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Exposure to several common pathogens may increase the risk of having a stroke, a new study shows.
Led by Dr. Mitchell Elkind, an associate professor of neurology at Columbia University Medical Center in New York City, the research team found that the pathogens Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus and herpes simplex virus 1 and 2 may be implicated in accelerating arterial disease, which in turn increases the risk of stroke.
The team’s work appears in the Nov. 9 online edition of the Archives of Neurology, and will be published in the January 2010 print issue of the journal.
“These are infections that regularly pop up when we study heart disease,” said Elkind. “They are very common in the population.”
Scientists are not completely sure how the pathogens harm arterial function, but several theories offer suggestions. One possibility is that chronic infection leads to inflammation in the blood vessels, which can constrict blood flow. Another possibility, said Elkind, is that the pathogens disrupt the normal functioning of the arterial walls.
Strokes occur when there is a disruption in the blood supply to the brain, such as a blockage in an artery or other blood vessel. When this happens, brain cells begin to die, causing brain damage and even death. Common functions affected or lost during a stroke include speech, movement and memory.
Stroke is the third-leading cause of death in the United States, according to the National Stroke Association. Strokes have many causes, but it is widely known that certain risk factors increase the chances of having a stroke. These include high blood pressure, diabetes, high cholesterol, smoking and obesity.
In recent years, evidence has been uncovering the role of pathogens in cardiovascular disease, particularly the pathogens featured in Elkind’s research. Scientists reported several years ago that untreated gum disease and other oral infections can spread and cause heart disease.
Elkind’s study tracked 1,625 adults from a multi-ethnic community in Manhattan for 7.6 years. During that time, 67 patients suffered a first stroke. Even taking into account other risk factors, such as high blood pressure and diabetes, Elkind’s team found that the majority of the patients tested positive for one or more of the suspected pathogens.
“Each individual infection was positively, though not significantly, associated with stroke risk after adjusting for other risk factors,” the researchers wrote. “The infectious burden index was associated with an increased risk of all strokes after adjusting for demographics and risk factors.”
It is too early to tell which pathogens contributed to the strokes, to what extent they contributed and how they contributed (through simple exposure or chronic infection), said Elkind. What’s more, there may be other pathogens involved that were not included in the study, he added.
It is also too early to make any clinical recommendations. If scientists conclusively determine that pathogens are capable of causing strokes years after people come in contact with them, possible treatments may include wider and longer use of antibiotics, Elkind added.
Dr. Kishore Ranade, a neurologist affiliated with the Mount Kisco Medical Group in New York, said he was impressed with the findings. He suspects that pathogens work with other risk factors to cause strokes.
“Cumulative data have been suggesting that pathogens play a role in heart disease in general,” said Ranade. “And what’s bad for the heart is bad for the brain.”
Methods to gauge blood cholesterol to determine vascular disease risk can be simplified, researchers in England say.
Their method measures levels of either total or high-density lipoprotein (HDL, or “good” cholesterol) in the blood or apolipoproteins (proteins that help transport cholesterol), without the need to have patients fast and without regard to another form of blood fat called triglycerides.
“Expert opinion is divided” on which combination of measurements is ideal in gauging cardiovascular risk, explained John Danesh, of the Emerging Risk Factors Collaboration Coordinating Centre at the University of Cambridge, and colleagues.
In order to examine the association between major blood fats and apolipoproteins and coronary heart disease and ischemic stroke, the researchers analyzed data on more than 300,000 people without initial vascular disease who took part in 68 long-term studies.
During the follow-up periods of the studies, there were almost 8,900 nonfatal heart attacks, more than 3,900 coronary heart disease deaths, over 2,500 ischemic strokes, 513 hemorrhagic strokes and more than 2,500 unclassified strokes, the study authors noted.
The analysis of the data yielded a number of findings.
First of all, risk tied to blood levels of non-HDL-C and HDL-C were nearly identical to those seen with the two apolipoproteins (B and AI), the team found. “This finding suggests that current discussions about whether to measure cholesterol levels or apolipoproteins in vascular risk assessment should hinge more on practical considerations (e.g., cost, availability, and standardization of assays),” Danesh and colleagues wrote.
Secondly, risk assessments “were at least as strong in participants who did not fast as in those who fasted [before testing],” the team added, and risk was similar with non-HDL cholesterol as with directly measured LDL (”bad”) cholesterol.
Finally, measuring for triglyceride blood fats “provides no additional information about vascular risk given knowledge of HDL-C and total cholesterol levels, although there may be separate reasons to measure triglyceride concentration (e.g., prevention of pancreatitis),” according to the report in the Nov. 11 issue of the Journal of the American Medical Association.
“The current analysis of more than 300,000 people has demonstrated that [blood fat] assessment in vascular disease can be simplified by measurement of either cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride,” the researchers concluded.
Hospital workers who see many patients may play a disproportionate role in spreading dangerous hospital-acquired infections, a new study finds.
These so-called peripatetic workers, such as radiologists or physical therapists, visit many patients in the course of a day, said Laura Temime, a researcher at the Conservatoire National des Arts et Metiers in Paris, and lead author of a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.
“Although to my knowledge, an increased super-spreading potential of ‘peripatetic’ health-care workers has never really been formalized as a major hypothesis, there have been several reports of nosocomial outbreaks that have been traced back to such ‘peripatetic’ health-care workers,” Temime said.
Her study adds to the evidence, she said. The study used a mathematical model of a hypothetical intensive care unit that was presumed free of the pathogen to see how easily hospital-based infections, such as methicillin-resistant Staphylococcus aureus (MRSA) spread.
Containing these outbreaks is of grave importance, public health officials agreed.
For the study, Temime divided workers into three groups — a nurse-like group, which made frequent visits to a small number of patients assigned to them; a physician-like group, which made infrequent visits to a larger number of patients, and the peripatetic group, which visits all patients daily, such as physical therapists.
Next, using a complex mathematical model, the researchers assumed how long the patients would stay — an average of 10 days — and how much exposure they would have to each of the three categories of workers, plus how compliant the workers were with hand washing.
Then they computed the impact. They found infection rates increased by up to three times more when a peripatetic worker failed to wash his hands, compared to workers in the other groups.
The conclusions sound very logical, said Dr. Zachary Rubin, an epidemiologist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica. However, he added, “this is a mathematical model, and you have to do studies with human beings to see if the data is still true or not.”
Temime said she and her colleagues are doing just that. They are involved in a European project called Mastering Hospital Antimicrobial Resistance (MOSAR), in which data on exposures and bacterial colonization will be collected on patients and health-care workers. “We are planning to use this data to validate our model,” Temime said.
For now, many hospitals are stepping up efforts to promote hand washing among employees. Because the peripatetic workers have “major superspreading potential,” the study authors recommend individual surveillance of these health-care workers.
Rubin said that hospitalized patients shouldn’t be shy about asking the health-care workers who come in contact with them to follow infection control guidelines. Some hospitals have posted signs in patient rooms asking “Did your health-care worker wash his hands?” to make patients more aware of the importance of hand washing, he said.
“If a patient is concerned [about lack of hygiene from a health-care worker], he can always talk to the head nurse or charge nurse,” Rubin said, as well as the hospital’s patient advocate or his own physician
New research suggests a link between women’s exposure to household insecticides — including roach and mosquito killers — and the autoimmune disorders rheumatoid arthritis and lupus.
The scientist did not find a direct cause-and-effect relationship between insecticide exposure and the illnesses, and it’s possible that the women have something else in common that accounts for their higher risk. But epidemiologist Christine Parks, lead investigator of the study, said the findings do raise a red flag.
“It’s hard to envision what other factors might explain this association,” said Parks, an epidemiologist with the National Institute of Environmental Health Sciences who was to present the study over the weekend at the American College of Rheumatology annual meeting in Philadelphia.
Previous research has linked agricultural pesticides to higher risk of rheumatoid arthritis and lupus, two diseases in which the immune system goes haywire and begins to attack the body. Farmers, among others, appear to be vulnerable.
Parks and her colleagues wanted to find out whether smaller doses of insecticides, such as those people might encounter at home from either personal or commercial residential use, might have a similar effect.
The researchers examined data from a previous study of almost 77,000 postmenopausal women aged 50 to 79. Their findings were to be released Monday at the American College of Rheumatology’s annual scientific meeting in Philadelphia.
Women who reported applying insecticides or mixing them — about half — had a higher risk of developing the two autoimmune disorders than women who reported no insecticide use. This was the case whether or not they had lived on a farm. Those who used or mixed the insecticides the most — judged by frequency or duration — had double the risk.
Even so, the risk of developing the diseases remained very low. Overall, Parks said, about 2 percent of older adults develop the conditions.
Parks said the insecticides that the women used included insect killers, such as those designed to eradicate ants, wasps, termites, mosquitoes and roaches. They didn’t include insect repellents.
There are some caveats to the research. For one, it’s not clear exactly what products the women used or when. “Over time, there have been major changes in what products were available for home use,” Parks said.
And while researchers tried to take into account the influence of factors like age that may boost a woman’s risk of getting autoimmune diseases, it’s possible they missed something that boosted the risk of illness.
Could gardening, which often entails insecticide use, be a contributing factor? That’s possible. But Parks said a lot of insecticide use takes place inside the home, not outside in the garden.
For now, she said, the findings indicate the need for “more research on environmental risk factors and better understanding of what factors might explain these findings, what chemicals might be associated with these risks.”
She declined to speculate on how insecticides might cause problems in the body.
“I would recommend that people read the labels and take precautions to minimize their personal exposure” to insecticides, she said. “This is the case regardless of whether these results are implicating a chemical that’s on the market now or was before.”
Despite a long-standing federal ban on the sale of small turtles, the reptiles continue to be sold in the U.S. and to make owners, usually young children, sick with Salmonella — sometimes very sick, health officials warn in a report released Monday.
“Most people are unaware of the dangers of turtles as pets,” Dr. Julie Harris, a medical epidemiologist with the Centers for Disease Control and Prevention in Atlanta, told Reuters Health.
Turtles and other reptiles are well-known reservoirs for Salmonella, and while the sale and distribution of small turtles — measuring less than 4 inches — was officially outlawed in the United States in 1975, cases of turtle-associated Salmonella infection continue to occur.
Salmonella, Harris said, is a “serious infection,” which can lead to hospitalization and, in some cases, death. “Children are more susceptible than adults, and often have more complications from infection,” she added.
In the journal Pediatrics, Harris and colleagues detail a large outbreak of turtle-associated Salmonella, occurring between May 2007 and January 2008 and involving 34 states and 107 people.
“In this outbreak, 59 percent of patients were 10 years of age or younger, and 33 percent of all patients interviewed were hospitalized,” Harris said.
“We observed a strong association between turtle exposure and Salmonella infections in this outbreak,” the investigators report.
Forty-seven of 78 patients interviewed — a full 60 percent — reported contact with turtles during the week prior to their becoming sick.
Small turtles remain available to the public illegally from various sources, including pet shops, flea markets, street vendors, and the internet.
And don’t be fooled by sellers: “No one has succeeded in making a Salmonella-free turtle,” Harris said. “Antibiotic treatment of eggs often results in turtles with drug-resistant Salmonella infections.”
“Even if a turtle is born without Salmonella, because Salmonella exists in many places in the environment, it is difficult if not impossible to keep a turtle free of Salmonella,” Harris added.
Care
If you think that you or your child might have an RSV infection that requires medical care, schedule an appointment with a healthcare provider. Such visits are common for young children. The healthcare provider will evaluate the severity of the illness and decide how best to treat it. RSV symptoms in most infants, children, and adults clear up on their own in a week or two.
Transmission
RSV spreads when an infected person coughs or sneezes, sending respiratory droplets into the air. These droplets contain RSV and can end up in other people’s mouths or noses, where they can cause infection. The droplets can also land on objects that people touch, such as toys or countertops. People can be exposed to and possibly infected by RSV by touching these objects and then touching their mouths or noses. Children often pass the virus to one another at their school or daycare center.
Prevention
To help prevent the spread of RSV, people who have cold-like symptoms should
Cover their mouth and nose when coughing or sneezing,
Wash their hands often with soap and water for 15–20 seconds,
Avoid sharing cups and eating utensils with others, and
Refrain from kissing others.
There is not yet a vaccine to protect against RSV. However, for children at high risk for serious disease, such as certain premature infants and infants with certain lung and heart conditions, monthly shots with a drug called palivizumab can help prevent serious illness during RSV season. Ask your healthcare provider if your child would be a good candidate for the drug.
Symptoms
RSV symptoms are like those of many other respiratory illnesses. Infants and young children may experience a fever, reduced appetite, runny nose, cough, and wheezing. Older children and adults may have a runny nose, sore throat, headache, cough, and a feeling of general sickness. RSV also can lead to more serious illnesses, such as pneumonia and bronchiolitis, in both children and adults.
Respiratory syncytial virus (RSV) is a contagious viral disease that can lead to serious health problems—especially for young children and older adults. There is no vaccine to prevent RSV. However, there are simple ways you can protect your child or yourself from getting sick during RSV season.
Some quick facts about respiratory syncytial virus, or RSV:
It is a contagious viral disease that may infect a person’s lungs and breathing passages.
Almost everyone gets RSV by age 2.
People can get the disease more than once.
Most people recover from the disease in a week or two, but RSV can be severe, most commonly for children 6 months of age and younger and for older adults. Premature infants or those with lung or heart problems are especially at risk for serious disease.
The number of RSV cases typically rise in the fall, peak in the winter, and decline in early spring, but the exact timing of RSV season varies by location.
A national survey has found that more than 8 million adults in the United States seriously considered suicide last year, with younger adults the most likely to contemplate taking their own lives.
In addition to nearly 8.3 million thinking about committing suicide, 2.3 million made a plan to do so, and 1.1 million actually attempted it, according to a federal government study released Thursday.
The findings are from data collected in a 2008 survey of 46,190 people aged 18 or older. It’s the first national scientific survey of its size to examine this public health issue, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
The study found significant age-related differences in the risk of suicidal thoughts, planning and attempts. For example, adults aged 18 to 25 were far more likely (6.7 percent) to have seriously considered suicide than those aged 26 to 49 (3.9 percent) and those aged 50 and older (2.3 percent). Similar disparities were found in suicide planning and attempts.
Females had marginally higher levels of suicidal thoughts and behaviors than males. Only 62.3 percent of those who attempted suicide received medical attention for their suicide attempts, while only 46 percent of those who attempted suicide stayed in a hospital overnight or longer for treatment of their suicide attempts.
Substance abuse was associated with increased risk of seriously considering, planning or attempting suicide, the report showed. People with substance abuse disorders were more than three times as likely to have seriously considered suicide as those without substance abuse disorders — 11 percent versus 3 percent. Those with substance abuse disorders were four times more likely to have planned a suicide (3.4 percent versus 0.8 percent) and nearly seven times more likely to have attempted suicide (2 percent versus 0.3 percent).
“This study offers a far greater understanding of just how pervasive the risk of suicide is in our nation, and how many of us are potentially affected by it,” Eric Broderick, SAMHSA acting administrator, said in a news release from the agency.
“While there are places that people in crisis can turn to for help like the National Suicide Prevention Lifeline [1-800-273-TALK], the magnitude of the public health crisis revealed by this study should motivate us as a nation to do everything possible to reach out and help the millions who are at risk — preferably well before they are in immediate danger,” Broderick said.
Scientists have long known that poverty can inhibit a child’s intellectual development. But now researchers have found a possible equalizer — a good day care environment.
High-quality day care for the youngest poor kids may be enough to offset negative home environments and provide them the foundation for good school skills, at least up to the fifth grade, according to a new study.
Led by Eric Dearing, an associate professor at Boston College’s Lynch School of Education, the research team found significant benefits from higher quality day care in the first five years of life.
Impoverished families may be too overwhelmed by the stresses of survival to devote time or resources to help their children achieve later academic success, but Dearing believes quality child care can fill the gap.
“Even minimal exposure to higher-quality child care at times was enough to offset the deprivation often encountered when growing up poor,” said Dearing, whose team analyzed data on more than 1,300 children, many of them living at or below the federal poverty line, in 10 regions around the United States. The data, part of a long-term federal study that began in 1991, included half-day observations of children in child care.
Dearing defined “higher quality” day care as settings that offer above-average personal attention, intellectual stimulation and emotional comfort to babies and toddlers. Higher quality day care, he said, should not be confused with the elite services found in affluent communities. Rather, it can be as informal as a grandmother’s house or as organized as an established neighborhood day care center.
The findings appear in the September/October issue of Child Development.
The study team, including researchers from Samford University in Alabama and the Harvard Graduate School of Education, found that the benefits of higher quality day care applied to most children, from poor to middle-class. And the more exposure to good day care, the bigger the impact, Dearing added. Most of the day care facilities in the study had no admissions standards, and there was no bias toward children with higher IQs, he noted.
The effect was seen in children from families with close to middle-class incomes, and got more significant as family income levels dropped, the researchers said. This meant that even a brief experience with higher-quality early child care was associated with significantly better math achievement by the time the child reached middle school.
As little as one or two years of day care corresponded to a 5 percent increase in math scores for children from lower-class families (200 percent of the poverty line), and this increment grew as the family income level went down.
“The greatest estimated benefits of higher-quality care were evident for the poorest children, but even for children close to 200 percent of the poverty line the effects of higher-quality child care compared favorably with those for (a rise in) family income,” according to the study. “For these children, in fact, just one or two episodes in higher-quality child care produced estimated impacts on achievement similar in size to achievement gains that would be expected if a family’s income increased enough to move them from low-income to approximately middle class.”
Impoverished mothers and fathers, as much as more affluent parents, need places to care for their kids while they work or go to school. These families are often forced to rely on substandard day care because they have few choices, Dearing said.
The study did not make specific recommendations to improve day care in poor communities, but Dearing suggested the need to better educate parents on how to obtain quality day care and provide more public funding of day care. For those kids without access to higher quality care, later intervention in public schools may be effective, too.
Marta Flaum, a psychologist from Chappaqua, N.Y., agreed with Dearing’s conclusions.
“It certainly makes sense, given what we know about the critical role that early experiences play in child development,” said Flaum. “The first few years of life are absolutely critical for stimulating language, reasoning and problem solving, and encouraging a curiosity and love of learning. There are windows of opportunity for mastering such important benchmarks, and if skills are not acquired during these periods, learning is much slower and there is a risk of permanent developmental lag.”
In related news, another study has found that children who were breast-fed as infants have superior cognitive skills compared with kids who were fed formula. Scientists believe that docosahexaenoic acid (DHA), an essential fatty acid found in mother’s milk, is responsible for the improved cognitive skills.
When DHA was added to infant formula, babies showed greater cognitive improvement than the babies fed on regular formula.
“Currently, there is no clear consensus on whether infant formula should be supplemented with DHA,” lead author James R. Drover, assistant professor of psychology at Memorial University in Canada, said in a news release. “However, our results clearly suggest that feeding infants formula supplemented with high concentrations of DHA provides beneficial effects on cognitive development.”
If you don’t drink enough water — especially on a hot day — you could become dehydrated. That’s an obvious cause.
But a number of other things can cause dehydration, a potentially dangerous lack of bodily fluids.
The U.S. National Library of Medicine offers this list:
-Having diarrhea or vomiting.
-Urinating frequently, perhaps from uncontrolled diabetes or using diuretic medication.
-Sweating excessively.
-Having a fever.
-Not eating due to nausea or lack of appetite.
-Having a sore throat or painful sores in the mouth.