Health & Fitness (140)
Doctors initially attributed the donor's death to other causes. But during an investigation prompted by the kidney recipient's death in February, lab testing found evidence of rabies in the donor's brain tissue and also detected encephalitis, a brain inflammation that can be caused by rabies.
The virus was consistent with raccoon rabies and was nearly identical to a virus found in the transplanted kidney and other tissue from the recipient, an Army veteran from Maryland, said the report, compiled by researchers from the federal Centers for Disease Control and Prevention and others and published Tuesday in the Journal of the American Medical Association.
Investigators don't know if organs given to three other patients - the North Carolina donor's heart, liver and second kidney-were infected with the rabies virus, but all three were considered at risk. Their recipients received anti-rabies treatment "and to date remain well," said CDC researcher Dr. Neil Vora, the lead author.
While the case is rare, it underscores the need to improve screening for would-be organ donors with suspected encephalitis, the report's authors say. They say a uniform donor questionnaire could help better identify risk factors for the virus and that rabies should be considered in donors with unexplained encephalitis.
The United Network for Organ Sharing issued guidance last year to help organ procurement organizations screen for encephalitis and other central nervous system infections in potential donors. It urged caution in accepting organs from donors with an untreated central nervous system infection.
The researchers want to improve awareness that rabies can be the cause of encephalitis, said co-author Dr. Sridhar Basavaraju, another CDC researcher. But he added, "We wouldn't want to mandate any screening that would potentially exclude transplantable organs."
The study is based on a review of laboratory tests and medical records, and interviews with relatives of the organ donor and recipient. It provides the most detailed account of the chain of events that led to the two deaths and the investigation that followed, which prompted health authorities to recommend vaccines for dozens of people who were in contact with the donor or recipients.
The case attracted public attention because of the rare circumstances, including the long time between infection and death of the transplant recipient - about a year and a half.
It was just the third documented transmission of rabies through a solid organ transplant, the report says.
Also, there are only roughly two human rabies deaths in the United States each year, and all but two domestic cases between 2000 and 2010 were linked to bats, according to the report. The authors say raccoons pose an under-recognized risk for infection and their spread into urban areas raises concern.
The patient who received the North Carolina donor's kidney at the Walter Reed National Military Medical Center in Bethesda, Md. in September 2011 has not been publicly identified.
The donor was 20-year-old William Edward Small, an avid outdoorsman from North Carolina who got sick after a fishing trip in Florida, where he was undergoing Air Force training.
Small's initial symptoms included nausea, vomiting and fever - which could indicate rabies but also other less serious conditions that are much more common. Doctors thought Small had eaten tainted fish.
Questioned during the organ procurement process, relatives said they didn't know of any recent risk of rabies exposure, and doctors did not test him.
Investigators say they learned during subsequent interviews that Small trapped raccoons for use as bait during hunting-dog training exercises, and had been bitten at least twice by the animals, 18 months and seven months before developing symptoms. He was not treated for those bites.
"If you don't ask specific questions, you don't get specific answers," said Dr. Michael Green, chairman of an advisory committee on disease transmission for the United Network for Organ Sharing.
"At the time these questions are being asked initially, families are often traumatized, in shock," Green said. "They're losing a loved one. They may not be thinking normally or straight or remember all those details."
---- JAMA: HTTP://WWW.JAMA.COM
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The manufacturer of the Plan B One Step morning-after contraceptive has been granted exclusive rights by the FDA to market their drug over-the-counter without age restrictions. The decision was released earlier this week.
The Food and Drug Administration approved Teva Pharmaceuticals' Plan B One Step for over the counter sale...no prescription or proof of age required. In its decision, the FDA granted a three year period during which Teva can sell its' single tablet product exclusively on pharmacy shelves, while generic drugs will still require a prescription for young women 16 and younger.
Most metro St. Louis pharmacies carry Teva's Plan B, which is a two-pill dosage and some already have the Plan B One Step in the pharmacy. The FDA decision will now move that product on to the store shelves.
A study of older men found those who regularly skipped breakfast had a 27 percent higher risk of a heart attack than those who ate a morning meal. There's no reason why the results wouldn't apply to other people, too, the Harvard researchers said.
Other studies have suggested a link between breakfast and obesity, high blood pressure, diabetes and other health problems seen as precursors to heart problems.
"But no studies looked at long-term risk of heart attack," said Eric Rimm, one of the study authors at the Harvard School of Public Health.
Why would skipping breakfast be a heart attack risk?
Experts aren't certain, but here's what they think: People who don't eat breakfast are more likely to be hungrier later in the day and eat larger meals. Those meals mean the body must process a larger amount of calories in a shorter amount of time. That can spike sugar levels in the blood and perhaps lead to clogged arteries.
But is a stack of syrupy pancakes, greasy eggs and lots of bacon really better than eating nothing?
The researchers did not ask what the study participants ate for breakfast, and were not prepared to pass judgment on whether a fatty, sugary breakfast is better than no breakfast at all.
Other experts agreed that it's hard to say.
"We don't know whether it's the timing or content of breakfast that's important. It's probably both," said Andrew Odegaard, a University of Minnesota researcher who has studied a link between skipping breakfast and health problems like obesity and high blood pressure.
"Generally, people who eat breakfast tend to eat a healthier diet," he added.
The new research was released Monday by the journal Circulation. It was an observational study, so it's not designed to prove a cause and effect. But when done well, such studies can reveal important health risks.
The researchers surveyed nearly 27,000 men about their eating habits in 1992. About 13 percent of them said they regularly skipped breakfast. They all were educated health professionals - like dentists and veterinarians - and were at least 45.
Over the next 16 years, 1,527 suffered fatal or non-fatal heart attacks, including 171 who had said they regularly skipped breakfast.
In other words, over 7 percent of the men who skipped breakfast had heart attacks, compared to nearly 6 percent of those who ate breakfast.
The researchers calculated the increased risk at 27 percent, taking into account other factors like smoking, drinking, diet and health problems like high blood pressure and obesity.
As many as 18 percent of U.S. adults regularly skip breakfast, according to federal estimates. So the study could be important news for many, Rimm said.
"It's a really simple message," he said. "Breakfast is an important meal."
Hawaii tops the charts in the government's first state-by-state look at how long Americans age 65 can expect to live, on average, and how many of those remaining years will be healthy ones.
Retirement-age Mississippians fared worst, with only about 17 1/2 more years remaining and nearly seven of them in poorer health.
U.S. life expectancy has been growing steadily for decades, and is now nearly 79 for newborns. The figures released Thursday by the Centers for Disease Control and Prevention estimate life expectancy for people 65 years old, and what portion will be free of the illnesses and disabilities suffered late in life.
"What ultimately matters is not just the length of life but the quality of life," said Matt Stiefel, who oversees population health research for Kaiser Permanente.
The World Health Organization keeps "healthy life expectancy" statistics on nearly 200 countries, and the numbers are used to determine the most sensible ages to set retirement and retirement benefits. But the measure is still catching on in the United States; the CDC study is the first to make estimates for all 50 states.
Overall, Americans who make it to 65 have about 19 years of life ahead of them, including nearly 14 in relatively good health, the CDC estimated.
But the South and parts of the Midwest clearly had lower numbers. That's not a surprise, experts said.
Southern states tend to have higher rates of smoking, obesity, diabetes, heart disease, and a range of other illnesses. They also have problems that affect health, like less education and more poverty.
These are issues that build up over a lifetime, so it's doubtful that moving to Hawaii after a lifetime in the South will suddenly give you more healthy years, they said.
After Mississippi, Kentucky, West Virginia and Alabama had the lowest numbers for both life expectancy and healthy life expectancy. States with the best numbers included Florida - a magnet for healthy retirees - as well as Connecticut and Minnesota.
The estimates were made using 2007 through 2009 data from the census, death certificates and telephone surveys that asked people to describe their health. The CDC's Paula Yoon cautioned not to make too much of the differences between states. Results could have been swayed, for example, by how people in different states interpreted and answered the survey questions.
- Nationally, women at 65 can expect nearly 15 more years of healthy life. Men that age can expect about 13 years.
- Blacks fared much worse than whites. They could expect 11 years of healthy life, compared to more than 14 for whites.
The CDC report makes "painfully clear" the disparities in the health of whites and blacks in their final years, said Ellen Meara, a health economist at Dartmouth College.
CHICAGO (AP) - A pair of new Illinois laws will fund diabetes research and track economic costs of the disease.
Gov. Pat Quinn signed the bills Thursday at a conference organized by the University of Chicago Medicine's Kovler Diabetes Center.
One measure creates a special license plate. Just over half of the $40 cost of the plate will go to the Diabetes Research Checkoff Fund.
House minority leader Tom Cross sponsored the bill. He hopes the license plate will serve as a "moving billboard" for diabetes awareness.
The second bill requires the Illinois State Diabetes Commission to report regularly on the economic and social costs of diabetes and efforts to prevent the disease.
The laws take effect Jan. 1.
The Illinois Department of Public Health says about 800,000 state residents have diabetes.
An experimental surgical knife can help surgeons make sure they've removed all the cancerous tissue, doctors reported Wednesday. Surgeons typically use knives that heat tissue as they cut, producing a sharp-smelling smoke. The new knife analyzes the smoke and can instantly signal whether the tissue is cancerous or healthy.
Now surgeons have to send the tissue to a lab and wait for the results.
Dr. Zoltan Takats of Imperial College London suspected the smoke produced during cancer surgery might contain some important cancer clues. So he designed a "smart" knife hooked up to a refrigerator-sized mass spectrometry device on wheels that analyzes the smoke from cauterizing tissue.
The smoke picked up by the smart knife is compared to a library of smoke "signatures" from cancerous and non-cancerous tissues. Information appears on a monitor: green means the tissue is healthy, red means cancerous and yellow means unidentifiable.
To make sure they've removed the tumor, surgeons now send samples to a laboratory while the patient remains on the operating table. It can take about 30 minutes to get an answer in the best hospitals, but even then doctors cannot be entirely sure, so they often remove a bit more tissue than they think is strictly necessary.
If some cancerous cells remain, patients may need to have another surgery or undergo chemotherapy or radiation treatment.
"(The new knife) looks fabulous," said Dr. Emma King, a head and neck cancer surgeon at Cancer Research U.K., who was not connected to the project. The smoke contains broken-up bits of tumor tissue and "it makes sense to look at it more carefully," she said.
The new knife and its accompanying machines were made for about >250,000 ($380,000) but scientists said the price tag would likely drop if the technology is commercialized.
The most common treatment for cancers involving solid tumors is removing them in surgery. In the U.K., one in five breast cancer patients who have surgery will need further operations to get rid of the tumor entirely.
Scientists tested the new knife at three hospitals between 2010 and 2012. Tissue samples were taken from 302 patients to create a database of which kinds of smoke contained cancers, including those of the brain, breast, colon, liver, lung and stomach.
That was then used to analyze tumors from 91 patients; the smart knife correctly spotted cancer in every case. The study was published Wednesday in the journal Science Translational Medicine. The research was paid for by groups including Imperial College London and the Hungarian government.
At a demonstration in London on Wednesday, doctors used the new knife - which resembles a fat white pen - to slice into slabs of pig's liver. Within minutes, the room was filled with an acrid-smelling smoke comparable to the fumes that would be produced during surgery on a human patient.
Takats said the knife would eventually be submitted for regulatory approval but that more studies were planned. He added the knife could also be used for other things like identifying tissues with bad blood supply and identifying the types of bacteria present.
Some experts said the technology could help eliminate the guesswork for doctors operating on cancer patients. "Brain cancers are notorious for infiltrating into healthy brain tissue beyond what's visible to the surgeon," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "If this can definitively tell doctors whether they've removed all the cancerous tissue, it would be very valuable," he said.
Still, Lichtenfeld said more trials were needed to prove the new knife would actually make a significant difference to patients. Early enthusiasm for new technologies hasn't always panned out, he said, citing the recent popularity of robotic surgery as an example.
"It expanded very rapidly but is now hitting some bumps along the road," he said.
Lichtenfeld said it's unclear whether more widespread use of the smart knife will actually help patients live longer and said studies should also look into whether the tool cuts down on patient's surgery times, their blood loss and rate of wound infections.
"This is a fascinating science and we need to adopt any technology that works to save patients," Lichtenfeld said. "But first we have to be sure that it works."
It's by far the largest study to look at this, and researchers say the conclusion makes sense. Working tends to keep people physically active, socially connected and mentally challenged - all things known to help prevent mental decline.
"For each additional year of work, the risk of getting dementia is reduced by 3.2 percent," said Carole Dufouil, a scientist at INSERM, the French government's health research agency.
She led the study and gave results Monday at the Alzheimer's Association International Conference in Boston.
About 35 million people worldwide have dementia, and Alzheimer's is the most common type. In the U.S., about 5 million have Alzheimer's - 1 in 9 people aged 65 and over. What causes the mind-robbing disease isn't known and there is no cure or any treatments that slow its progression.
France has had some of the best Alzheimer's research in the world, partly because its former president, Nicolas Sarkozy, made it a priority. The country also has detailed health records on self-employed people who pay into a Medicare-like health system.
Researchers used these records on more than 429,000 workers, most of whom were shopkeepers or craftsmen such as bakers and woodworkers. They were 74 on average and had been retired for an average of 12 years.
Nearly 3 percent had developed dementia but the risk of this was lower for each year of age at retirement. Someone who retired at 65 had about a 15 percent lower risk of developing dementia compared to someone retiring at 60, after other factors that affect those odds were taken into account, Dufouil said.
To rule out the possibility that mental decline may have led people to retire earlier, researchers did analyses that eliminated people who developed dementia within 5 years of retirement, and within 10 years of it.
"The trend is exactly the same," suggesting that work was having an effect on cognition, not the other way around, Dufouil said.
France mandates retirement in various jobs - civil servants must retire by 65, she said. The new study suggests "people should work as long as they want" because it may have health benefits, she said.
June Springer, who just turned 90, thinks it does. She was hired as a full-time receptionist at Caffi Plumbing & Heating in Alexandria, Va., eight years ago.
"I'd like to give credit to the company for hiring me at that age," she said. "It's a joy to work, being with people and keeping up with current events. I love doing what I do. As long as God grants me the brain to use I'll take it every day."
Heather Snyder, director of medical and scientific operations for the Alzheimer's Association, said the study results don't mean everyone needs to delay retirement.
"It's more staying cognitively active, staying socially active, continue to be engaged in whatever it is that's enjoyable to you" that's important, she said.
"My parents are retired but they're busier than ever. They're taking classes at their local university, they're continuing to attend lectures and they're continuing to stay cognitively engaged and socially engaged in their lives."
-- AP Medical Writer Lindsey Tanner in Chicago contributed to this report.
Alzheimer's info: HTTP://WWW.ALZHEIMERS.GOV
Alzheimer's Association: HTTP://WWW.ALZ.ORG