2008.04.01 — U.N. Seeks to Curb World’s Traffic Deaths
April 01, 2008
U.N. Seeks to Curb World’s Traffic Deaths
TUESDAY, April 1 (HealthDay News) — Over 1.2 million people die each year on the world’s roadways — more than are killed by major scourges such as malaria or diabetes.
In response to this growing epidemic, the United Nations’ General Assembly on Monday approved the first ever conference on road safety, to be held next year in Russia.
It’s high time the issue of traffic fatalities got the attention it deserves, advocates said, especially since experts expect vehicle ownership in populous nations such as China and India to double in the next 20 years.
“We have an epidemic in the making — one that we can stop,” said Dr. Mark Rosenberg, the U.S. member of the Commission for Global Road Safety and moderator of a press briefing Monday at the United Nations in New York City. “We have solutions at hand — what we don’t have is the attention of the world to this problem,” he added.
The Make Roads Safe campaign, a Washington, D.C.-based advocacy group that’s long lobbied for global action on traffic deaths, offered these grim statistics on the scope of the problem:
- More than 1 million people are killed worldwide, and more than 50 million are injured in traffic accidents each year.
- Road deaths are now the number-one global killer of people aged 10 to 24.
- While 965 people lost their lives in air crashes last year, more than 3,000 people die on the world’s roadways every day.
- 85 percent of traffic casualties occur in low- and middle-income countries. For example, the rate of child deaths due to road accidents in South Africa is 26 per 100,000 population, compared with 1.7 per 100,000 in Europe.
- Someone is killed or badly injured on the world’s roads every six seconds.
“A lot of us have been trying to bring this issue forward for a long time, but the public tends not to look at these things as something that is preventable,” said Dr. Linda Degutis, president of the American Public Health Association.
Changes in driver behaviors are key, Degutis said. In many countries, truck, bus and other transport employees drive recklessly due to economic pressures, with little policing to restrain them. “The quicker they can do a route, the faster they can get there, the more money they make,” she said. “There’s just not that incentive to be safe. We have to create those incentives for safety.”
There was some star power on hand at the U.N. to help focus attention on the issue. Michelle Yeoh, the Chinese actress best known to Western audiences for her roles in Crouching Tiger, Hidden Dragon and Memoirs of a Geisha, spoke to delegates of her recent experiences as a Make Roads Safe campaign ambassador in Asia.
“I honestly wasn’t prepared, on our first fact-finding trip to Vietnam, for the emotional trauma that greeted us,” Yeoh said. She recounted visiting a hospital and meeting a bewildered 5-year-old girl who had lost a foot after a traffic accident, then talking with a woman whose 9-year-old daughter had perished in a motorcycle crash.
Yeoh also attempted something millions of Vietnamese do every day: cross a chaotic urban roadway.
“Some of you may know that I make action movies. But for five seconds, I just stood there, terrified,” she said. “I didn’t think that I could do it.”
Other advocates of the U.N. campaign include former U.S. President Jimmy Carter, a Nobel Peace Prize laureate, and fellow Nobel Peace Prize winners Archbishop Desmond Tutu of South Africa and Oscar Arias Sanchez, president of Costa Rica.
Traffic deaths aren’t only a scourge of the developing world. In fact, road accidents remain the leading killer of American youth aged 13 to 24, according to the Make Roads Safe campaign.
“We hear tragedies about school shootings, drug abuse, everything else, but what we forget is that the tragedies we suffer from motor-vehicle crashes on a daily basis dwarf everything else,” said Daniel Vocelle, 20, a student at Vanderbilt University in Nashville who is also a Make Roads Safe youth ambassador.
Vocelle’s motivation to join the fight against traffic deaths came after a cousin was killed in a 2006 motorcycle crash. “It was other drivers swerving out in front of him and not seeing,” he said. “There are so many accidents now where people are just careless.”
Still, certain measures have successfully reduced traffic deaths in the United States and should work elsewhere, experts said.
According to Rosenberg, these interventions include simple, low-cost steps such as installing barriers along the median to prevent head-on collisions; converting four-way intersections into safer traffic circles; and installing speed bumps.
Encouraging governments to beef up policing of reckless or drunk drivers, as well as improving driver training, can also help decrease the carnage, said Rosenberg, who is director of the Decatur, Ga.-based Task Force for Child Survival and Development.
Next year’s global summit, which will gather together high-ranking ministers of transport and health from most of the U.N.’s member states, should help spur real change, Rosenberg added.
“We need high-level attention from every country to this problem, so that they can work together to turn this around,” he said.
More information
There’s more on efforts to reduce traffic deaths worldwide at the Make Roads Safe campaign.
SOURCES: Mark Rosenberg, M.D., director, Task Force for Child Survival and Development, and U.S. member, Commission for Global Road Safety; Linda Degutis, Dr.P.H., president, American Public Health Association, Washington, D.C.; Michelle Yeoh, actress; Daniel Vocelle, Make Roads Safe campaign youth ambassador
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2008.04.01 — Study Finds Older Corneas Suitable for Transplantation
April 01, 2008
Study Finds Older Corneas Suitable for Transplantation
TUESDAY, April 1 (HealthDay News) — People up to the age of 75 should be allowed to donate corneas for transplant, says a U.S. National Eye Institute-funded study.
The researchers found that tissue from donors aged 66 to 75 had the same five-year success rate (86 percent) as corneas from donors aged 12 to 65.
The research, coordinated by the Jaeb Center for Health Research in Tampa, Fla., included 1,101 patients, aged 40 to 80, enrolled by 105 surgeons at 80 sites. The patients were followed for five years after corneal transplant. A transplant was considered a failure if a repeat corneal transplant was needed or if the transplanted cornea was cloudy for at least three months.
The findings were published in the April issue of Ophthalmology.
This is “the largest study of its type on corneal transplantation ever done. Its size and five-year patient follow-up, along with a simple trial design, have provided us with clear and important insights into contemporary transplantation,” study co-chairman Dr. Mark J. Mannis, professor and chairman of the department of ophthalmology at the University of California, Davis, said in a prepared statement.
In the United States, more than 33,000 corneal transplants are done each year. For the past 10 years, there’s been an adequate supply of donor corneas, the study authors noted. However, supply could become a problem due to new U.S. Food and Drug Administration regulations that require additional screening and testing of potential donors for contagious diseases, registration of eye banks, more detailed records and labels, and stricter quarantine procedures.
In addition, some surgeons are reluctant to use corneas from older people, so many eye banks only accept corneas from donors aged 65 or younger.
The study authors said the use of corneas from older donors could expand the donor pool by as much as 20 percent to 35 percent.
“Surgeons and patients now have scientific evidence that older donor corneas are suitable for transplantation,” study co-chairman Dr. Edward J. Holland, a professor of ophthalmology at the University of Cincinnati and director of the Cornea Service at the Cincinnati Eye Institute, said in a prepared statement. “Further, when corneas are readily available, transplant procedures can be scheduled more efficiently, allowing both surgeons and patients to plan for them.”
The findings have come at a good time, according to Dr. Paul A. Sieving, director of the National Eye Institute.
“The pressure on eye banks to provide corneas is increasing. The results of this study will expand the available donor pool and should persuade surgeons to use corneas from older donors. These changes will greatly benefit the growing number of individuals who need corneal transplants,” Sieving said in a prepared statement.
More information
The Eye Bank Association of America has more about corneal transplant.
– Robert Preidt
SOURCE: U.S. National Eye Institutes, news release, April 1, 2008
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2008.04.01 — Scientists Uncover How HIV Hides Inside Cells
April 01, 2008
Scientists Uncover How HIV Hides Inside Cells
TUESDAY, April 1 (HealthDay News) — U.S. researchers say they’ve discovered how HIV — the virus that causes AIDS — hides in human cells to avoid being destroyed by the body’s immune cells.
They explained that when a normal virus, such as the common cold, infects a person, the immune system responds and produces cells that quickly eliminate the virus. However, HIV makes itself appear as part of the normal trash in a cell, rather than being clearly visible on the cell surface.
“HIV can make a protein called Nef, which helps the virus hide,” researcher Dr. Kathleen Collins, an associate professor at the University of Michigan, said in a prepared statement.
“Nef interferes with one important part of our defenses, which helps our immune system recognize infected cells, by displaying pieces of the infecting virus or bacteria on the cell surface, forming a target for our bodies’ killer cells. When HIV infects one of our cells, the protein Nef binds to this helper system and alters it in such a way that the cell believes it belongs in the cellular trash bin rather than on the surface where our main defenses can see it,” she said.
Collins added that the Nef protein recruits other proteins naturally made by cells to help HIV hide from immune cells. She and her colleagues identified these natural proteins and developed inhibitors that block their actions and reverse the activity of Nef. This may help the immune system to detect and destroy HIV.
“We are currently screening a whole range of substances, looking for small molecule inhibitors which could be developed into drugs to provide better therapies for people with HIV and AIDS,” Collins said.
“We have discovered that Nef takes on notably different shapes and structural forms in different contexts, which allows it to reveal or obscure different traffic signals within the infected cell as needed. Once we have a better understanding of the surfaces and shapes involved in these interactions, we will be in a better position to develop medicines which may someday help to combat AIDS.”
The research was to be presented April 1 at the Society for General Microbiology annual meeting, in Edinburgh, Scotland.
More information
The U.S. Centers for Disease Control and Prevention has more about HIV/AIDS.
– Robert Preidt
SOURCE: Society for General Microbiology, news release, March 31, 2008
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2008.04.01 — Restrictive Prescription Drug Policies Hurt Schizophrenics
April 01, 2008
Restrictive Prescription Drug Policies Hurt Schizophrenics
TUESDAY, April 1 (HealthDay News) — Restrictive prescription drug policies can cause schizophrenia patients to stop taking their medications, a Harvard Medical School study suggests.
Researchers looked at Medicare beneficiaries with schizophrenia in Maine before, during and after a policy that required patients to use an authorized medication (step treatment) before they were permitted to be prescribed drugs not on the preferred list. They were compared to Medicare beneficiaries with schizophrenia in New Hampshire, where there was no such regulation.
The study found that the Maine patients were 29 percent more likely to stop or disrupt medication when subject to the tightened policy. In addition, the restrictive drug policy — originally designed to reduce costs — provided only minimal savings.
After less than one year, the Maine policy was replaced by a provider education program, noted the authors of the study, which was published online April 1 in the journal Health Affairs.
“This study calls into question the effectiveness of many similar policies throughout the country,” study senior author Stephen Soumerai, a professor at Harvard Medical School, said in a prepared statement. “Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient.”
As their medication choices are restricted, more patients discontinue treatment, Soumerai noted.
Previous research has found that interruptions in taking antipsychotic medications are likely to lead to recurrence of psychotic episodes and higher hospitalization rates and costs for patients.
Schizophrenia affects 1 percent of the U.S. population, or about 3 million people. Without antipsychotic medication, about 80 percent of patients will suffer a serious recurrence of their illness within a year, according to background information in the study.
While prior authorization and step treatment policies may be appropriate for some types of medications, such policies put patients with chronic mental illness at particular risk, the study authors said.
“Given the tremendous variation in individual responses to drugs as well as the devastating impact of treatment disruptions on schizophrenic patients, a policy that pushes all patients toward a limited number of preferred drugs may do more harm than good,” Soumerai said. “It would be much better to focus on ensuring that antipsychotic drugs are prescribed for evidence-based reasons and that preferred drugs are prescribed only to patients who can benefit from them.”
More information
Mental Health America has more about schizophrenia.
– Robert Preidt
SOURCE: Harvard Medical School, news release, April 1, 2008
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2008.04.01 — Report Claims Clinical Trials Miss Many Populations
April 01, 2008
Report Claims Clinical Trials Miss Many Populations
TUESDAY, April 1 (HealthDay News) — A new analysis of the American clinical trial process suggests that the system for testing new drugs has routinely excluded or under-represented women, older people, minorities, disabled individuals and rural populations for decades.
“We’ve got a big problem,” said Daniel S. Goldberg, chief policy adviser for the report. “And it’s extremely urgent that we fix it. Because we’re trying to figure out how to streamline health care and make people healthy, of course. And the fact that we have under-representation in clinical trials undermines both of these goals and undermines the quality of the evidence we come up with.”
The report was conducted by the Chronic Disease Prevention & Control Research Center at Baylor College of Medicine in conjunction with the Intercultural Cancer Council, both based in Houston.
Part of a team of more than 300 analysts led by Armin D. Weinberg, Goldberg and his colleagues spent four years conducting an in-depth review of policy positions held by public, private and nonprofit clinical trial sponsors in the United States. Their research was funded by what is described as an “unrestricted educational grant” provided by Genentech Inc.
The team noted that about 80,000 clinical trials are conducted in this country each year, and that less than 1 percent of the American population — 2.3 million men and women — participate in such trials.
Additional trial problems, such as the lack of adequate training for members of institutional review boards, who are legally obligated to assess the structure of a proposed trial, were cited.
The report also admonished against the wasting of limited resources that results when government institutions and private industry duplicate each other’s efforts in conducting trials focused on the same disease or treatment.
However, it is the continuing absence of specific constituencies in many trial populations that gets the lion’s share of the criticism.
The research looked at cancer clinical trials and found that only 25 percent of patients in such trials were over the age of 65. In addition, older people were often excluded from studies focused on Alzheimer’s, arthritis and incontinence, the researchers noted.
As evidence of the problem, Weinberg and his colleagues honed in on a study of clinical trial composition that found that, between 1995 and 1999, blacks, Asian-Pacific Islanders, Hispanics and Native Americans together made up for less than 10 percent of patients included in new cancer drug trials.
Under-representation of this sort, they say, leads to results that do not account for a host of factors — genetic, cultural, racial, religious, linguistic, as well as variables related to age and gender — that could have a huge impact on how well new drugs do in the real world.
To address these shortcomings, the team proposed nine policy solutions:
- government regulatory changes;
- increased collaboration between government and private industry on clinical trial design;
- increased community involvement in patient participation;
- scientific journal oversight of patient breakdowns;
- new, specialized training for review boards;
- reallocation of research funding to avoid duplication and address disparities;
- increased public education;
- increased focus on easing the patient participation process;
- guaranteeing insurance coverage for all related costs.
“The bottom line is there has been a lot of discussion and attention paid in recent years to how clinical trials are put together, and, in particular, the need to account for differences in study patient populations,” said Weinberg. “And that’s the good news. But the bad news is that as a practical matter, it has yet to have a real impact on studies themselves.”
“And the problem is that many people, when they take a pill, don’t realize that it didn’t come out of thin air,” added Weinberg. “So, we hope that our work will help people appreciate how the process works, and that what we’re talking about is the next generation and how we improve the products and type of therapies that we will have in the future.”
Adil Shamoo, a professor of biochemistry and bioethics at the University of Maryland School of Medicine in Baltimore, agreed that trials must ensure proper patient representation. And he stressed that the problem stems from a lack of structural focus, rather than from any lack of potential volunteers.
“We have an extremely willing volunteer population in this country, so there is no question that proper trial representation is doable,” said Shamoo, who is also the co-founder of the nonprofit Citizens for Responsible Care and Research, based in Columbia, Md. “And medicine is going to be given to millions of different people, so you do need that representation. Otherwise, you can have risks that you won’t know about.”
Other reports released this week buttress the findings of the Baylor team.
On Monday, Duke University researchers reported at the American College of Cardiology meeting in Chicago that although more women are being included in clinical cardiology trials, their numbers are still so low that it’s questionable whether the results can actually be applied to women. And a commentary in the April issue of The Lancet Oncology stressed that more teens and young adults need to be included in trials of new cancer drugs, because they are currently under-represented.
More information
For additional information on clinical trials, visit the U.S. National Institutes of Health.
SOURCES: Daniel S. Goldberg, chief policy adviser, Intercultural Cancer Council, and doctoral student, ethics and medical humanities, University of Texas Medical Branch, Galveston, Texas; Armin D. Weinberg, Ph.D., director, Chronic Disease Prevention & Control Research Center, Baylor College of Medicine, Houston; Adil Shamoo, Ph.D., professor, biochemistry and bioethics, University of Maryland, School of Medicine, Baltimore, and co-founder, Citizens for Responsible Care and Research, Columbia, Md.
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2008.04.01 — Rap Music Glorifying Drug Use
April 01, 2008
Rap Music Glorifying Drug Use
TUESDAY, April 1 (HealthDay News) — Rap music is glamorizing drug use, according to a study by researchers at the University of California, Berkeley, who found a sixfold increase in drug references in songs over the past two decades.
“Positive portrayals of drug use have increased over time, and drug references increased overall,” study author Denise Herd, associate dean of students at the School of Public Health, said in a prepared statement.
“This is an alarming trend, as rap artists are role models for the nation’s youth, especially in urban areas. Many of these young people are already at risk and need to get positive messages from the media,” Herd said.
She and her colleagues analyzed 341 lyrics from the most popular rap songs between 1979 and 1997. During that time, references to drugs increased sixfold, and there was an increase in songs featuring positive attitudes toward drugs and the consequences of drug use, and an increase in references of drug use to signify glamour, wealth and sociability. In addition, there was a significant change in the types of drugs mentioned in rap songs.
Of the 38 most popular rap songs between 1979 and 1984, only four (11 percent) contained drug references. By the late 1980s, that increased to 19 percent and by 1993, to 69 percent.
These findings indicate “a shift from cautionary songs, such as those that emphasized the dangers of cocaine and crack, to songs that glorify the use of marijuana and other drugs as part of a desirable hip-hop lifestyle,” Herd said. “This is alarming, because young children are exposed to these messages. I don’t think this is a story we as a society want them to absorb.”
For example, she noted that references to cough medicine abuse in lyrics from Southwestern groups performing an underground rap genre called “Screw Music” may be linked to high numbers of Houston teens abusing codeine-laced cough syrup.
“Rap music is like CNN for black teens. But much of what is discussed in rap is in code. The kids understand, but parents don’t,” said Herd, who recommended parents monitor their children’s music and learn about the terms used in popular songs.
The study was published in the April issue of Addiction Research & Theory.
Earlier research by Herd found that alcohol use is increasingly glorified in rap music.
More information
The Nemours Foundation offers advice to parents about discussing drugs with their children.
– Robert Preidt
SOURCE: Addiction Research & Theory, April 2008
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2008.04.01 — Obesity Drug Shows Mixed Success Against Atherosclerosis
April 01, 2008
Obesity Drug Shows Mixed Success Against Atherosclerosis
TUESDAY, April 1 (HealthDay News) — The weight-loss drug Acomplia may or may not help slow atherosclerosis, a buildup of arterial plaque that’s connected with carrying too much weight.
A new trial did not find any evidence that the drug actually slowed disease progression, although it did show a decrease in one measure of plaque build-up in arteries.
Acomplia also showed a high rate of psychiatric side effects, notably depression and anxiety, the study found.
Still, Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City, who was not involved with the study, said: “I think it’s important for us to understand that this wasn’t a negative trial. It’s very important that we look at this more closely. What decrease in blood pressure and cholesterol as parameters are needed, or really how much decrease in obesity is needed for us to see a change in atherosclerosis volume? It might pan out to show something beneficial. We just don’t know.”
The findings, from researchers at the Cleveland Clinic, were published April 2 in the Journal of the American Medical Association and were released early Tuesday to coincide with a presentation at the American College of Cardiology annual meeting, in Chicago. The study was funded by Sanofi Aventis, which makes Acomplia.
Data on a second anti-obesity drug, taranabant, also presented at the conference, also showed a high rate of psychiatric problems, although the medication did show some promise helping patients lose weight.
In the United States, two-thirds of adults are overweight, and more than one-third are obese. People with weight concentrated in their midsection have a higher risk of type 2 diabetes, high blood pressure and other risk factors for atherosclerotic cardiovascular disease or disease related to the build-up of plaque in the arteries.
Not for lack of effort, researchers have yet to happen on a “magic” treatment for obesity and its attendant problems.
One drug that has shown some promise, Acomplia (rimonabant), has been approved for use in Europe but not in the United States. Last June, the U.S. Food and Drug Administration did not recommend approval of the drug, pending more information on psychiatric side effects.
The drug works by inhibiting the cannabinoid type 1(CB1) receptors, which are involved in regulating food ingestion.
For the new study, 839 patients at 112 centers in Australia, Europe and North America were randomly selected to receive either Acomplia or a placebo. All participants, who also had coronary disease, received dietary counseling as well.
Coronary intravascular ultrasonography (IVUS) at the end of 18 months revealed a 0.25 percent increase in percent atheroma volume (PAV) in those taking rimonabant, compared to 0.51 percent in the placebo group. And change in normalized total atheroma volume (TAV) decreased in the Acomplia group but increased in the placebo group. PAV and TAV are basically two ways to measure how clogged an artery is.
Those taking Acomplia also saw other benefits: They lost more weight (9.5 pounds versus 1.1 pounds in the placebo group); their waist circumference went down more (1.77 inches versus 0.39 inches); their HDL or “good” cholesterol increased more (22.4 percent versus 6.9 percent) and triglyceride levels went down further (20.5 percent versus 6.2 percent). But LDL or “bad” cholesterol levels and blood pressure stayed about the same in both groups.
More worrisome, 43.4 percent of those in the Acomplia group experienced psychiatric problems, most notably anxiety and depression, compared to 28.4 percent in the placebo group.
More information
The U.S. Centers for Disease Control and Prevention has more on overweight and obesity.
SOURCES: Suzanne Steinbaum, D.O., director, Women and Heart Disease, Lenox Hill Hospital, New York City; April 2, 2008, Journal of the American Medical Association; April 1, 2008, presentation, American College of Cardiology annual meeting, Chicago
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2008.04.01 — Normal Weight Doesn’t Always Equal Healthy Weight
April 01, 2008
Normal Weight Doesn’t Always Equal Healthy Weight
TUESDAY, April 1 (HealthDay News) — Despite appearances to the contrary, more than half of normal-weight Americans have a high percentage of body fat. And, like their overweight contemporaries, this makes them susceptible to heart disease, diabetes and other metabolic disorders, a new study says.
Men whose body fat is greater than 20 percent and women whose body fat is greater than 30 percent are suffering from “normal weight obesity,” the study authors said, even though their weight may be normal for their size.
“The prevalence of people with a high amount of body fat despite a normal weight is relatively high,” said lead researcher Dr. Francisco Lopez-Jimenez, a cardiologist with the Mayo Clinic in Rochester, Minn. “Many of these people have metabolic abnormalities.”
These findings should alert doctors that body weight isn’t the only way to protect against health problems caused by excess pounds, Lopez-Jimenez said. Even normal-weight people should be advised to exercise and eat a healthful diet to reduce their level of fat, especially belly fat, he added.
The findings were expected to be presented Tuesday at the American College of Cardiology’s annual meeting, in Chicago.
For the study, Lopez-Jimenez and his colleagues collected data on 2,127 people who participated in the U.S. government’s Third National Health and Nutrition Examination Survey. Specifically, the researchers looked at risk factors for heart disease, diabetes, and metabolic syndrome, a precursor of diabetes.
The researchers found that 61 percent of the participants had levels of body fat that indicated “normal weight obesity.” In addition, Lopez-Jimenez’s group found changes in blood chemistry that can affect heart and metabolic health, including high cholesterol; high levels of leptin, a hormone found in fat and other tissues that’s involved in appetite regulation; and high rates of metabolic syndrome.
Lopez-Jimenez said the study shows that just because your weight may be normal for your size, it doesn’t mean you aren’t at risk for heart disease and diabetes.
“If you have a normal weight, don’t feel that everything is just OK,” Lopez-Jimenez said. “If you have an excess amount of fat, you might have metabolic abnormalities as well,” he said.
One expert agrees that normal body weight is not synonymous with good health.
“Body weight is a very blunt instrument; it is not a reliable gauge of obesity, or health, at the individual level,” said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine. “For example, a muscular man may have a very high body weight, yet be perfectly fit and healthy. Many people whose body weight is in the normal range are anything but.”
And some people are vulnerable to weight gain in all the wrong places, such as in and around the vital organs of the abdomen, notably the liver, Katz said.
“Even a small amount of extra fat where it matters most can wreak metabolic havoc, increasing risk for diabetes and heart disease, while leaving you with a body weight that looks perfectly innocent,” Katz said. “Excess body fat in the belly is a menace, whatever your weight. This study should sensitize patients and providers alike to this concern.”
More information
For more about metabolic syndrome, visit the U.S. National Library of Medicine.
SOURCES: Francisco Lopez-Jimenez, M.D., cardiologist, Mayo Clinic, Rochester, Minn.; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; April 1, 2008, presentation, American College of Cardiology annual meeting, Chicago
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2008.04.01 — Home Defibrillators Fail to Boost Survival Rates
April 01, 2008
Home Defibrillators Fail to Boost Survival Rates
TUESDAY, April 1 (HealthDay News) — Putting external defibrillators in the homes of people after they had a heart attack didn’t improve their survival rate, a new study found.
But, the leader of the study still sees plenty of encouraging news in the research and is not necessarily ruling out the use of those heart-shocking devices in the home.
In a 37-month trial, half of 7,001 heart attack survivors had defibrillators put in their homes, while the other half got standard instructions to call for emergency help if a second heart attack occurred. But, the death rate for both groups was just about the same — 222 of the people given defibrillators and 228 of those not given the devices, said study leader Dr. Gust H. Bardy, director of the Seattle Institute for Cardiac Research.
The findings were to be presented Tuesday at the American College of Cardiology annual meeting, in Chicago, and were published in the April 1 online edition of the New England Journal of Medicine. The results were also expected to be published in April 24, 2008, print issue of the journal.
People in the study weren’t considered suitable for implanted defibrillators. The devices they took home were identical to those now found in many public places for use in cardiac emergencies.
“It really amazed me that the survival prospects for this group were so promising,” Bardy said. “A 2 percent-a-year death rate for 60-year-old patients, that surprises me.”
Most of the deaths in the defibrillator group were due to non-cardiac causes, Bardy noted. “The event rate was so low,” he said of cardiac deaths, “and the usage of the defibrillators is less than it should be. It’s not that the devices are ineffective. When they were used, they did real well.”
The defibrillators, which deliver an electric shock to restart an arrested heartbeat, were used 18 times, and six of those people survived, Bardy said. “Long-term survival of one out of three is not bad,” he said.
Partly because of the high cost of external defibrillators, their home use should not be encouraged, said an accompanying editorial in the journal by Dr. David J. Callans, professor of medicine at the University of Pennsylvania. “Future efforts should turn toward education, modification of risk factors and other methods for primary prevention of heart disease,” Callans said in a statement.
But Dr. Robert Femia, chairman of emergency medicine at Lenox Hill Hospital in New York City, disagreed with Callans. “Early defibrillation offers the best chance for survival,” Femia said. “My point is that there may be a role for a defibrillator as part of a plan developed by your physician on an individual basis.”
Such a plan usually is lacking after a heart attack, Bardy said. “One thing that is not standard practice is consciousness-raising,” he said. “Most post-myocardial infarct [heart attack] patients don’t have a discussion of mortality, don’t have a discussion of cardiac arrest, don’t have a discussion of what to do if there is a cardiac arrest.”
Any discussion with a doctor after a heart attack should include advice about carefully taking any medications that are prescribed, Bardy said, and about other medical measures needed to keep arteries clear.
When such steps are taken, he said, “the patient may or may not choose an external defibrillator. I see no downside for an external defibrillator. Whether or not it will help in the long run, I don’t know.”
More information
The facts about external defibrillators are available from the U.S. Food and Drug Administration.
SOURCES: Gust H. Bardy, M.D., director, Seattle Institute for Cardiac Research, Seattle, Wash.; Robert Femia, M.D., chairman, emergency Medicine, Lenox Hill Hospital, New York City; April 1, 2008, presentation, American College of Cardiology annual meeting, Chicago; April 1, 2008, New England Journal of Medicine, online
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2008.04.01 — Health Tip: Potassium-Rich Foods
April 01, 2008
Health Tip: Potassium-Rich Foods
(HealthDay News) – Potassium is a mineral that plays an important role in regulating blood pressure. The U.S. Department of Agriculture recommends that most people get 4,044 milligrams of potassium each day.
Here are some good food sources of potassium, says the American Academy of Family Physicians:
- Potatoes, both sweet and regular.
- Beans; especially lima beans, soybeans, white beans and kidney beans.
- Yogurt and skim milk.
- Bananas, peaches, cantaloupes and honeydew melons.
- Fish, such as halibut, yellowfin tuna, rockfish and cod.
- Tomato products, such as tomato sauce, juice, puree and paste.
– Diana Kohnle
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