September

prostate probMen with a certain pattern of baldness at age 45 had a 39% increased risk of developing aggressive prostate cancer versus men with no baldness, a new U.S. study found.

Men with frontal baldness and moderate baldness on the crown of the head had a higher risk of developing an aggressive form of prostate cancer.

Researchers said the finding adds to evidence of a hormone-based, biological link between baldness and prostate cancer, but added that more studies would be needed to support whether baldness patterns should be part of a screening system. Until more research is available, men shouldn’t be overly concerned about baldness patterns, the study’s researchers said.

The hair-loss pattern associated with a higher risk was frontal baldness plus moderate baldness on the vertex, or crown of the head, which about 10% of the men in the study recalled having at age 45. Other patterns—frontal only, and frontal plus mild or severe vertex baldness—weren’t associated with an increased risk of aggressive prostate cancer. The results of the study were published online Monday in the Journal of Clinical Oncology.

The finding arose from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, a large study started in the early 1990s by the National Cancer Institute to determine whether certain screening methods reduce cancer death rates.

In one segment of the trial, from 2006 to 2008, researchers provided questionnaires to men asking them to choose one of five illustrations that most closely resembled their hair-loss patterns at the age of 45, based on memory. The median age of the approximately 39,000 men who responded to the survey was about 70.

After a median follow-up period of 2.8 years after they responded to the survey, about 1,140 cases of prostate cancer were diagnosed. About half of them were classified as aggressive.

About 53% of the total group recalled some form of male-pattern baldness at age 45. Overall, men who had any of the baldness patterns at the age of 45 didn’t have a statistically significant increased risk of any form of prostate cancer later in life, versus men with no baldness.

baldnessHowever, men with frontal plus moderate vertex balding—about 10% of the men in the study—had a 39% increased risk of aggressive prostate cancer versus men with no baldness. Researchers called this a statistically significant finding, meaning it wasn’t likely due to chance.

Still, a large majority of men in this group, and in the study’s other groups, weren’t diagnosed with any prostate cancer during the follow-up period.

If future studies confirm the link, “it may help the doctor-patient discussion about whether men should opt for prostate cancer screening,” said Michael Cook, an epidemiologist with the NCI and one of the study’s authors.

Until then, he cautioned, men shouldn’t be “overly concerned” about their baldness patterns, and shouldn’t alter their current practices and beliefs about prostate cancer screening.

The study had certain limitations, including relying on men’s recollection of their baldness patterns years earlier, and an under-representation of black men.

Prostate-cancer screening has become controversial in recent years amid evidence that it has led to overtreatment of the disease. The American Cancer Society estimates a man’s lifetime risk of developing prostate cancer is 15.3%, while the risk of dying from it is 2.7%.

Source: Wall Street Journal

VaccinationOn August 13, 2014, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Wyeth Pharmaceuticals, Inc., a subsidiary of Pfizer Inc.]) among adults aged ≥65 years. PCV13 should be administered in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax23, Merck & Co., Inc.]), the vaccine currently recommended for adults aged ≥65 years. PCV13 was approved by the Food and Drug Administration (FDA) in late 2011 for use among adults aged ≥50 years. In June 2014, the results of a randomized placebo-controlled trial evaluating efficacy of PCV13 for preventing community-acquired pneumonia among approximately 85,000 adults aged ≥65 years with no prior pneumococcal vaccination history (CAPiTA trial) became available and were presented to ACIP. The evidence supporting PCV13 vaccination of adults was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and determined to be type 2 (moderate level of evidence); the recommendation was categorized as a Category A recommendation. This report outlines the new recommendations for PCV13 use, provides guidance for use of PCV13 and PPSV23 among adults aged ≥65 years, and summarizes the evidence considered by ACIP to make this recommendation.

Streptococcus pneumoniae (pneumococcus) remains a leading infectious cause of serious illness, including bacteremia, meningitis, and pneumonia, among older adults in the United States. Use of a 7-valent pneumococcal conjugate vaccine (PCV7) since 2000 and PCV13 since 2010 among children in the United States has reduced pneumococcal infections directly and indirectly among children, and indirectly among adults. By 2013, the incidence of invasive pneumococcal disease (IPD) caused by serotypes unique to PCV13 among adults aged ≥65 years had declined by approximately 50% compared with 2010, when PCV13 replaced PCV7 in the pediatric immunization schedule. However, in 2013 an estimated 13,500 cases of IPD occurred among adults aged ≥65 years. Approximately, 20%–25% of IPD cases and 10% of community-acquired pneumonia cases in adults aged ≥65 years are caused by PCV13 serotypes and are potentially preventable with the use of PCV13 in this population.

On December 30, 2011, PCV13 was approved for use among adults aged ≥50 years to prevent pneumonia and invasive disease caused by S. pneumoniae serotypes contained in the vaccine. The new use for Prevnar 13 was approved under FDA’s accelerated approval pathway, which allows for earlier approval of products that provide meaningful therapeutic benefit over existing treatments for serious and life-threatening illnesses. FDA defined “meaningful therapeutic benefit over existing treatments” as protection of adults aged ≥50 years from nonbacteremic pneumococcal pneumonia or nonbacteremic pneumococcal pneumonia combined with protection from IPD. On June 20, 2012, ACIP recommended routine use of PCV13 for adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants. The ACIP decision to recommend PCV13 use among adults aged ≥65 years was deferred until data became available on 1) the impact of PCV13 use in children on disease in adults (i.e., indirect effects) and 2) the efficacy of PCV13 against noninvasive pneumococcal pneumonia among adults. In accordance with accelerated approval requirements, a randomized placebo-controlled trial (CAPiTA trial) was conducted in the Netherlands among approximately 85,000 adults aged ≥65 years during 2008–2013 to verify and describe further the clinical benefit of PCV13 in the prevention of pneumococcal pneumonia. The results of the CAPiTA trial demonstrated 45.6% (95% confidence interval [CI] = 21.8%–62.5%) efficacy of PCV13 against vaccine-type pneumococcal pneumonia, 45.0% (CI = 14.2%–65.3%) efficacy against vaccine-type nonbacteremic pneumococcal pneumonia, and 75.0% (CI = 41.4%–90.8%) efficacy against vaccine-type IPD among adults aged ≥65 years.

Two randomized, multicenter, immunogenicity studies conducted in the United States and Europe among older adults showed that PCV13 induced an immune response as good as or better than that induced by PPSV23. Functional antibody responses were measured 1 month after vaccination using an opsonophagocytic activity (OPA) assay. In adults aged 60–64 years with no prior pneumococcal vaccination, PCV13 elicited OPA geometric mean antibody titers (GMTs) to the 12 serotypes common to both vaccines that were comparable with, or higher than, responses elicited by PPSV23. In adults aged ≥70 years who previously had been immunized with a single dose of PPSV23 ≥5 years before enrollment, PCV13 elicited OPA responses that were comparable with those elicited by PPSV23 for two serotypes and higher for 10 serotypes.Vaccine

Immunogenicity studies evaluating responses to PCV7 and PPSV23 administered in series showed a better immune response when PCV7 was administered first. An evaluation of immune response after a second pneumococcal vaccination administered 1 year after the initial study doses showed that subjects who received PPSV23 as the initial study dose had lower OPA antibody responses after subsequent administration of PCV13 than those who had received PCV13 as the initial dose followed by a dose of PPSV23, regardless of the level of the initial OPA response to PPSV23. Studies evaluating the immune response after a sequence of PCV7 or PCV13 followed by PPSV23 with intervals of 2, 6, and 12 months or 3–4 years demonstrated that after the PPSV23 dose, antibody levels were higher than the pre-PCV baseline, and a noninferior response was observed when compared with post-PCV antibody levels. None of the studies were designed to evaluate the optimal interval between vaccine doses.

Safety of PCV13 was evaluated in approximately 6,000 PPSV23-naïve and PPSV23-experienced adults aged ≥50 years. Overall incidence of serious adverse events reported within 1 month of an initial study dose of PCV13 or PPSV23 did not differ between the two vaccines and ranged from 0.2% to 1.7%. From 1 to 6 months after an initial study dose, the overall incidence of serious adverse events ranged from 1.2% to 5.8% among persons vaccinated with PCV13 and 2.4% to 5.5% among persons vaccinated with PPSV23. Rates of reported serious adverse events in the treatment groups were similar among studies that enrolled PPSV23-naïve subjects and studies that enrolled PPSV23-experienced subjects. Common adverse reactions reported with PCV13 were pain, redness, and swelling at the injection site; limitation of movement of the arm in which the injection was given; fatigue; headache; chills; decreased appetite; generalized muscle pain; and joint pain. Similar reactions were observed in adults who received PPSV23.

Indirect effects from PCV13 use among children, if similar to those observed after PCV7 introduction, might further reduce the remaining burden of adult pneumococcal disease caused by PCV13-types. A preliminary analysis using a probabilistic model following a single cohort of persons aged 65 years demonstrated that adding a dose of PCV13 to the current PPSV23 recommendations for adults aged ≥65 years, compared with current PPSV23 recommendations, would lead to additional health benefits. This strategy would prevent an estimated 230 cases of IPD and approximately 12,000 cases of community-acquired pneumonia over the lifetime of a single cohort of persons aged 65 years, assuming current indirect effects from the child immunization program and current PPSV23 vaccination coverage among adults aged ≥65 years (approximately 60%). In a setting of fully realized indirect effects assuming the same vaccination coverage, the expected benefits of PCV13 use among this cohort will likely decline to an estimated 160 cases of IPD and 4,500 cases of community-acquired pneumonia averted among persons aged ≥65 years.

CDC will assess the implementation and impact of the recommendation for PCV13 use among adults aged ≥65 years, including coverage with PCV13 and PPSV23, and impact of PCV13 on vaccine-type IPD burden and community-acquired pneumonia. Monitoring disease trends among adults who do not receive PCV13 might help quantify indirect effects and the long-term utility of routine PCV13 use among adults. ACIP will be updated routinely on changes in the burden of IPD and community-acquired pneumonia among adults during the next 3 years to determine the need for revisions to the adult PCV13 recommendations.

A single dose of PPSV23 is recommended for routine use in the United States among adults aged ≥65 years. Effectiveness of PPSV23 in preventing IPD in adults has been demonstrated, but the data on the effectiveness of this vaccine in preventing noninvasive pneumococcal pneumonia among adults aged ≥65 years have been inconsistent. PPSV23 contains 12 serotypes in common with PCV13 and 11 additional serotypes. In 2013, 38% of IPD among adults aged ≥65 years was caused by serotypes unique to PPSV23. Given the high proportion of IPD caused by serotypes unique to PPSV23, broader protection is expected to be provided through use of both PCV13 and PPSV23 in series. ACIP considered multiple factors when determining the optimal interval between a dose of PCV13 and PPSV23, including immune response, safety, the risk window for protection against disease caused by serotypes unique to PPSV23, as well as timing for the next visit to the vaccination provider.

Both PCV13 and PPSV23 should be administered routinely in series to all adults aged ≥65 years.

Pneumococcal vaccine-naïve persons. Adults aged ≥65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.

getting shotPrevious vaccination with PPSV23. Adults aged ≥65 years who have previously received ≥1 doses of PPSV23 also should receive a dose of PCV13 if they have not yet received it. A dose of PCV13 should be given ≥1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6–12 months after PCV13 and ≥5 years after the most recent dose of PPSV23.

Potential Time-Limited Utility of Routine PCV13 Use Among Adults ≥65 Years. The recommendations for routine PCV13 use among adults aged ≥65 years will be reevaluated in 2018 and revised as needed.

ACIP recommendations for routine use of PCV13 in adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants remain unchanged.

Concomitant administration of PCV13 and trivalent inactivated influenza vaccine (TIV) has been demonstrated to be immunogenic and safe. PCV13 can be coadministered with TIV in an adult immunization program. However, a randomized double-blind trial found slightly lower pneumococcal serotype–specific geometric mean concentrations and lower proportion achieving at least a fourfold rise in hemagglutination inhibition assay titer for one of three influenza subtypes (influenza A[H3N2]) with PCV13 plus TIV compared with PCV13 alone or TIV alone among adults aged ≥65 years. Currently, no data are available on coadministration with other vaccines (e.g., tetanus, diphtheria, and acellular pertussis vaccine or zoster vaccine) among adults.

Before administering PCV13, vaccination providers should consult the package insert for precautions, warnings, and contraindications. Vaccination with PCV13 is contraindicated in persons known to have a severe allergic reaction (e.g., anaphylaxis) to any component of PCV13 or PCV7 or to any diphtheria toxoid–containing vaccine.

Source: CDC

Airports in Guinea, Liberia and Sierra Leone are relying on a familiar tool to stop the spread of Ebola: the thermometer.

Airport staff are measuring the temperature of anyone trying to leave the country, looking for “unexplained febrile illness,” according to the Centers for Disease Control and Prevention, which is advising these countries on their exit screening processes.

Ebola ThermometerOther countries that are far from the infected region are screening passengers arriving from West Africa or who have a history of travel to the region. Temperature takers include Russia, Australia and India.

Travelers who exhibit an elevated fever, generally over 101.4 degrees Fahrenheit (though it varies by country), are stopped for further screening. That could mean a questionnaire or medical tests.

Critics of exit screening have pointed out the flaws in using thermometers: fever can lay dormant for two to 21 days in someone who’s been infected with Ebola, and low-grade fevers can be lowered further by simple medications like Tylenol or Advil.

While they can’t predict symptoms before they emerge, the CDC is prepared to thwart those trying to mask a fever with a pill.

“Airline and airport staff are trained to do visual checks of anyone who looks even slightly ill,” says Tai Chen, a quarantine medical officer from the CDC who returned from Liberia this past Tuesday. “And most airports are using multiple temperature checks, starting when you arrive on the airport grounds in your car until you get on the plane. Even if you take medication, your fever will likely have manifested by then.”

Here’s a look at the three methods that can be used in airport exit screening.

Ear Gun Thermometer:

Looks like: An electric toothbrush without the head.ear tests

How it works: The pointy end, covered with a plastic cap, goes in the patient’s ear while the other end is held by the airport employee six or eight inches away. After each use, the cap is discarded and replaced.

What it measures: The human ear drum’s temperature closely mimics the body’s internal temperature. The closer the thermometer can get to the ear drum without touching the fragile membrane, the more accurate the reading.

Is it accurate? The average ear gun thermometer doesn’t get close enough to the membrane to give a true reading, says Marybeth Pompeii, chief clinical scientist at Exergen, a thermometer company. Instead, it averages nearby temperatures and applies “an algorithm to produce the final temperature.” But Dr. Amesh Adalja, a public health expert for the Infectious Disease Society of America, says this margin of error won’t matter when it comes to catching Ebola patients: “Ear thermometers are accurate within a reasonable range. If you have a fever, these thermometers will register it.”

Other concerns: Because the same thermometer is used on many passengers, the device could become contaminated. All those plastic caps add to the expense. And the airport staff with the thermometer is in close proximity with potentially infectious passengers.

Also, the thermometers need to be calibrated correctly — which could explain how NPR correspondent Jason Beaubien registered a cool 91 degrees Fahrenheit in Sierra Leone last month. This temperature indicates extreme hypothermia, but was of little concern to the airport workers, who were looking for dangerously high temperatures, not low.

Full-Body Infrared Scanners

Looks like: It’s a camera, sometimes mounted on a tripod. A passenger probably wouldn’t even notice it.scanner

How it works: Its heat-sensing abilities will turn you into a heat map on a computer screen.

Bonus: The scanner can assess a group of passengers and they don’t even have to stop to be screened.

What it measures: External body temperature. Passengers who show up as green and yellow – the colors for normal body temperatures — are cleared for travel. Anyone with a red forehead is stopped for further screening.

The full-body infrared scanner depicts body temperature with colors on a computer screen. China used the device during the 2003 outbreak of the respiratory virus SARS. Some airports have turned to the scanner as part of Ebola screening.

The full-body infrared scanner depicts body temperature with colors on a computer screen. China used the device during the 2003 outbreak of the respiratory virus SARS (pictured, above). Some airports have turned to the scanner as part of Ebola screening.

Is it accurate? These machines measure skin temperature as a proxy for core body temperature, which isn’t always reliable.

“They measure the heat radiating off of someone,” says Adalja. “That’s not quite the same as internal body temperature.”

Pompeii thinks they are too easily fooled.

“You can just go to the ladies room and splash some water on your forehead. You’re going to exhibit evaporative cooling, even if you have a high fever. And you’ll just sail through,” says Pompeii. Meanwhile, she notes that rushing to catch a flight or having an alcoholic drink could raise your external temperature.

The FDA hasn’t approved full-body infrared scanners for use in the U.S., but they were popular in Asia during the SARS and Avian flu epidemics.

According to a 2011 study in the journal BMC Infectious Diseases, these machines correctly identify a passenger as febrile or non-febrile less than 70 percent of the time. This means healthy passengers could be stopped unnecessarily, and infected passengers could be getting on a plane.

Handheld Infrared Thermometer:

Looks like: A handheld ray gun.handheld

How it works: From a distance of about six inches, the airport employee points the laser at a passenger’s hand or forehead and the infrared technology can estimate the body’s internal temperature. Originally invented for industrial use to measure the temperature of extremely hot or cold items, the handheld thermometer has obvious appeal in a disease outbreak.

“You don’t have to touch anyone,” says Francisco Alvarado-Ramy, a medical officer for the Center for Disease Control. “The risk of cross-contamination and infection is less, and you spend less time worrying about disinfecting the tool.”

The process is also less invasive than the ear gun and more thorough than the full-body infrared scanners.

Is it accurate? “When you are holding something away from the individual, there is dust, air current, humidity, and these things can affect the temperature measurement,” says Pompeii. “And your inch is different than my inch, which means everyone is measuring slightly differently.”

Despite these variances, the FDA approves most handheld infrared thermometers for use in medical settings. They are also the thermometer of choice for the U.S. government, which donated 30 of these infrared scanners for use in the Nigerian airport on Aug. 24.

“The move in hospitals is toward these infrared thermometers,” says Adalja. “They are within the range of the most accurate temperatures.”

Postscript: There is one way of checking temperature that is far more reliable than the rest.

“The most accurate temperature is achieved with a rectal thermometer,” says Pompeii. “But I don’t think airlines can do that.”

Source: NPR.com

A progressively rising blood pressure trajectory is not an inevitable part of aging in men who remain active and maintain high levels of cardiorespiratory fitness, a prospective, population-based study found.

exerciseThe study included almost 14,000 men without high blood pressure, cardiovascular disease, or cancer at baseline followed for three and a half decades.

Men in the study who were categorized as having the lowest level of fitness, based on baseline treadmill tests, reached a systolic blood pressure (SBP) of >120 mmHg at approximately 46 years of age, compared with 54 years of age among those whose fitness levels were highest. Age-related diastolic blood pressure differences (DBP) were far more pronounced, with low-fitness men reaching >80 mmHg at approximately 42 years old compared with beyond age 90 in the highest fitness group.

“This suggests that highly fit men are likely to reach abnormal SBP values about a decade later than men in the low fitness category, implying that improving fitness levels may reduce the duration of elevated SBP,” researcher Junxiu Liu, MD, of the University of South Carolina Columbia, and colleagues wrote in the Journal of the American College of Cardiology, published online Sept. 15.

Exercise Keeps Heart Young

The study is one of two published in the issue suggesting that staying physically fit throughout life can keep aging hearts healthy.

In a separate investigation, researchers in Texas examined the impact of long-term exercise on left ventricular (LV) compliance and distensibility in around a hundred older men and women.

The study showed that while low levels of casual, lifelong exercise did not prevent decreased compliance and distensibility, four to five ≥30 minute exercise sessions a week throughout adulthood did prevent most age-related LV stiffness.

“This finding holds important implications for global health, as ventricular stiffening has been implicated in the pathophysiology of many common cardiovascular conditions affecting the elderly,” researcher Paul S. Bhella, MD, of the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, and colleagues, wrote.blood pressure

Fit Men Had ‘Younger’ BP

The study by Liu and colleagues included an all male cohort from the Aerobics Center Longitudinal Study, which was a large study that included mostly white, college-educated people with middle to high socioeconomic status.

The men were between the ages of 20 and 90 at study entry, and they completed between three and 28 (mean 3.8) follow-up medical examinations between 1970 and 2006. Fitness was measured by a maximal treadmill exercise test, and longitudinal data were analysed using linear mixed models.

Cardiovascular fitness was assessed using the Balke maximal treadmill exercise test, with total treadmill time (highly correlated with oxygen uptake) used as an index of aerobic power. Participants were classified into low (<33rd percentile), moderate (33rd to 66th percentile), or high fitness categories (>66th percentile), according to the distribution of age-specific treadmill time.

Information on age, smoking status, and alcohol consumption were obtained by self-administered questionnaire. Body fat percentage was assessed using hydrostatic weigh in, skin fold thickness measurements, or both.

Among the key findings from the study:

-DBP tended to increase until nearly 60 years of age, when a decrease was observed, while SBP tended to increase over all age periods.

-Multivariate analysis revealed that average SBP increased by 0.30 mmHg (95% CI 0.29-0.31) with 1-year age increment after adjusting for body fat percent, fitness, resting heart rate, glucose level, triglyceride level, cholesterol level, current smoking, heavy alcohol consumption, and parental history of hypertension.

– had a yearly increase of 0.14 mm Hg (95% CI 0.13-0.15) before age 60 years.

-Overall, abnormal SBP (>120 mm Hg) began to occur at approximately 50 years of age and abnormal DBP (>80 mm Hg) began to occur at 60 years of age.

-Higher fitness levels significantly modified the risk in SBP trajectory across the lifespan, and the age-fitness interaction remained significant after adjusting for known hypertension risk factors.

Study strengths included the large number of participants, the longitudinal measure of SBP, DBP, and other time varying covariates, and the assessment of body fat percentage to measure obesity.

Limitations included the exclusion of women from the study, as well as the inclusion of only a small percentage (5%) of nonwhite and low income men, which limited its generalizability to these populations.

Findings May Not Apply to Women, Nonwhite Men

In an editorial accompanying the study, Stanley S .Franklin, MD, of the University of California Irvine, and Gary L. Pierce, PhD, of the University of Iowa, Iowa City, wrote that the exclusion of women was a major study limitation.

“There is some evidence that men have a steeper rate of increase in aortic stiffening beyond 50 years of age compared with women; therefore, fitness may have a different modifying effect on SBP and DBP trajectory with aging in women than men,” they wrote.

Even with the limitations, Franklin and Pierce wrote that the study suggests “habitual aerobic exercise may counteract the burden of cardiometabolic abnormalities that accelerate artery stiffening- characterized as ‘early vascular aging’ — and therefore slow the onset and severity of isolated systolic hypertension.”

Regular Exercise Preserves LV Function

In the study by Bhella and colleagues, 102 healthy older people (>64 years of age) were recruited and screened for lifelong patterns of exercise. The participants were stratified into four groups: sedentary (<2 ≥30 minute sessions/week), casual (2 to 3 sessions/week) committed (4 to 5 sessions/week) and competitive (6 to 7 sessions/week).

Right heart catheterization and echocardiography were performed while pre-load was manipulated using lower body negative pressure and rapid saline infusion to define LV pressure-volume relationships.

Peak oxygen uptake and LV mass increased with escalating doses of lifelong exercise, with little change in systolic function. At baseline, LV distensibility was greater in committed (21%) and competitive (36%) exercisers than in sedentary participants.

Group LV stiffness constants (sedentary: 0.062±0.039; casual: 0.079±0.052; committed: 0.055±0.033; and competitive: 0.035 ±0.033) revealed increased stiffness in sedentary subjects compared with competitive athletes, whereas lifelong casual exercise had no effect. They also showed greater compliance in committed exercisers than in sedentary or casual exercisers.

bp cupThe researchers noted that sedentary aging, and the decreases in LV compliance and distensibility that accompany it, may set the stage for the cardiovascular conditions that affect the elderly, such as atrial fibrillation and heart failure with preserved ejection fraction.

In a commentary published with the study, Wilbur Y.W. Lew, MD, of the VA San Diego Healthcare System and the University of California San Diego, wrote that the effects of exercise on the heart are multifactorial and complex and that potential factors that prevent age-related changes in LV compliance include lowering blood pressure and arterial stiffness, decreasing cardiovascular comorbidities, improving endothelial function, and activating metabolic and signaling pathways to reduce chronic inflammation, fibrosis, and LV remodeling.

“A long-term commitment to exercise preserves LV compliance comparable to a young heart,” he wrote. “This may facilitate diastolic filling and preserve diastolic function. We face challenges to establishing causality, identifying mechanisms, and applying these results to an increasingly sedentary population.”

Source: medpagetoday.com

In an analysis of cohort studies, a history of kidney stones was associated with an increased risk for coronary heart disease (CHD) and stroke. The data suggest that the risk may be higher in women than men.

The studies included close to 50,000 patients with kidney stones and 3.56 million controls. Results found kidney stone history to be associated with a 19% greater risk for CHD and a 40% greater risk for stroke. Additionally, women showed a statistically significant increased risk for myocardial infarction, while men did not.

The researchers noted that a lack of studies separately evaluating for effect modification by sex, along with other limitations, could explain the risk difference among men and women. Though, they added that several recent studies have shown a gender difference in kidney stone-related CHD and stroke risk.

One was reported in JAMA in July 2013. kidney stones

The prospective study included 45,748 men and 196,357 women in the U.S. without a history of CHD at baseline, including 19,678 who reported a history of kidney stones. Two cohorts of women and one of men were followed for up to 24 years.

The study found that women with a history of kidney stones had about an 18% increased risk for CHD and a 48% increased risk compared with women who had never had a kidney stone.

An even larger study from Alberta, Canada, reported in March of this year, showed similar differences in risk by gender.

The study included close to 3.2 million people registered in Alberta’s universal healthcare system between 1997 and 2009 who were followed for a median of 11 years.

The study showed that people who had at least one kidney stone had a 40% higher risk for heart attack, a 63% higher risk for blockage of blood flow to the heart and other organs, and a 26% higher risk for stroke. The magnitude of increased risk appeared more pronounced for women than men.

Both studies were included in the newly-published meta-analysis.

Gary C. Curhan, MD, who was a co-author on both, said the new data make a strong case for a real gender difference in cardiovascular disease risk associated with kidney stone history.

Curhan is a professor of medicine at Harvard Medical School and a renal disease specialist at Brigham and Women’s Hospital, Boston.

“The risk certainly seems to be higher in women than men, but I would not say the risk is zero in men.” “These two studies give us more confidence that this association is real. The next step is to try and answer the question ‘Why is there a difference?'”

Source: medpage Today

sick at office

If someone infected with a stomach bug walked into an office and began touching things, how long would it take for that virus to spread around the whole building? Within as little as two hours, concludes a new study.

Viruses can contaminate a single doorknob or elevator button and then spread through an entire office, hotel, or health care facility within two to four hours, the study found.

The research was designed to track not only how fast viruses can spread, but also what works to stop them.

For the experiment, microbiologist Charles Gerba of the University of Arizona, Tucson, and his team decided to deliberately infect a building. They used something called bacteriophage MS-2, a kind of virus that lives and multiplies within bacteria. They chose this particular bacteriophage because it is similar in size and resists disinfectants in the same way as noroviruses.

Noroviruses are the most common cause of gastroenteritis – often called stomach flu – and outbreaks are common in health care facilities and cruise ships. That’s because the viruses can live on surfaces for days and infect humans easily when they touch the contaminated surfaces and then touch their mouths.

For the experiment, the researchers dabbed the bacteriophage on one or two commonly touched surfaces, such as a doorknob or tabletop, in office conference rooms as well as in a health care facility.

hand sanitizerAfter a few hours, they then sampled 60 to 100 surfaces that were capable of carrying infectious organisms, such as light switches, countertops, push buttons, coffee pot handles, faucet handles, phones and computer equipment.

Within two to four hours, between 40 to 60 per cent of the surfaces they sampled were contaminated with the phage.

The researchers then looked at what could stop the spread of the phage.

Cleaning personnel were provided with disinfectant wipes containing QUATS (quaternary ammonium compounds), which are considered effective against viruses such as norovirus and flu. QUAT-based wipes and cleaners are generally used only by professional maintenance teams.

After disinfection, the number of surfaces on which virus was detected was reduced by 80 per cent or more. The concentration of the virus was also reduced by 99 percent or more.

“The results shown that viral contamination of (surfaces) in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses,” Gerba said in a statement.

The research was presented at this week’s Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, which is a meeting of the American Society for Microbiology.

Source: CTV News

Lou Gehrig ALS

Amyotrophic lateral sclerosis has been all over the news lately because of the ubiquitous A.L.S. ice bucket challenge. That attention has also reinvigorated a long-simmering scientific debate about whether participating in contact sports or even vigorous exercise might somehow contribute to the development of the fatal neurodegenerative disease, an issue that two important new studies attempt to answer.

Ever since the great Yankees first baseman Lou Gehrig died of A.L.S. in 1941 at age 37, many Americans have vaguely connected A.L.S. with athletes and sports. In Europe, the possible linkage has been more overtly discussed. In the past decade, several widely publicized studies indicated that professional Italian soccer players were disproportionately prone to A.L.S., with about a sixfold higher incidence than would have been expected numerically. Players were often diagnosed while in their 30s; the normal onset is after 60.

These findings prompted some small, follow-up epidemiological studies of A.L.S. patients in Europe. To the surprise and likely consternation of the researchers, they found weak but measurable associations between playing contact sports and a heightened risk for A.L.S. The data even showed links between being physically active — meaning exercising regularly — and contracting the disease, raising concerns among scientists that exercise might somehow be inducing A.L.S. in susceptible people, perhaps by affecting brain neurons or increasing bodily stress.

But these studies were extremely small and had methodological problems. So to better determine what role sports and exercise might play in the risk for A.L.S., researchers from across Europe recently combined their efforts into two major new studies.

The more impressive of these, which was published in May in Annals of Neurology, involved almost two dozen researchers from five nations, who developed a deceptively simple but scientifically rigorous research approach. They asked 652 A.L.S. patients if they’d be willing to talk about their lives and activities and did the same with 1,166 people of matching ages, genders and nationalities. They conducted extensive in-person interviews with each volunteer, asking them how active they had been in professional or amateur sports, at their jobs and during leisure time. They also asked about past histories of injuries and accidents, including concussions and other head trauma but also other injuries.

They then compared answers from the people with A.L.S. to those of healthier people.

The results should reassure those of us who exercise. The numbers showed that physical activity — whether at work, in sports or during exercise — did not increase people’s risk of developing A.L.S. Instead, exercise actually appeared to offer some protection against the disease. Even pro athletes showed no heightened risk, although they represented such a tiny subset of the patients with A.L.S. that firm conclusions cannot be drawn, the researchers say.

One aspect of people’s lives did significantly increase their risk of developing A.L.S.: a history of multiple hits to the head. Men and women who had sustained at least two concussions or other serious head injuries were much more likely than other people, including never-concussed athletes, to develop A.L.S.

ice bucket

These results coincide closely with those of the other new study, a review article published in July in the European Journal of Epidemiology, which gathered data from 50 years’ worth of epidemiological studies related to A.L.S. risk (including the other new study) and teased out the effects of physical activity. Most of the studies were limited in scope, but they amplified one another’s validity when combined, the researchers thought.

And their main finding was that “in the general population, physical activity is not a risk factor for A.L.S.,” said Dr. Benoit Marin, a neuroepidemiologist at the French Institute of Health and Medical Research in Paris who oversaw the new review.

But as Dr. Marin also pointed out, the studies involved were all associational, meaning that they cannot establish cause and effect. Exercise and a reduced risk for A.L.S. might be linked to other lifestyle factors, such as a healthy diet, and not to each other.

The new studies also cannot dispel the lingering and troubling questions about the effects of head injuries from contact sports.

“I would not consider this issue settled,” said Ettore Beghi, a neuroscientist at the Mario Negri Institute for Pharmacological Research in Milan and senior author of the study published in May in Annals of Neurology.

In the United States, a few researchers have begun to look at football and A.L.S. risk, a plausible research concern, Dr. Beghi said, given evidence that head trauma sustained playing football might contribute to neurodegenerative diseases. But to date, the football data has been inconclusive.

For now, he and other scientists are continuing to study Italian soccer players, as well as athletes in other sports, including rugby, which, for some reason, confers no increased risk of A.L.S., although it involves considerable contact. Such research may ultimately “shed some light on the underlying mechanisms of the disease, which are still poorly understood,” Dr. Beghi said.

The greatest obstacle to advancing the research, he added, is “the lack of funding,” a situation that could be ameliorated, somewhat, with all of that ice dousing.

Source: New York Times

Airlines and sun exposure

Pilots and flight attendants may be at an increased risk of developing the most deadly form of skin cancer, suggests a new analysis.

While the study cannot pinpoint why flight crews are at higher risk, the researchers suggest it could be the result of greater exposure to ultraviolet (UV) radiation, which causes damage to the DNA in skin cells, at high altitudes.

“This is very worrisome and awareness needs to increase and protective measurements must be undertaken,” said the study’s lead author, Dr. Martina Sanlorenzo from the University of California, San Francisco.

Pilots and other members of the cabin crew should be aware of the increased risk, she told Reuters Health in an email. Additionally, they should get skin checks and protect themselves from UV radiation.

Skin cancer is the most common form of cancer in the U.S., Sanlorenzo and her colleagues write in JAMA Dermatology.

Over 3.5 million Americans will be diagnosed with skin cancers in 2014, according to the American Cancer Society. About 76,000 people will be diagnosed with melanoma, which is the type of skin cancer that is most likely to lead to death.

Past studies have suggested that airline pilots and other flight crew members are prone to getting more skin cancers, but the association was poorly understood, the researchers write.

For the new analysis, they combined data from 19 previous studies published between 1990 and 2013. In total, they had data on over a quarter million people.

The researchers used a measure known as standardized incidence ratio, which helps gauge whether the cancer cases observed among specific groups of people are more or less than what would be expected in the general population.

According to the National Cancer Institute, the average American has about a 2 percent risk of developing melanoma during his or her lifetime.

Among participants in the 19 studies, the researchers found that melanoma was about twice as common among pilots and flight crew members than would be expected in the general population.

The researchers caution that they can’t say why cabin crews may be more likely to develop melanoma. It could be due to greater exposure to solar radiation as altitude increases and the protective barrier of the atmosphere thins.

There may, however, be other unknown factors among cabin crews, apart from UV exposure, that affect their melanoma risk, the study team writes.

The researchers don’t have any data on airplane passengers, but Sanlorenzo notes that “frequent flyers that fly as often as cabin crew should get regular skin checks and protect themselves from UV radiation.”

She suggested that the U.S. Federal Aviation Administration should take more measurements of how much UV radiation pilots and cabin crews are exposed to inside commercial planes, versus, for example, aircraft with special radiation-blocking windows.

“A prospective study could be done studying melanoma incidence in pilots/cabin crew flying airplanes where windows block UVA and UVB (radiation) entirely,” she said.

UVA and UVB radiation from the sun damage skin-cell DNA and are partly responsible for skin aging and for promoting skin cancer.

Source: Reuters

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