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Bacteria Could Be Weapon Against Mosquito-Borne Dengue

By Robert Preidt
HealthDay Reporter

FRIDAY, Nov. 22, 2019 (HealthDay News) — Lab-altered mosquitoes have made a big dent in the spread of dengue fever, researchers report.

How? Australian scientists released mosquitoes carrying a bacteria that prevents transmission of the dengue virus.

The strategy resulted in a 76% decrease in dengue transmission in a community in Indonesia that has frequent dengue outbreaks. Similar reductions were seen in an urban area near Rio de Janeiro, and around Nha Trang, Vietnam.

Releases of Wolbachia-carrying mosquitoes in Far North Queensland, Australia, that began eight years ago led to a 96% decline in cases of dengue transmission, the World Mosquito Program (WMP) researchers said.

The findings were presented Nov. 21 at the annual meeting of the American Society of Tropical Medicine and Hygiene, in National Harbor, Md. Such research is considered preliminary until published in a peer-reviewed journal.

Dengue is a mosquito-borne virus that causes intense joint pain and can also trigger deadly complications. There are no drugs to treat dengue infection. There is a vaccine, but it’s been plagued with safety problems.

There’s been a worldwide increase in dengue infections, and there are fears that climate change will make it worse, the investigators said.

“We are very encouraged by the public health impact we are seeing — it highlights the potential of this approach to fight dengue and related mosquito-borne diseases at a global scale,” said Cameron Simmons, director of impact assessment and an expert in the epidemiology of dengue at WMP.

“Evidence is rapidly accumulating that areas where Wolbachia-infected mosquitoes have been deployed have fewer reports of dengue than untreated areas,” Simmons added in a meeting news release.

Wolbachia-infected mosquitoes are created in the laboratory by injecting the bacteria into their eggs. The bacteria also has been shown to inhibit chikungunya and Zika, according to the researchers.

The Wolbachia field tests are ongoing and, given the promising results to date, are being expanded to Colombia, Sri Lanka, India and Western Pacific island nations.

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SOURCE: American Society of Tropical Medicine and Hygiene, news release, Nov. 21, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Infants May Not Be as Immune to Measles as Thought

By Elizabeth Heubeck
HealthDay Reporter

THURSDAY, Nov. 21, 2019 (HealthDay News) — A surprising new study upends the notion that antibodies passed from mother to fetus protect infants from measles for as much as a year.

In fact, infants’ immunity wanes much more rapidly than once thought, researchers report in the December issue of Pediatrics. The finding drives home the importance of community-wide immunizations.

Measles is a serious disease, particularly among infants. Not only do they have a higher risk of infection, but also complications and hospitalizations. They’re also most vulnerable to death,” said senior study author Shelly Bolotin, a scientist at Public Health Ontario, in Toronto, Canada.

For the study, the researchers tested blood samples from 196 infants under 12 months of age to determine the presence of measles antibodies. The results were unexpected.

In their first month of life, 20% lacked sufficient antibodies to protect against the highly contagious virus, the study found. At 3 months, 92% had antibody levels below the protective threshold. By 6 months, none had antibodies at levels that could protect against measles.

Typically, babies have been presumed to be immune to measles for a year due to their mothers’ antibodies.

The authors attributed the quicker-than-expected loss of immunity to the type of protection received in the womb from their mothers.

Measles has been eliminated since 1998 in Canada, where the study took place. As such, mothers in the study probably got their protection from a shot and not through a previous infection, which may produce more antibodies. Nor would the mothers’ immunity have been boosted from measles circulating in the community.

“This study really underscores the need to protect infants in the first year of life,” Bolotin said.

Measles — a serious viral disease whose initial symptoms include a rash and fever — is highly contagious, especially among very young children. Though rare, complications — including pneumonia, hearing loss and death — are most common among vulnerable populations, such as infants, according to the U.S. Centers for Disease Control and Prevention (CDC).

In 2000, the CDC declared measles eradicated in the United States, thanks largely to a nationwide vaccination program. But the disease is present in other countries, and unvaccinated visitors sometimes bring the virus with them. That happened earlier this year, sparking repeated outbreaks that threatened the nation’s eradication status.

Continued

Among the 1,200-plus cases reported during the 2019 outbreaks, the median age of infected individuals was 6. Median means half were younger, half were older. More than 90% of cases occurred in people who were unvaccinated or whose vaccination status was unknown, according to the CDC.

The worst outbreak happened in New York City when visitors from Israel and Europe — sites of recent outbreaks — mingled with Orthodox Jewish communities where many were unvaccinated.

While vaccine refusal is most often rooted in parents’ religious beliefs, the recent “anti-vaxxer” trend — popularized by celebrities in the media — can also influence parents’ decisions regarding vaccines. The World Health Organization recently identified vaccine hesitancy as one of the top 10 threats to global health.

Vaccine refusal and hesitancy threaten herd immunity: the community-wide resistance to disease that takes hold when a high proportion of people are vaccinated. Roughly 95% of the population needs to be protected to maintain herd immunity against measles, according to Dr. Sean O’Leary, an expert on pediatric infectious diseases.

“If we maintain a highly vaccinated population, measles outbreaks are not going to be an issue,” said O’Leary, an associate professor at University of Colorado School of Medicine, in Aurora. “If measles is not circulating, it would be very rare for a young infant to be exposed to the virus.”

That’s because herd immunity protects vulnerable individuals, such as infants who are too young to be vaccinated. The CDC recommends babies receive the first of two shots for measles, mumps and rubella starting at 12 months of age.

With the new evidence that immunity from mom wanes sooner than previously thought, why not give babies their shots sooner?

O’Leary explained that even if antibodies from mom are no longer at a protective level, those still present may prevent a live vaccine from working very well. The vaccinated infant might then be unable to ward off measles if exposed, he said.

That’s why it’s so important that individuals who can get vaccinated against measles, do, experts agree.

“Because it’s been eliminated for the better part of two decades, people don’t remember measles’ devastating effects,” said study author Bolotin.

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SOURCES: Shelly Bolotin, Ph.D., scientist in applied immunization research and evaluation, Public Health Ontario, Toronto, and assistant professor, public health, University of Toronto, Canada; Sean O’Leary, M.D., associate professor, pediatrics-infectious diseases, University of Colorado School of Medicine, Aurora, and pediatrics-infectious diseases director, Colorado Pediatric Practice-Based Research Network; Nov. 21, 2019,Pediatrics, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Inducing Labor Safer Bet for Late-Term Pregnancies

By Robert Preidt
HealthDay Reporter

THURSDAY, Nov. 21, 2019 (HealthDay News) — The risk of newborn death in late-term pregnancies may be lower if labor is induced rather than taking a wait-and-see approach, a new study suggests.

It’s widely believed that mothers and babies have an increased risk of problems at or beyond 42 weeks of pregnancy. (A normal-term pregnancy is 40 weeks.) Some studies have suggested that inducing labor at or after 41 weeks reduces those risks, but there is no consensus on managing healthy pregnancies that last more than 41 weeks, according to background information about the study.

The researchers were led by Ulla-Britt Wennerholm, an associate professor in obstetrics and gynecology at the University of Gothenburg’s Sahlgrenska Academy in Sweden. They looked at more than 2,700 Swedish women, average age 31, with an uncomplicated, single pregnancy. They were randomly assigned to induced labor at 41 weeks or wait and see (expectant management) until induced labor at 42 weeks if necessary.

Rates of death and complications such as breathing problems, pneumonia and sepsis were not statistically different between the two groups: 2.4‘ in the induced labor group and 2.2% in the wait-and-see group.

Other outcomes, such as cesarean section birth and mothers’ health after giving birth, were also similar in the two groups, according to the study published in the journal BMJ.

However, it found that six babies in the wait-and-see group died, compared with none in the induced labor group, leading to an early halt of the study. For every 230 women induced at 41 weeks, one newborn death would be prevented, the researchers concluded.

They said women with low-risk pregnancies “should be informed of the risk profile of induction of labor versus expectant management and offered induction of labor no later than at 41 full weeks. This could be one [of few] interventions that reduces stillbirth.”

Labor induction at 41 weeks “looks like the safer option for women and their babies,” Sara Kenyon, a professor at the University of Birmingham in England, and colleagues wrote in an accompanying editorial.

It’s important to give pregnant women a choice, according to the editorial authors. “Clear information about available options should be accessible to all pregnant women, enabling them to make fully informed and timely decisions,” they wrote.

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SOURCE:BMJ, news release, Nov. 20, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Recalls of Blood Pressure Med Took Toll on Patients’ Health

By Dennis Thompson
HealthDay Reporter

WEDNESDAY, Nov. 20, 2019 (HealthDay News) — Emergency room visits for high blood pressure surged following last year’s recall of the popular heart drug valsartan, Canadian researchers report.

Within the first month of the recall, there was a 55% increase of people coming to Ontario-area emergency departments complaining of high blood pressure, said lead researcher Cynthia Jackevicius. She is a senior scientist with the Institute for Clinical Evaluative Sciences, in Toronto.

Some of these patients likely were valsartan users who stopped taking the blood pressure med after seeing scary recall news citing a potential carcinogen found in some lots of the drug, Jackevicius said.

“Nine out of 10 did have an alternative replacement” for valsartan within three months. “However, that means that one out of 10 did not,” Jackevicius said.

“That’s a little bit concerning, that some of these patients may have either been confused or concerned, and decided not to switch to another medication,” she added.

The recall occurred in July 2018 in both Canada and the United States, after generics maker Mylan Pharmaceuticals detected trace amounts of a probable cancer-causing chemical called N-nitrosodiethylamine (NDEA) in valsartan meds.

It was an unusually large recall that involved intense media interest, and Jackevicius and her colleagues wondered how it might have affected the drug’s users.

So they turned to Canadian prescription and medical records to track how valsartan users responded to the crisis.

Dr. Mary Norine Walsh, a past president of the American College of Cardiology and a cardiologist at St. Vincent Heart Center of Indiana, said, “It’s really interesting data, because my assumption would have been in Canada and the U.S. that substitution was made pretty much instantly.”

That’s what happened — mostly.

Within one month, 85% of patients had a new prescription for an alternative to their generic valsartan, Jackevicius said. By three months, 90% had a prescription for a different blood pressure drug.

But that left 10% of patients with recalled valsartan who hadn’t been prescribed an alternative, Jackevicius noted.

“Maybe they heard about the recall on the news and never went to their physician or clinician to get a substitution,” Walsh said.

Continued

“When there’s a recall like this, is there a patient lack of trust in the system? Do they not get back on drugs because they’re afraid? I don’t know,” Walsh asked.

In the immediate aftermath of the recall, people swarmed Ontario emergency departments for blood pressure treatment, the researchers found.

Many of these folks likely were people who were afraid to take their valsartan and went to the ER for a replacement drug when they couldn’t reach their doctor, Jackevicius suggested.

“That’s not really the best place to go” when your drug is recalled, she said. “Going to the emergency department is not a good use of the resources there, and it’s not a good use of the patient’s time.”

However, there were also probably quite a few who stopped taking the drug altogether and suffered symptoms related to high blood pressure, Jackevicius and Walsh said.

According to Walsh, “People did worse if they came off it, which is not surprising because the primary reason they were prescribed it was for hypertension.”

Jackevicius said the incident revealed holes in medicine’s response to major drug recalls.

Empowering pharmacists to reach out to patients and prescribe alternatives could be one way to improve the response to a recall, Jackevicius said.

Pharmacists have direct knowledge of the specific drugs handed out to patients that their doctors don’t, she explained.

“It would make sense that they take more responsibility and be given the authority to substitute common medications, to be a point person in the event of a recall,” Jackevicius said. “They are accessible and would know similar medications that might be OK for that condition.”

Public health officials also could help by promptly creating a consensus list of approved alternative medications, so doctors and pharmacists could quickly and efficiently move patients onto a new prescription, she added.

Jackevicius presented her study last weekend at the American Heart Association’s annual meeting, in Philadelphia. The work was also published recently in the journal Circulation.

WebMD News from HealthDay

Sources

SOURCES: Cynthia Jackevicius, Pharm.D., senior scientist, Institute for Clinical Evaluative Sciences, Toronto, Canada; Mary Norine Walsh, M.D., past president,  American College of Cardiology, and cardiologist, St. Vincent Heart Center of Indiana; Nov. 11, 2019,Circulation

Copyright © 2013-2018 HealthDay. All rights reserved.

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California Sues Juul for Targeting Teens

Juul, the top-selling maker of e-cigarettes in the United States, is being sued by California for allegedly targeting teens with it early marketing campaigns.

The lawsuit, filed Monday, also alleges that Juul’s website didn’t previously adequately verify customers’ ages, the Associated Press reported.

This is just one of many legal battles for Juul. It’s the focus of numerous state and federal investigations into whether its early marketing campaigns helped trigger the teen vaping crisis in the United States.

Juul denies that it marketed to teens and notes that it’s stopped advertising and taken most of its flavors off the market, the AP reported.

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What Happened to People With Half a Brain Removed

By Alan Mozes
HealthDay Reporter

TUESDAY, Nov. 19, 2019 (HealthDay News) — Many people think of their brain as an overstuffed attic. Every square-inch is either crammed with information or working overtime to help the body function properly. So is it even conceivable that a person be normal with just half a brain?

Yes, apparently it is, according to a new analysis that assessed brain health among six adults who had undergone a hemispherectomy as children. The highly invasive surgery, which entails removal or severing of half the brain, had been part of a pediatric epilepsy treatment to reduce seizure risk.

“The people with hemispherectomies that we studied were remarkably high-functioning,” study author Dorit Kliemann said in a statement. “They have intact language skills. When I put them in the [brain] scanner, we made small talk, just like the hundreds of other individuals I have scanned,” she explained.

“You can almost forget their condition when you meet them for the first time,” added Kliemann, who is a post-doctoral scholar in cognitive neuroscience at the California Institute of Technology, in Pasadena.

Kliemann and her team noted that the six patients in the study had all struggled with relentless epileptic seizures from a very early age, with one patient initially struck by seizures just minutes after birth.

Hemispherectomies are typically performed as a means to bring such “intractable” epilepsy under control, the team explained. The aim is to isolate whichever half (or hemisphere) of the brain is affected by the disease. That can mean either actual removal of the problematic half of the brain or a cutting off of all physical connections between the two halves.

All of the patients had undergone full removal of half their brain. The youngest patient was just 3 months old at the time of surgery, while the oldest had been 11. Four involved excision of the right side of the brain, while two had the left side removed.

Now in their 20s and 30s, the six patients agreed to undergo functional MRI brain scans while awake at the Caltech Brain Imaging Center.

Continued

Brain activity was tracked in areas tasked with regulating vision, movement, emotion and thought processes.

Results were then stacked up against those of six healthy adults who also underwent scans, and with data previously collected on nearly 1,500 healthy adults (average age of 22).

Because brain networks devoted to a single regulatory function often span both hemispheres of the brain, the team expected to see weaker neural activity among the hemispherectomy patients. That was not the case.

In fact, scans revealed normal in-network communication and activity function. And communication running between different regulatory networks was actually found to be stronger than normal among hemispherectomy patients.

The findings were published online Nov. 19 in the journal Cell Reports.

Dr. Joseph Sirven, a professor of neurology with the Mayo Clinic in Florida and editor-in-chief of Epilepsy.com, said the findings did not strike him as entirely surprising. He said he often sees patients functioning at a very high level post-hemispherectomy.

“But what surprises me is the degree of compensation that was noted,” added Sirven, who was not part of the study team.

“And if we could figure out the way that the brain compensates in this dramatic setting, and harness this compensatory mechanism for patients affected by stroke, traumatic brain injury or other conditions, that would be a very big deal,” Sirven noted.

That thought was echoed by Kliemann. “As remarkable as it is that there are individuals who can live with half a brain, sometimes a very small brain lesion — like a stroke or a traumatic brain injury or a tumor — can have devastating effects,” she noted.

That is why it’s so important to get a better understanding of exactly how the brains of hemispherectomy patients managed to reorganize and compensate for the loss of half a brain, Kliemann said. Because doing so could eventually lead to new “targeted intervention strategies” to help other types of patients struggling with the debilitating effects of a variety of brain injuries, she theorized.

Caltech’s Brain Imaging Center supplied this video showing MRI scans of the brain of one patient who underwent hemispherectomy. Scan “slices” from the top to the bottom of the brain are shown:

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Sources

SOURCES: Joseph Sirven, M.D., professor, neurology, Mayo Clinic, Jacksonville, Fla., editor-in-chief, Epilepsy.com and former vice chair, epilepsy section, American Academy of Neurology; Nov. 19, 2019,Cell Reports, online

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Umbilical Cord ‘Milking’ Dangerous for Preemies

By Steven Reinberg
HealthDay Reporter

TUESDAY, Nov. 19, 2019 (HealthDay News) — Squeezing the last drops of blood from the umbilical cord has been touted to help preterm babies get more of the nutrients they need, but it may be dangerous, a new study finds.

When umbilical cord blood is forced into the baby’s abdomen, the pressure can cause tiny blood vessels in the brain to rupture. This is especially dangerous for the most preterm infants, the researchers said.

The study, funded by the U.S. National Institutes of Health, was stopped due to the heightened risk of internal bleeding.

In the study, researchers wanted to see if so-called “cord milking” was a good alternative to delayed cord clamping. Delayed clamping lets cord blood flow into the infant at a natural pace.

“Most doctors try delayed cord clamping when they can, and they occasionally will do the cord milking,” said lead researcher Dr. Anup Katheria, a neonatologist at Sharp Mary Birch Hospital for Women and Newborns, in San Diego, Calif.

Babies who get cord blood aren’t just getting blood, he said.

“These babies are getting stem cells and other cells that might help them develop a little bit better than babies that don’t receive this extra blood,” Katheria said. “They also get iron, which is a potent nutrient for brain development, and there’s probably other things in the blood that might help these babies.”

But, given these findings, he that said cord milking should be avoided in extremely preterm babies, those born at 23 to 27 weeks of pregnancy.

For the study, Katheria’s team recruited women who were pregnant for less than 32 weeks and were at risk for preterm delivery. They were randomly assigned to umbilical cord milking or a 60-second delay in cord clamping.

The team had planned to enroll 1,500 infants (750 in each group). Because the study was cut short, only 474 babies were included, according to the report.

Among infants who had cord milking 12% died or developed severe brain bleeds, compared with 8% in the delayed-clamping group. The researchers said this difference wasn’t statistically significant.

Continued

Neither was the death rate at 7% in the cord-milking group and 6% in the delayed-clamping group.

But the rate of severe brain bleeding was significantly higher among babies who had cord milking (8%) versus those who had delayed clamping (3%), the findings showed.

The greatest risk for severe brain bleeding was among infants born in the 23rd to 27th weeks of pregnancy, the study found. All 20 babies in the cord-milking group who suffered brain bleeds were born at this stage of pregnancy.

Among infants born at 28 to 32 weeks, none in the cord-milking group had bleeding, compared with three in the delayed-clamping group, which was not a significant difference, the researchers said.

Because the risk of brain bleeding was seen only in extremely preterm infants, Katheria’s team is continuing to compare cord milking to delayed clamping in babies born at 30 to 32 weeks’ gestation to see if either procedure will affect development as they grow. The infants will be evaluated at 2 years of age.

An earlier study of preemies delivered by cesarean section suggested that cord milking benefited preemies’ brain development.

Dr. Saima Aftab is medical director of the Fetal Care Center at Nicklaus Children’s Hospital in Miami. She said, “The current recommendation is that for preterm infants, delayed cord clamping is safe and should be done.”

This study shows that cord milking isn’t safe and “people should abandon that practice,” Aftab added.

The report was published Nov. 19 in the Journal of the American Medical Association.

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Sources

SOURCES: Anup Katheria, M.D., neonatologist, Sharp Mary Birch Hospital for Women and Newborns, San Diego, Calif.; Saima Aftab, M.D., medical director, Fetal Care Center, Nicklaus Children’s Hospital, Miami; Nov. 19, 2019,Journal of the American Medical Association

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Studies Confirm HPV Shot Is Safe

By Serena Gordon
HealthDay Reporter

MONDAY, Nov. 18, 2019 (HealthDay News) — The HPV vaccine gives parents a chance to prevent their children from developing some types of cancer, and two new studies reaffirm what past research has found — the vaccine is safe.

The two studies included millions of doses of Gardasil 9 vaccine, the only vaccine currently used in the United States for the prevention of HPV-related cancers.

“The data from our study was very reassuring. We saw nothing unexpected or surprising. With Gardasil 9, we can now prevent a large portion of cervical, oropharyngeal [mouth, tongue and throat] and other cancers,” said one of the studies’ lead author, Dr. James Donahue. He’s an epidemiologist with the Marshfield Clinic Research Institute in Wisconsin.

The studies and an accompanying editorial were published Nov. 18 in the journal Pediatrics.

Human papillomavirus (HPV) is a sexually transmitted virus. It’s estimated that 79 million people in the United States are already infected with HPV. Around 14 million new infections with HPV occur every year. About half of those are teens and young adults, according to the editorial. Sometimes these infections get better on their own, but many do not.

HPV is responsible for more than 33,000 cancers each year — 20,000 in women and 13,000 in men. Routine use of the Gardasil 9 vaccine could prevent about 90% of these cancers, the editorial said.

Yet editorial author Dr. H. Cody Meissner, from Tufts University Medical Center in Boston, noted that the rates of immunization with the HPV vaccine remain low.

He said there are a number of reasons why people are vaccine-hesitant overall, and those issues are compounded because this vaccine prevents a sexually transmitted infection.

“Sexuality is a difficult topic for pediatricians and many parents, and this vaccine got designated as a way to prevent sex-transmitted infection. But what’s far more important is that it prevents a common deadly cancer,” Meissner said.

Some people worry that giving a child a vaccine for a sexually transmitted infection might encourage their child to be more promiscuous, but Meissner said studies have shown that isn’t true.

Continued

Additionally, he said, “People may be misinformed or misunderstand safety issues surrounding the vaccine. No vaccine is absolutely safe, but aspirin isn’t safe and people take it. The likelihood of complications is very low, and there’s an enormous upside to this vaccine.”

Dr. David Fagan, vice chair of pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y., wasn’t involved in the studies, but reviewed the findings.

“What the public may not and clearly needs to know is that there are systems in place to monitor for vaccine safety. Both of these studies confirm what we as physicians already know, that vaccines are safe and specifically that the HPV vaccine is safe,” Fagan said.

Donahue’s study involved near real-time surveillance of vaccine safety data from 2015 to 2017. During the study period, nearly 839,000 vaccine doses were given. Researchers didn’t find any new safety concerns.

The second study, led by Dr. Tom Shimabukuro from the U.S. Centers for Disease Control and Prevention, looked at a three-year period and included about 28 million vaccine doses given. In that large group, approximately 7,200 people had an adverse reaction.

More than 97% of the adverse events weren’t serious, that study found. These events included headache, dizziness, fainting and injection site irritation.

Fagan said he frequently points out to parents that the HPV vaccine prevents cancer.

“If you had the choice to prevent your child getting cancer by immunizing them with a vaccine that is safe, wouldn’t you do that for your child?” he said.

The CDC recommends the HPV vaccine for males and females between the ages of 9 and 26. Two doses are recommended between the ages of 11 and 12, though they can be given as early as age 9. If someone hasn’t been given the HPV vaccine by their 15th birthday, they’ll need three doses of the vaccine.

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Sources

SOURCES: James Donahue, D.V.M., Ph.D., epidemiologist, Marshfield Clinic Research Institute, Marshfield, Wisc.; H. Cody Meissner, M.D., professor, pediatrics, Tufts University Medical Center and Tufts University School of Medicine, Boston; David Fagan, M.D., vice chair, pediatrics, Cohen Children’s Medical Center, New Hyde Park, N.Y.; Nov. 18, 2019,Pediatrics

Copyright © 2013-2018 HealthDay. All rights reserved.

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Trump Backs Off Flavored E-Cigarette Ban

Nov. 18, 2019 — U.S. President Donald Trump’s pledge in September to ban the sale of most flavored e-cigarettes to stem the rise in vaping among young people appears to be weakening.

Two months after he made the promise, Trump has yielded to pressure from lobbyists and political advisers and not taken any action on vaping, saying only that he wants to study the issue, The New York Times reported.

The proposed ban on flavored vaping products had wide support from health officials and others as an outbreak of severe vaping-related lung injuries has added to concerns about the teen vaping crisis.

On Nov. 11, Trump tweeted that he would be “meeting with representatives of the vaping industry, together with medical professionals and individual state representatives, to come up with an acceptable solution to the vaping and E-cigarette dilemma.”

However, one senior White House official said no such meeting had been scheduled, The Times reported.

In the absence of federal government action on vaping, several states have moved to ban flavored vaping products. That’s led to legal challenges from the industry and lobbying of lawmakers and the White House to prevent new rules that would affect adults’ use of e-cigarettes, The Times reported.

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Cheap, Older Gout Drug Could Be a Lifesaver After Heart Attack

By Dennis Thompson
HealthDay Reporter

SUNDAY, Nov. 17, 2019 (HealthDay News) — A cheap drug that’s been around for centuries as a gout treatment might also shield heart attack survivors from future heart crises, new trial results show.

The drug, colchicine, is derived from a plant called the autumn crocus, researchers explained Saturday at the annual meeting of the American Heart Association, in Philadelphia.

In the new trial, colchicine reduced by as much as 34% a heart attack survivor’s combined risk of either dying from heart disease or having cardiac arrest, a heart attack, a stroke or angioplasty.

Experts described the study as a “landmark” effort.

“These results provide confirmation that inflammation management reduces cardiovascular risk, and it was an example of a successful repurposing of a broadly available and relatively safe generic drug for a new application,” said Dr. Aruna Pradhan, a preventive medicine doctor at Brigham and Women’s Hospital in Boston.

Colchicine currently is used to treat gout and pericarditis (inflammation of the heart’s lining), two conditions caused by inflammation, said lead researcher Dr. Jean-Claude Tardif, director of research at the Montreal Heart Institute.

“You just give a few tablets of colchicine and the pain, the warmth, the redness, all the inflammatory signs go away,” Tardif said.

Tardif and his colleagues reasoned that colchicine might be able to reduce the risk of future heart problems by lowering inflammation in heart attack patients.

The trial involved more than 4,700 heart patients, with about half given daily low-dose colchicine taken by mouth and the rest provided a placebo. Nearly all patients also received the drug regimen normally prescribed to heart attack survivors — aspirin, blood thinners, statins and/or beta blockers.

Three years later, results showed that people on colchicine fared significantly better than those taking a placebo.

Besides the 34% reduction in all adverse heart events, the trial also found that patients taking colchichine had a 74% reduction in stroke risk, and a 50% reduction in their likelihood of being rushed to hospital for angioplasty/stenting after suffering chest pain.

The drug also appears to be safe. The most concerning side effect appears to be an increased risk of pneumonia, which affected about 1% of colchicine patients. Pradhan said pneumonia risk might be affected by the drug’s effect on inflammation.

Continued

Tardif said his research team is proceeding with a second trial focusing on heart risk among patients with type 2 diabetes.

Based on these findings, heart doctors will be thinking long and hard about adding colchicine to the drug cocktail prescribed to heart attack patients, said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine.

“When you have a safe drug that is easily available, it’s going to be hard to hold this back,” Lloyd-Jones said.

The trial was funded by the provincial government of Quebec and received no drug company funding. However, colchicine’s new promise already appears to be affecting its sticker price, even though it’s a generic drug, Lloyd-Jones added.

He said that he recently saw a patient with gout on Thursday who complained that his colchicine prescription costs had unexpectedly skyrocketed.

“He told me that just in the last month, his colchicine out-of-pocket costs went from $ 50 to $ 270 a month in Chicago,” Lloyd-Jones said. “I really wonder whether there’s some gaming going on here, and I do not want to see that.”

Tardif expressed shock, given colchicine’s low cost in Canada.

“There’s something wrong with a system where 90 minutes away you get a drug for 50 times less what others are paying,” Tardif said, referring to what his patients pay in Montreal, an hour-and-a-half flight away.

The results were also published Saturday in the New England Journal of Medicine.

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Sources

SOURCES: Aruna Pradhan, M.D., MPH, preventive medicine doctor, Brigham and Women’s Hospital, Boston; Jean-Claude Tardif, M.D., director, research,  Montreal Heart Institute; Donald Lloyd-Jones, M.D., ScM, chair, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Nov. 16, 2019,New England Journal of Medicine, Nov. 16, 2019, presentation, American Heart Association annual meeting, Philadelphia

Copyright © 2013-2018 HealthDay. All rights reserved.

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Apple Removes Vaping Apps From Store

Nov. 15, 2019 — Apple said Friday that it’s removed 181 vaping-related apps from its mobile App Store worldwide.

The company said the now-banned apps — a mix of stores, social networks, news and games — will continue to work for people who already have them and can be transferred to new devices, CNN reported.

In June, Apple halted the promotion of vaping products in its app store and has not approved any new vaping-related apps since then.

“Recently, experts ranging from the CDC to the American Heart Association have attributed a variety of lung injuries and fatalities to e-cigarette and vaping products, going so far as to call the spread of these devices a public health crisis and a youth epidemic. We agree, and we’ve updated our App Store Review Guidelines to reflect that apps encouraging or facilitating the use of these products are not permitted,” the company said in a statement.

The removal of the vaping-related apps was welcomed by groups such as the American Heart Association and the Campaign for Tobacco-Free Kids.

“By taking e-cigarette related apps off the App Store, Apple will help reduce youth exposure to e-cigarette marketing and discourage youth use of these products. Apple is setting a welcome example of corporate responsibility in protecting our kids,” Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a statement, CNN reported.

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Are Vaping Bans the Way to Go?

CDC: “Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products,” Nov. 14, 2019.

News release, House Committee on Energy and Commerce, Nov. 13, 2019.

Public Health Law Center: “States and Tribes Stepping in to Protect Communities from the Dangers of E-cigarettes: Actions and Options (2019).”

Peter Grinspoon, MD, instructor, Harvard Medical School; board member, Doctors for Cannabis Regulation.

Michael Siegel, MD, professor of community health sciences, Boston University School of Public Health.

Meredith Berkman, co-founder, Parents Against Vaping.

National Conference of State Legislatures: State, governor, and department of health actions.

News releases, Campaign for Tobacco-Free Kids, Nov. 13, 2019.

National Youth Tobacco Survey, November 2019.

Journal of the American Heart Association: “Electronic Cigarette Use Prevalence, Associated Factors, and Pattern by Cigarette Smoking Status in the United States From NHANES (National Health and Nutrition Examination Survey) 2013-2014.”

News release, Cannabis Control Commission, Nov. 12, 2019.

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Juul Delivers More Nicotine Than Other E-Cigarettes: Study

By Robert Preidt
HealthDay Reporter

FRIDAY, Nov. 15, 2019 (HealthDay News) — Juul electronic cigarettes deliver nicotine at a much higher rate than most other types of e-cigarettes, new research shows.

Juul is by far the leading e-cigarette brand sold in the United States, and is particularly popular among youth.

In the new study, researchers from Penn State University College of Medicine analyzed blood samples from six Juul users who were asked to puff on their device every 20 seconds for 10 minutes — a total of 30 puffs.

“The Juul users we studied obtained blood nicotine concentrations almost three times as high as most of the e-cigarette users we previously studied,” said study first author Jessica Yingst, a research project manager.

In fact, “Juul’s nicotine delivery is very similar to that of cigarettes,” she said in a university news release.

The Juul users were also asked to rate their withdrawal symptoms and other effects like nicotine craving and anxiety both before and after vaping. They had higher levels of nicotine dependence than more than 3,000 long-term users of other e-cigarettes, according to the study.

Juul Labs did not respond to a request for comment from HealthDay.

Prior studies of other e-cigarette brands with high liquid nicotine concentrations found that many delivered very little nicotine to the user, the researchers noted.

“In previous studies, we found that e-cigarette users were less addicted than smokers. However, the high nicotine delivery of the product and the scores on this study suggest that Juul is probably as addictive as cigarettes,” said study co-author Jonathan Foulds, a professor of public health sciences.

The researchers said the high addiction potential of Juul e-cigarettes is a good reason for nonsmokers to avoid them, but they may still offer smokers a less harmful form of nicotine consumption.

“In previous work, we determined that Juul delivered lower levels of some harmful chemicals than cigarettes and even some other e-cigarettes,” said study co-author John Richie, a professor of public health sciences.

E-cigarettes pose a dilemma for public health experts, according to Foulds.

Continued

“This type of product is likely addictive and is attractive to teenagers,” he said. “But those same qualities that make it addictive may enable it to help adult smokers switch to a much less harmful form of nicotine consumption.”

In recent weeks, Juul has announced that it would no longer sell mint, fruit or dessert flavors of its products.

The company made these moves as it faces widespread criticism that its flavored nicotine products are hooking a generation of teenagers on nicotine and vaping.

The company also faces multiple investigations by U.S. Congress, the U.S. Food and Drug Administration and several state attorneys general. Juul is also being sued by adults and underage vapers who allege they became addicted to nicotine by using Juul’s products.

The study was published Nov. 15 in the journal JAMA Open Network.

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Sources

SOURCE: Penn State University, news release, Nov. 15, 2019

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Almost Half of Older Americans Fear Dementia, Try Untested Ways to Fight It

By Amy Norton
HealthDay Reporter

FRIDAY, Nov. 15, 2019 (HealthDay News) — Many Americans believe they are likely to develop dementia — and they often turn to unproven ways to try to better their odds, a new study suggests.

In a survey, researchers found that almost half of Americans in their 50s and 60s believed they were at least “somewhat likely” to develop dementia. Yet few — 5% — said they had talked to their doctor about ways to lower their risk.

Instead, one-third or more were taking fish oil, vitamin E or other supplements to help ward off memory decline — even though none have been proven to have such benefits.

“It certainly seems like people believe that supplements or fish oil help preserve their memory,” said lead researcher Dr. Donovan Maust, a geriatric psychiatrist at the University of Michigan, in Ann Arbor.

Maust said that might reflect “excitement” over initial research suggesting that certain supplements might ward off memory decline — excitement that wasn’t tempered when later studies failed to show benefits.

The findings, published online Nov. 15 in JAMA Neurology, are based on 1,019 adults aged 50 to 64 who were surveyed in 2018. They were asked whether they thought they were “somewhat likely,” “very likely” or “unlikely” to develop dementia in their lifetime.

Overall, 44% believed they were somewhat likely, while 4% chose the “very likely” option.

How accurate were they? It’s hard to say, since the terms are vague, according to Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association.

But, he added, it would be reasonable for anyone to see themselves as somewhat likely to develop dementia: Around 10% of Americans aged 65 and older have dementia; the rate soars to roughly one-third among people aged 85 and up.

Fargo, who was not involved in the study, said that more can be gleaned by looking at the responses of different groups of participants.

For example, black Americans were much more likely than whites to see themselves as unlikely to develop dementia: 63% endorsed that belief, versus 49% of white respondents.

Continued

In reality, black Americans have a higher rate of dementia.

Maust made the same point. “It’s striking,” he said, “that African American respondents thought their odds of developing dementia were half of non-Hispanic white respondents — when in fact their risk is more than twice as high.”

Fargo called that finding an “unfortunate surprise,” and said it points to a gap in public education efforts.

Respondents were also asked whether they were taking any of several measures to “maintain or improve” their memory. About one-third said they were using fish oil, while 40% said they were taking vitamins or other supplements. Over half said they did crossword puzzles.

None of those strategies are proven. Fargo did, however, note that crossword lovers might be the kind of people who maintain a generally “cognitively stimulating” life — and there is evidence to support benefits from doing so.

It’s thought that people with more education, or who engage in lifelong learning, may have more “cognitive reserve,” Fargo explained. The theory is, those people can withstand more of the brain damage that marks dementia before developing symptoms.

Studies are ongoing to figure out the best strategies for slowing or preventing dementia. Fargo said the Alzheimer’s Association is sponsoring a trial, called U.S. Pointer, that is testing a combination of tactics — including diet, exercise, and mental and social stimulation.

For now, Maust said the best bet is to take care of your overall health and control any chronic medical conditions — especially those that affect the heart and blood vessels, like high blood pressure and diabetes. Studies have long noted a connection between heart health and dementia, and a recent clinical trial showed that tight control of high blood pressure curbed older adults’ risk of mild cognitive impairment.

“I think people may not appreciate the extent to which risk of dementia can be reduced by addressing chronic medical conditions,” Maust said.

If you believe your memory or thinking skills are deteriorating, Fargo advised seeing your doctor.

“In some cases,” he said, “there may be a treatable underlying cause, like sleep apnea, vitamin-B12 deficiency or depression.”

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Sources

SOURCES: Donovan Maust, M.D., M.S., associate professor/associate director, geriatric psychiatry program, University of Michigan, Ann Arbor; Keith Fargo, Ph.D., director, scientific programs and outreach, Alzheimer’s Association, Chicago; Nov. 15, 2019,JAMA Neurology, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Not Getting Enough Shut-Eye? You Have Plenty of Company

By Robert Preidt
HealthDay Reporter

FRIDAY, Nov. 15, 2019 (HealthDay News) — More Americans are having trouble falling and staying asleep, and smartphones and technology are probably to blame, researchers report.

Their analysis of data from nearly 165,000 adults nationwide showed that the number who reported difficulty falling asleep at least once a week was up 1.4% between 2013 and 2017, and those who had trouble staying asleep rose 2.7%.

Those percentages may appear small, but it means that as many as 5 million more adults have sleep problems, according to study leader Zlatan Krizan, a professor of psychology at Iowa State University (ISU), in Ames, Iowa.

“How long we sleep is important, but how well we sleep and how we feel about our sleep is important in its own right,” Krizan said in a university news release. “Sleep health is a multidimensional phenomenon, so examining all the aspects of sleep is crucial for future research.”

The study was published online recently in the journal Sleep Health.

Krizan and his team could not say what’s contributing to the increase in sleep problems, but technology is likely a factor, according to lead author Garrett Hisler. He’s a former ISU graduate student who is now a postdoctoral associate at the University of Pittsburgh.

“We know from our previous research there is a correlation between smartphone use and insufficient sleep among teens,” Hisler said in the news release.

“If we’re on our phone before bed or we’re receiving alerts in the middle of the night, that can make it harder to fall asleep and stay asleep throughout the night,” he explained.

Too little sleep and poor sleep can increase the risk of heart disease, and sleep quality affects overall well-being, the researchers noted.

Krizan said, “We know that how well people sleep is generally very reflective of people’s health and may be an indicator of other conditions. If we want a full picture of the population’s health, it’s important to measure and track these changes in sleep trends over time.”

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SOURCE: Iowa State University, news release, Nov. 12, 2019

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