, and prevent the disease globally. The United States has made great strides in protecting children from the serious, and sometimes deadly, effects of pneumonia through recent vaccination efforts. Tennessee, for example, is experiencing historically low rates of pneumonia hospitalizations in children aged <2 years since pneumococcal conjugate vaccines were introduced in 2000. Data suggest that this progress also is being seen across the country. In spite of this success, however, pneumonia still kills approximately 50,000 people in the United States each year, 85% of whom are adults aged ≥65 years. In response, this year CDC recommended pneumococcal conjugate vaccine for adults aged ≥65 years.

Globally, pneumonia kills nearly 1 million children aged <5 years each year. In addition to bacterial pathogens, many viruses such as respiratory syncytial virus, influenza, and measles also are major causes of pneumonia globally. Many deaths and illnesses from pneumonia can be prevented with the use of 1) pneumococcal, Haemophilus influenzae type b (Hib), influenza, and measles vaccines; 2) appropriate antimicrobial therapy; and 3) supportive health care, among other strategies.

Communities around the world face a range of respiratory disease threats, including reemerging or newly identified pathogens. In late summer, infection with the uncommon enterovirus EV-D68 led to the hospitalization of hundreds of children in multiple states. In and around the Arabian Peninsula, a recently recognized coronavirus (Middle East respiratory syndrome coronavirus) has been fatal in about one third of reported cases. Vaccines are not available to provide protection against these or many of the other pathogens that commonly cause pneumonia, including respiratory syncytial virus, human metapneumovirus, and Mycoplasma pneumoniae, highlighting the importance of research into vaccine development as well as effective treatment and diagnostics for viral and bacterial pneumonia. Additional information regarding World Pneumonia Day is available at https://worldpneumoniaday.org.

Source: CDC
The Presidential Healthcare Center offers Prevnar-13 as a special order vaccination.