Health Topics - Health-and-Age

Friday

12Mar2010

Is There Full Recovery after a TIA (Transient Ischemic Attack)?

Fri, March 12, 2010 at 03:00AM

Symptoms of a transient ischemic attack (TIA, or mini-stroke) are the same as those for a stroke, and include sudden onset of any of these:

· Numbness or weakness of the face, arm, or leg, especially on one side
· Confusion, or trouble talking or understanding
· Vision problems
· Difficulty in walking, dizziness, or loss of balance or coordination
· Severe headache with no known cause

With a TIA, symptoms go away within 24 hours, but that doesn’t mean the patient should forget about the episode. Overall, the risk of a patient having a stroke within 7 days of having a TIA is about 1 in 20 (5%). Ignoring the episode completely can lead to an 11% risk of a stroke, while receiving specialist neurology care can reduce the risk to 1%.

What’s the best post-TIA regime to prevent a major stroke? According to Indiana University researchers presenting at the American Stroke Association’s Conference, it’s a modified version of cardiac rehabilitation. A study of 14 first-time TIA victims agreed to take part in a modified cardiac rehab program. This consisted of 1½-hour sessions 3 times a week for 6 weeks, involving monitored aerobic exercise, resistance t raining, and health education.

High blood pressure – the number one risk factor for stroke – was reduced by averages of 8.7 mm Hg systolic and 7.2 mm Hg diastolic during the program. (It’s known that a 5 mm Hg systolic reduction leads to a 14% reduction in stroke risk, and a 5 mm Hg diastolic to a 42% reduction in stroke risk.) Moreover, gait speed and endurance were significantly improved, also signs of improved cardiovascular health.

These findings emphasize the need for a rehab program after a TIA to reduce the likelihood of a subsequent major stroke.

Robert Griffith |

Post a Comment |

Thursday

11Mar2010

Does Frequent Napping Portend Diabetes?

Thu, March 11, 2010 at 03:00AM

We’re told that a brief after-lunch nap is good for our memory, which is encouraging news for the millions of older people who enjoy a post-prandial snooze. However, a report from China in the journal Sleep casts a shadow on this.

Napping in China is, apparently, a social norm, often starting in childhood. Data from the Guangzhou Biobank Cohort Study was analyzed in a search for a relationship between napping and the occurrence of type 2 diabetes. There were almost 20,000 men and women over 50 in the database. Fasting blood glucose levels were used to diagnose diabetes. The amount of napping was self-reported on a questionnaire.

Overall, diabetes was found in 13.5% of the 20,000 subjects. It was found in15.1% of those who reported napping daily, and in 14.7% of those napping 4-6 times a week. These percentages remained essentially unchanged after adjustments were made for age, gender, lifestyle, sleep habits, health status, and overweight.

When a sub-sample of 3,800 participants were re-contacted for additional information, it was found that there was an increased risk of diabetes in those with longer nap duration - 41% higher for those who napped longer than 30 minutes, and 35% higher for those who napped less than 30 minutes, compared with those who never took naps.

How important are these findings for the US population? The Chinese in the study had an average age of 61 (women) or 64 (men). So they are somewhat younger than the majority of US people who nap daily, or even 4-6 days a week – I’m assuming that nearly all regular US nappers must be retired i.e. over 65. Moreover, most US nappers probably have conditions that cause tiredness and increase the urge to nap, whereas the Chinese in the study were “raised to nap”. Nevertheless, the findings may give the regular US napper pause; at the very least, he or she should have an annual blood sugar test (or better, an HbA1c level).

Robert Griffith |

Post a Comment |

Wednesday

10Mar2010

Your Glycated Hemoglobin (HbA1c) Predicts Cardiovascular Risk

Wed, March 10, 2010 at 03:00AM

In January I blogged about the call for hemoglobin A1c – also known as glycated hemoglobin or HbA1c – to be used as the standard test for diagnosing diabetes. Thus type 2 diabetes would be diagnosed in persons with an HbA1c of 6.5% or greater, without the need for blood glucose testing. Further support for wider use of HbA1c has now been published in the New England Journal of Medicine.

Johns Hopkins researchers measured HbA1c and fasting blood glucose levels in 11,000 healthy adults in 1990-1992, and followed them for an average of 14 years.

The subjects were classified into 5 groups (quintiles) according to their HbA1c levels: below 5%, 5% - 5.5%, 5.5% to 6%, 6% to 6.5%, or above 6.5%. The risk of occurrence during follow-up for diabetes, coronary heart disease events (heart attack, severe angina, sudden cardiac death), and all-cause death was significantly increased in the three HBA1c groups above the 5.5% point; ischemic stroke was increased above the 6% level. The higher the HbA1c group, the higher the incidence of the condition – with one exception. The risk of all-cause mortality formed a J-shaped curve, with the lowest and highest HbA1c levels being predictive of death.

The analysis results were unchanged after corrections made for differences between the groups in gender, age, race, family history of disease, lifestyle factors, lipid levels, and fasting glucose levels. This clearly shows that HbA1c levels, especially above 6.0%, are better than fasting glucose for predicting long-term cardiovascular risk. And we know from other studies that HbA1c is superior to fasting glucose for diagnosis of type 2 diabetes. It behooves people over 50 to get up to speed on the HbA1c test and its meaning.

Post a Comment |

Tuesday

09Mar2010

The Only Proven Fountain of Youth

Tue, March 9, 2010 at 03:00AM

The January Archives of Internal Medicine contained a series of articles justifying the statement: “regular physical activity has been associated with greater longevity as well as reduced risk of physical disability and dependence, the most important health outcome, even more than death, for most older people”.

The first study, from Harvard Medical School, analyzed data from 13,500 women in the Nurses’ Health Study. The over 70-year-olds who engaged in regular physical activity in their middle age were less likely to undergo heart surgery, have chronic diseases like diabetes or osteoarthritis, or have any physical or mental impairment.

In the next study Vancouver scientists enrolled 155 women aged 65 to 75, and assigned them to one of 3 groups for a year: resistance training once a week, the same twice a week, or no resistance exercise, just balance and tone training (controls). Both groups doing resistance training improved their performance on mental tests (the Stroop Test of selective attention and conflict resolution) – averaging +12.6% and +10.9% for the once and twice a week training, with -0.5% for the controls.

The third study was reported from Germany. Bavarian citizens over 55 were enrolled in a 2-year study. Their mental functioning was measured using the 6-item Cognitive Impairment Test. At the start of the study, 10% of the participants had ‘cognitive impairment’ according to the test. After two years, 207 (6%) of the unimpaired participants developed cognitive impairment. However, the occurrence of new impairment varied according to the subjects’ activity level. Thus for participants who reported no physical activity it was 13.9%, for those who were moderately active (exercising less than 3 times a week) it was 6.7%, and for those with a high level of activity (exercising 3 times a week or more) it was 5.1%.

Finally, another German study showed the benefits of exercise on bone density and risk of falling in women over 65. There were 115 women assigned to follow an exercise program and 112 who followed a wellness information program (i.e. they were controls), for 18 months. The exercise consisted of a multipurpose 4-days-a-week program, emphasizing intensity of effort. Results showed that the exercising women ended up with significantly higher bone mineral density levels in the spine and hip, and a 66% reduced rate of falls. And the women in the control group were twice as likely to have fractures due to falls than those in the exercising group.

If that isn’t enough to convince skeptics to start exercising, remember there are 60 health benefits of physical exercise – at least according to one source!

Post a Comment |

Cancer,

Monday

08Mar2010

Coffee and the Risk of a Stroke

Mon, March 8, 2010 at 03:00AM

An American Stroke Association meeting poster (LB-P5) contains interesting information on the benefits of drinking coffee. We know that coffee consumption is linked to a decreased risk of developing diabetes, and can improve short-term memory. Now a British study shows that drinking coffee is linked with a decreased risk of stroke.

University of Cambridge scientists analyzed data from the European Prospective Investigation into Cancer; at enrollment in 1993-1997 the participants were aged 39 to 79, and had no prior stroke, heart attack, or cancer. Roughly 10,300 men and 12,600 women were followed for an average of 11 years.

80% of the participants drank coffee – an average of 3.1 cups a day – and 20% said they never drank coffee. There were 669 cases of stroke during follow-up. After adjustments were made for differences in smoking, social class, education level, BMI, alcohol intake, activity level, tea drinking, and a battery of blood chemical test results, a clear difference in the risk of stroke between the coffee-drinkers and non-drinkers was found. Compared with non-coffee drinkers, the coffee drinkers had a 27% reduced risk of stroke. In smokers, the reduction was 61%. Importantly, there was no ‘dose-dependence’ in coffee-drinking’s apparent protective effect. So there’s no reason to drink more coffee – one cup a day was enough in many of the subjects. It will, of course, be interesting to see if the results can be duplicated elsewhere, and then to find what factor, or factors, in coffee may be responsible.

Post a Comment |

Friday

05Mar2010

How Doctors Can Use “The Placebo Effect”, Ethically

Fri, March 5, 2010 at 03:00AM

Long, long before clinical trials were being done to provide evidence of a drug’s activity, the placebo effect was used by physicians to provide relief to patients with a wide range of symptoms. At the extreme end there was the snake oil of the travelling “doctor” in the West, but there’s little doubt that many medicines prescribed by family physicians in the early 1900s contained little more than a bitter-tasting substance put up in colored water. Nowadays a placebo is defined by its inert content and its use as a negative control substance in clinical trials. The trouble with an otherwise perfect experimental set-up is that the intended inert, negative control produces a measurable beneficial effect – the placebo effect. A good example is the rigid testing protocols for evaluating new antidepressant drugs, where the placebo effect may produce a good response in 30% to 40% of patients. An “effective” drug then has to produce a comparable (or better) response in 60% or more of the patients.

Recent research shows that placebo effects are genuine psychobiological events, and studies are reported showing that a placebo effect can be of several different kinds, and may even occur when no placebo has actually been given. This is the subject of an Australian publication in the Lancet.

The researchers cite a large study of patients with irritable bowel syndrome. Patients were given either no treatment at all, a placebo (a sham acupuncture treatment) or the placebo (sham acupuncture) plus supportive care (the clinician followed a script to convey attention, warmth, confidence, and thoughtful silence as he inserted the needles). The response rates in the 3 groups were 28% (no treatment), 44% (sham acupuncture alone), and 62% (sham acupuncture plus supportive care). Clearly the placebo effect of supportive care was added to that of the sham acupuncture; i.e. different sorts of placebo effect can be additive. Side effects can also be induced by placebos. In a similar study, patients given an inert pill were told they might experience adverse effects such as drowsiness, while those in another group were informed about the side effects of acupuncture. Both groups reported a 30% incidence of side effects, but in the first they were of the drowsiness type, and in the sham procedure they were those of acupuncture. Both these studies indicate that the placebo effect is the result of suggestibility.

So why shouldn’t the placebo effect be used deliberately in treatment, as in the bad old days? Maybe because it raises ethical issues, given our modern array of drugs and treatments that have been proven to be effective (at least to the FDA’s satisfaction). The Australian group point out that supportive care is clearly ethical, but only as an additive. They go on to suggest that one way a placebo pill might be given alone would be to tell the patient “this pill has no active drug and will work through psychological mechanisms to promote self-healing”. Good luck with that, as they say.

However, now it’s been shown that supportive care has a placebo effect, there’s no reason not to encourage all treatment regimens to include additional supportive care, without any practice of deception.

Post a Comment |

Thursday

04Mar2010

Sound Advice on Treating Muscle Cramps

Thu, March 4, 2010 at 03:00AM

A muscle cramp, commonly called a ‘Charley Horse’, arises when a muscle or group of muscles involuntarily contracts and cannot be relaxed by the subject’s will. Although cramps recover in a minute or so, prevention is often sought, as they are usually very painful. The American Academy of Neurology (AAN) formed a committee to establish guidelines for the best approach to treating or preventing leg muscle cramps; their recommendations are published in the journal Neurology. Here’s a summary.

For years, quinine or quinine derivatives have been the most popular drugs for leg cramps. Quinine is approved for treatment of malaria, and because malaria is life-threatening, the risks associated with quinine use are justifiable for that condition. But because of the drug's risks, the FDA believes it should not be used to prevent or treat leg cramps. The AAN committee also says that quinines should not be used routinely because of the potential for adverse events. Serious side effects include: cardiac arrhythmias (irregularities), thrombocytopenia (a decrease in blood platelets that can cause hemorrhage or clotting problems), severe hypersensitivity (allergic) reactions, and the potential for serious interactions with other drugs. Quinines should be considered only when cramps are very severe and the patient can be monitored for serious side effects.

What about other therapeutic approaches? None have been recommended as better than “possibly effective” by the committee, based on a positive result in a single clinical trial of questionable quality. The “possibly effective” substances are: vitamin B complex, naftidrofuryl oxalate (Praxilene® - a blood vessel dilator), lidocaine, and calcium channel blockers such as diltiazem (Cardizem®).

Things that don’t work, or haven’t been studied in clinical trial at all, – include gabapentin, baclofen, carbamazepine, oxcarbazepine, and stretching exercises for the affected muscle group.

I imagine most sufferers have tried the stretching approach. Your family physician can prescribe one or other of the “possibly effective” drugs. And, if all else fails, she/he can see if you are eligible to take prescription quinine. Being a former Brit, I take my quinine as an evening gin-and-tonic, but that’s less than a quarter of a therapeutic dose, so I still get the occasional Charley Horse.

Robert Griffith |

2 Comments |

Feeding Tubes Shouldn’t Be Needed for Dementia Patients

Wed, March 3, 2010 at 03:00AM

A study from Brown University, published in the Journal of the American Medical Association, has shown that larger, for-profit hospitals are more likely than smaller, non-profit hospitals to insert feeding tubes during acute-care admissions of nursing-home patients. It’s simplistic to conclude that the profit motive is responsible for this difference, but clearly it’s time to re-evaluate the need for feeding tubes in such patients. This is more important now that US Catholic bishops have announced that it’s not permissible to remove a feeding tube from someone who is not dying, except in rare circumstances.

Back in October last year the New England Journal of Medicine published an analysis of the clinical course of advanced dementia patients. Boston researchers studied 323 patients from 22 nursing homes, gathering clinical data and interviews with the patients’ health proxies. About 70% of the patients had Alzheimer’s, and 17% had vascular dementia. Over 40% of the patients developed pneumonia, 50% had at least one febrile episode, and 85% developed eating problems; 55% of them died during the 18 months study period.

During their final 3 months of life, over 40% of the patients had at least one ‘intensive intervention’ such as hospitalization, visit to the ER, tube feeding, or intravenous treatment. It was notable, however, that when the patient’s health proxy or surrogate understood the expected short time remaining, these interventions were much less likely, compared to those patients with less well-informed proxies.

It was also found that, in general, patients who could eat normally were not likely to die within the study period – only about 10% - compared with the 70% deaths in those with eating problems at some point.

I believe it’s time to ensure that health proxies are aware of the inevitability of death in advanced dementia patients who show one or more of the common complications – pneumonia, fever, and eating problems. The remaining time available to these patients should not be burdened by distressing interventions, such as the use of tube feeding or intravenous nutrition. And removal to hospital should be a well-studied decision, not just a speedy shifting of responsibility to another institution.

Post a Comment |