Category "Health"

Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking.

We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort.

During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure, intestinal ischemia, hypertensive heart disease, infections, various respiratory diseases, breast cancer, and prostate cancer. Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased.

A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated.

Source: The New England Journal of Medicine

Limited data exists on the safety of MMR vaccine in adults. We reviewed reports of adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS) to assess safety in this previously under-studied group.

VAERS is the national spontaneous vaccine safety surveillance system co-administered by CDC and the FDA. We searched the VAERS database for US reports of adults aged 19 years and older who received MMR vaccine from January 1, 2003 to July 31, 2013. We clinically reviewed reports and available medical records for serious AEs, pregnancy reports, and reports for selected pre-specified outcomes.

During this period, VAERS received 3,175 US reports after MMR vaccine in adults. Of these, 168 (5%) were classified as serious, including 7 reports of death. Females accounted for 77% of reports. The most common signs and symptoms for all reports were pyrexia (19%), rash (17%), pain (13%) and arthralgia (13%). We did not detect any new safety findings in empirical Bayesian data mining. We identified 131 reports of MMR vaccine administered to a pregnant woman; the majority of these vaccinations were in the first trimester and in 83 (62%), no AE was reported.

In our review of VAERS data, we did not detect any new or unexpected safety concerns for MMR vaccination in adults. We identified reports of pregnant women exposed to MMR which is a group in whom the vaccine is contraindicated, suggesting the need for continued provider education on vaccine recommendations and screening.

Source: Oxford Journals

Isolated systolic hypertension in young and middle-age adults was associated with an increased risk of death from cardiovascular causes later in life, according to a study done over 3 decades.

Men in the study with systolic blood pressure (BP) levels of 140 mmHg or higher and diastolic BP below 90 had a 28% increased risk for death from coronary heart disease compared with men with normal BP (hazard ratio 1.28, 95% CI 1.04-1.58), reported Donald M. Lloyd-Jones, MD, of Northwestern University Feinberg School of Medicine in Chicago.

In addition, women with isolated systolic hypertension (ISH) had a more than twofold greater death risk (HR 2.12, 95% CI 1.49-3.01) than women with optimal BP, they wrote in the Journal of the American College of Cardiology.

The findings provide strong evidence that ISH is a clinically meaningful condition in young and middle-age adults and not just pseudo or ‘white-coat’ hypertension, Lloyd-Jones told MedPage Today.

“It is not well supported by science, but there has been a belief by many that elevated systolic and not diastolic blood pressure in younger adults is benign,” he said. “Most previous research hasn’t really examined hypertension by subtype. That’s why we did this study.”

ISH is defined as a systolic BP of 140 mmHg or greater with a diastolic BP of less than 90 mmHg. It is common in the elderly, but relatively uncommon in younger and middle-age adults, the researchers wrote.

NHANES data suggest that the overall prevalence of ISH among adults in their 20s and 30s has more than doubled in recent decades, from 0.7% between 1988 and 1994 to 1.6% between 1999 and 2004, but there is still a great deal of uncertainty about the clinical consequences of ISH in younger adults.

Source: MedPage Today

In recent years, many people who exercise have begun wearing compression clothes. These snug-fitting socks, shorts, tights or shirts, which squeeze muscles as tightly as sausage casings, are reputed to improve performance during exercise and speed recovery afterward.

But a new study and several reviews of relevant research raise interesting questions about whether the garments really function as expected and help people to exercise better and, if they do, whether it is the clothing or people’s expectations doing most of the work.

The rationales for wearing compression clothing are logical enough. “The garments supposedly increase blood circulation and thus oxygen delivery for improved sport performance,” said Abigail Stickford, a postdoctoral researcher at the Institute for Exercise and Environmental Medicine at the University of Texas Southwestern Medical Center in Dallas, who led the new study of compression clothes.

The clothes also are thought to refine proprioception, which is someone’s sense of how the body is positioned in space. Better proprioception should, in theory at least, improve the efficiency of movement and reduce the number of muscles that need to be activated, making exercise less tiring.

Meanwhile, the clothes also are believed to reduce fatigue and soreness after exercise by literally squeezing the muscles with a kind of no-hands massage and, by increasing blood flow to muscles, help to flush out unwanted exercise-related biochemical.

Source: The New York Times

Both the incidence and mortality rates of Colon and Rectal Cancers have been decreasing in the United States, a trend that is largely attributed to the widespread screening of persons 50 years and older.

However, researchers from the University of Texas MD Anderson Cancer Center in Houston have highlighted a concerning trend: incidence rates are actually rising in young adults.

The most pronounced increase, which was observed in patients between 20 and 34 years old, was in the incidence of colon and rectal cancer at all stages (localized, regional, and distant).

Authors of a recent study analyzed Surveillance, Epidemiology, and End Results data for 393,241 patients with CRC between 1975 and 2010 and evaluated the age at diagnosis in 15-year intervals, beginning at age 20 years.

The overall age-adjusted incidence rates decreased by 0.92% during the study period.

However, although there has been a steady decrease in incidence among persons 50 years and older, the opposite is true for those in younger age groups, according to the authors, led by principal investigator George J. Chang, MD, associate professor, Departments of Surgical Oncology and Health Services Research at MD Anderson.

Source: The JAMA Network

*The Center’s Executive Physical includes Colon and Rectal Cancer screening and tumor marker tracking.

Investigators working to unravel the impact of genetics versus environment on traits such as obesity may also need to consider a new factor: when individuals were born.

In the current issue of PNAS Early Edition a multi-institutional research team reports finding that the impact of a variant in the FTO gene that previous research has linked to obesity risk largely depends on birth year, with no correlation between gene variant and obesity in study participants born in earlier years and a far stronger correlation than previously reported for those born in later years.

“Looking at participants in the Framingham Heart Study, we found that the correlation between the best known obesity-associated gene variant and body mass index increased significantly as the year of birth of participants increased,” says Harvard Medical School instructor James Niels Rosenquist of the Massachusetts General Hospital (MGH) Department of Psychiatry, lead author of the report. “These results — to our knowledge the first of their kind — suggest that this and perhaps other correlations between gene variants and physical traits may vary significantly depending on when individuals were born, even for those born into the same families.”

The authors note that most studies of interactions between genes and the environment have looked at differences within specific birth cohorts —groups born during a particular span of years — which would not account for changes in the larger environment that take place over time. To investigate whether different conditions experienced by different age groups might alter the impact of a gene variant, they analyzed data from participants in the Framingham Offspring Study (which follows the children of participants in the original study) gathered between 1971, when participants ranged in age from 27 to 63, and 2008.

Source: Harvard Gazette

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

Scientists from the Johns Hopkins Kimmel Cancer Center have created a statistical model that measures the proportion of cancer incidence, across many tissue types, caused mainly by random mutations that occur when stem cells divide. By their measure, two-thirds of adult cancer incidence across tissues can be explained primarily by “bad luck,” when these random mutations occur in genes that can drive cancer growth, while the remaining third are due to environmental factors and inherited genes.

“All cancers are caused by a combination of bad luck, the environment and heredity, and we’ve created a model that may help quantify how much of these three factors contribute to cancer development,” says Bert Vogelstein, M.D., the Clayton Professor of Oncology at the Johns Hopkins University School of Medicine, co-director of the Ludwig Center at Johns Hopkins and an investigator at the Howard Hughes Medical Institute.

“Cancer-free longevity in people exposed to cancer-causing agents, such as tobacco, is often attributed to their ‘good genes,’ but the truth is that most of them simply had good luck,” adds Vogelstein, who cautions that poor lifestyles can add to the bad luck factor in the development of cancer.

The implications of their model range from altering public perception about cancer risk factors to the funding of cancer research, they say. “If two-thirds of cancer incidence across tissues is explained by random DNA mutations that occur when stem cells divide, then changing our lifestyle and habits will be a huge help in preventing certain cancers, but this may not be as effective for a variety of others,” says biomathematician Cristian Tomasetti, Ph.D., an assistant professor of oncology at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health. “We should focus more resources on finding ways to detect such cancers at early, curable stages,” he adds.

In a report on the statistical findings, published Jan. 2 in Science, Tomasetti and Vogelstein say they came to their conclusions by searching the scientific literature for information on the cumulative total number of divisions of stem cells among 31 tissue types during an average individual’s lifetime. Stem cells “self-renew,” thus repopulating cells that die off in a specific organ.

Source: News Medical

*The Presidential Healthcare Center’s Executive Physicals include cancer screening and tumor marker tracking

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