CDC: Strokes rise among pregnant women, new moms (AP)

Strokes have spiked in the U.S. among pregnant women and new mothers, probably because more of them are obese and suffering from high blood pressure and heart disease, researchers report.

Hospitalizations for pregnancy-related strokes and "mini strokes" jumped from about 4,100 in 1994-95 to around 6,300 in 2006-07, a 54 percent increase, researchers said, extrapolating from figures in a large federal database.

"That is a very, very alarm-raising statistic that we need to take extremely seriously," said Dr. Olajide Williams, a neurologist at Columbia University and Harlem Hospital and an American Stroke Association spokesman. "We need to be more aggressive in screening these women for these risk factors."

The number of strokes is small, considering that around 4 million babies are born each year in the U.S. But pregnancy raises a woman's risk of a stroke because of all the hormone and blood changes that occur. If she starts out unhealthy, with a problem like diabetes or high blood pressure, she doubles her risk of suffering a stroke during or right after pregnancy, said Dr. Elena Kuklina, a stroke prevention expert at the Centers for Disease Control and Prevention.

She led the study, published Thursday in the American Heart Association journal Stroke.

Researchers used records from a sample of hospitals in nearly all states, covering up to 8 million hospitalizations each year. They looked at the number of women having strokes or transient ischemic attacks � TIAs, or "mini strokes" � while pregnant or in the three months after childbirth.

Rates were highest in the South and lowest in the Northeast.

Researchers also looked at the prevalence of high blood pressure and heart disease, health problems closely related to obesity, and concluded that this accounted for nearly all the rise in stroke-related hospitalizations. Researchers also noted that women are having children at later ages, and the risk of a stroke rises with age.

Sometimes pregnant women and new moms are so focused on the baby's health that they neglect to consider their own, Williams said.

"They're thinking about the baby's name, the special room and what color they're going to paint the room. They're thinking about motherhood," Williams said. "But an ounce of prevention is always the best recipe for a healthy life."

Kuklina agreed.

"If you plan a pregnancy, try to see your physician before you get pregnant" to be assessed for stroke risks, she advised. And if you are pregnant, "try to start your prenatal care as early as possible. It's important to live healthy lives, to have healthy diets, stop smoking if you are smoking, increase your physical activity and maintain your healthy weight before pregnancy and continue during pregnancy."

Earlier this year, CDC researchers using the same hospitalization records reported that strokes are rising dramatically among young and middle-aged Americans while dropping in older people, a sign that the obesity epidemic may be starting to shift the age burden of the disease.

Getting help fast, as soon as symptoms appear, is key to preventing long-term damage. The warning signs of a stroke are sudden onset of any of these: numbness or weakness on one side, severe headache with no known cause, confusion, and trouble walking, speaking or seeing.

___

Online:

Stroke information: http://www.strokeassociation.org and http://stroke.nih.gov

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Offensive launched to protect Somali relief effort (AP)

MOGADISHU, Somalia � African Union forces have launched an offensive in Somalia's capital so aid agencies can get emergency food supplies to thousands of starving people without coming under attack from al-Qaida-linked militants, an official said Thursday.

The al-Shabab fighters already have killed men who tried to escape the famine with their families, saying it is better to starve than accept help from the West.

Lt. Col. Paddy Ankunda said Thursday that AU peacekeeping forces have conducted a "short tactical offensive operation" in Mogadishu.

"This action will further increase security ... and ensure that aid agencies can continue to operate to get vital supplies to internally displaced," he said.

The devastating famine in the Horn of Africa threatens al-Shabab's hold on areas under its control, with the militants fearing that the disaster will drive away the people they tax and conscript into military service.

In the past, the militants have blocked aid workers from helping those in need in Somalia, fearing that foreign assistance would undermine their control.

A World Food Program plane with 10 tons of peanut-butter paste landed Wednesday in Mogadishu, the first of several planned airlifts in coming weeks.

That will help, but Lt. Col. Kuamurari Katwekyeire, the civil-military coordination chief for the African Union Mission in Somalia, known as AMISOM, said the U.N. and other aid groups need to do more.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Food supplements airlifted into famine-hit Somalia (AP)

MOGADISHU, Somalia � A plane carrying 10 tons of urgently needed nutritional supplements to treat malnourished children has landed in famine-hit Somalia, a U.N. official said Wednesday.

The airlift is part of a crisis intervention as famine threatens to spread across lawless Somalia.

David Orr, a World Food Program spokesman who flew with the shipment from neighboring Kenya to the Somali capital of Mogadishu, said it was the first airlift of food aid since the U.N. declared a famine in parts of Somalia last week.

Orr said the aid would be distributed to medical facilities to treat the malnourished children.

WFP spokeswoman Challiss McDonough said this is first of several planned airlifts in coming weeks. She said Wednesday's shipment of peanut butter-based nutritional paste will treat 3,500 malnourished children for one month.

McDonough said WFP decided to send in the airlift because of an urgent need to treat the growing number of internally displaced children suffering from malnutrition before their condition deteriorates.

She said about 18,000 children are suffering from malnutrition and that the number is expected to grow to 25,000.

WFP says it cannot reach 2.2 million people in need of aid in the militant-controlled areas in southern Somalia because of insecurity.

Somalia has been embroiled in conflict for two decades, since the last leader was overthrown by warlords who then turned on each other. Islamist militant groups have spent the last few years battling the weak U.N.-backed government in an attempt to overthrow it.

Al-Shabab � the most dangerous militant group in Somalia � said last week it will not allow the aid groups to operate in its territories, exacerbating the drought crisis.

Earlier this month al-Shabab, which has links to al-Qaida, had shown indications of wavering on its 2009 ban on certain aid groups in its territories.

The drought has created a triangle of hunger where the borders of Ethiopia, Kenya and Somalia meet. WFP estimates more than 11.3 million people need aid across drought-hit regions in East Africa. The majority of those affected live in pastoral communities whose herds have been wiped out because of a lack of water.

Separately, UNICEF said Wednesday that it is trying to vaccinate more than 300,000 children in Kenya in an emergency program designed to prevent an outbreak of disease as refugees stream into northern Kenya.

Jayne Kariuki from UNICEF said that four northern Kenyan regions will be targeted along with Dadaab, the world's largest refugee camp, during the two-week program to immunize the children against polio and measles.

The children will also receive vitamin A and de-worming tablets. In Liboi, a dusty town in Kenya near the border with Somalia, mothers in long robes clustered around with children as aid workers dispensed medicine under a thorn tree.

Kenya recorded it first polio case infection in 20 years in 2009, after a four-year-old girl was diagnosed with the disease along the country's remote border with Sudan.

Polio is an infectious disease that mainly strikes children under five. It causes paralysis and can be fatal.

In 2006, two refugees escaping the war in Somalia were diagnosed with the disease at the Dadaab refugee camp at Kenya's eastern border with Somalia. That outbreak was contained before it spread.

___

Tom Odula in Nairobi, Kenya, and Katharine Houreld in Liboi contributed to this report.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

For some, hypnosis eases pain, recovery of surgery (AP)

LONDON � As the surgeons cut into her neck, Marianne Marquis was thinking of the beach.

As she heard the doctors' voices, she was imagining her toes in the sand, the water lapping.

Marquis had been hypnotized before surgery to have her thyroid removed. She's among a growing number of surgical patients at the Belgian hospital, Cliniques Universitaires St. Luc in Brussels, who choose hypnosis and a local anesthetic to avoid the groggy knockout effect of general anesthesia.

These patients are sedated but aware, and doctors say their recovery time is faster and their need for painkillers reduced. This method is feasible for only certain types of operations.

In her case, Marquis, 53, imagined herself in a field near a beach � which her anesthetist began describing by whispering into her ear about 10 minutes before surgery. She remembers hearing the doctors talk to her, but said it was as if they were far away.

"I was imagining squishing my toes in the sand and feeling water come up over them," Marquis said. She felt a little pressure on her neck with the first incision but said it wasn't painful.

Since doctors began offering hypnosis at the hospital in 2003, hundreds of patients have chosen it. At another Belgian hospital, more than 8,000 surgeries have been done this way since 1992.

Doctors say nearly any surgery usually done with a local anesthetic could work with hypnosis and less pain medicine. Proponents say hypnosis can dull patients' sense of pain and that it also cuts down on the need for anesthetic.

That means patients recover faster and hospitals save money, according to some studies. But it may require doctors to spend more time with patients beforehand to do the hypnosis and they may need more careful monitoring during surgery.

The technique has become increasingly popular in France and Belgium in recent years. Some plastic and facial surgeons in Germany also use hypnosis, as well as some British dental surgeons.

The French Society of Anesthesiologists describes hypnosis as a valid way to supplement anesthesia to reduce stress, anxiety and pain but neither the Belgian nor British anesthesiology groups offer specific hypnosis advice. Because of demand, the French Society of Anesthesiologists created a special hypnosis branch in their organization last year.

There are no figures on how widely hypnosis is used across Europe. In several of the nearly dozen French hospitals in Rennes, a northwest city of about 200,000 people, it's used in about half of all operations, says Claude Virot, a psychiatrist and director of the Institute of Research and Training in Therapeutic Communication there. Virot helps organize hypnosis training and said about 500 health professionals get it every year in France.

Dr. Fabienne Roelants, Marquis' anesthetist, described hypnosis as a modified state of consciousness. "The patient's mind goes to a pleasant place, but the body stays in the operating room." At Roelants' hospital, one-third of all surgeries to remove thyroids and one-quarter of all breast cancer surgeries, including biopsies and mastectomies, use hypnosis and local anesthetic. She and colleagues hope to expand the technique to procedures like hernias, knee arthroscopies and plastic surgeries.

Roelants said if patients feel any pain during the procedure, anesthetists immediately give them a painkiller shot.

During a recent procedure in Brussels where Christel Place, 43, had her thyroid removed, she furrowed her brow a couple of times to signal to Roelants she needed more drugs. In a green-lit room that helps relax the patients, Place pictured herself hiking in the French Alps while surgeons sliced her neck open.

The thyroid is a small gland at the bottom of the neck and makes hormones to control the body's metabolism. It is sometimes removed when it becomes enlarged, overactive or cancerous. The surgery can be done either with local or general anesthesia and is considered low-risk.

Place said waking up from the surgery was more abrupt than she'd expected. "It was like I was really in the mountains and then 'poof,' it was over," Place said, laughing.

Other experts caution that hypnosis would be impossible in major operations involving the heart or other internal organs because the pain would be unbearable.

"If hypnosis doesn't work and you've got somebody's abdomen or chest open, then you're in big trouble," said George Lewith, a professor of health research at Southampton University. "You need to be able to switch to another option immediately," he said.

Consistency is also an issue. "It's not used routinely because it's not effective in everyone and it takes a while," said Dr. Mark Warner, president of the American Society of Anesthesiologists. He said doctors would need extra time to conduct hypnosis and would need to work more closely with surgeons.

Warner said there are no guidelines on its surgical use in the U.S. He often uses music therapy or asks patients to picture a soothing scene to distract them from any discomfort. "If we could get more research on the right patient groups that would benefit from (hypnosis), that would be wonderful," he said.

Some experts said hypnosis is a hard sell because no one really profits from it.

"The problem is the money doesn't really go into anyone's hands, and the only person who really benefits from it is the patient," said Guy Montgomery, an associate professor at the Mount Sinai Medical Center in New York, who led a study published in the Journal of the National Cancer Institute in 2007.

In that research, Montgomery and colleagues randomly assigned 200 patients in the U.S. having a breast biopsy or lumpectomy to either get hypnosis or a brief session with a psychologist beforehand. They found hypnotized patients needed fewer painkillers and sedatives and required less time in surgery. On average, each hypnotized patient cost the hospital about $770 less than those who weren't hypnotized.

Marquis recommends hypnosis to patients who want to avoid anesthesia, but warned it isn't for everyone.

"You have to be in the right mental frame of mind for this, be properly prepared and trust the medical staff to take care of you," she said. "If you're very skeptical of hypnosis and freaked out about whether it's going to work, it probably won't."

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Study looks at NYC fast-food menu calorie counts (AP)

NEW YORK � Like any fitness program, it works only if you pay attention to it.

A new study on New York City's effort to encourage healthy eating by posting calorie counts on menus shows that it worked for about one in six customers � or those who paid heed to them. Those who ignored the numbers or didn't see them ordered whatever they wanted, regardless of how fattening it was.

City health officials who conducted the study said that's good news. On any given visit, customers who looked at the counts generally ordered about 100 fewer calories than those who didn't, according to the results of the study published Tuesday in the British medical journal BMJ.

In 2008, New York became the first municipality in the U.S. to require chain restaurants to post the counts, and other places including California and Seattle followed suit. Starting next year, a federal law will require all chains with 20 or more locations to print calorie counts on menus. British fast-food restaurants are set to introduce a similar but voluntary initiative.

The study was the first large-scale look at the initiative's success at several different chains. Lynn D. Silver, assistant commissioner of the city Department of Health and Mental Hygiene and one of the study's authors, said it showed modest gains in getting people to order lower-calorie meals. But she said the law also led restaurants to widen their offerings of healthier food, such as salads.

"Calorie labeling alone won't cure the obesity epidemic but it is one part of trying to address it," Silver said.

About a third of adults in the U.S. are obese, according to the federal Centers for Disease Control and Prevention.

The study looked at lunchtime purchases at 11 fast-food chains around New York in 2007, before the city law was passed, and then again in 2009. Researchers asked customers for their receipts and spoke to them about their orders. There was no significant change overall. But customers did order fewer calories, on average, at three major chains: McDonald's, Au Bon Pain and KFC. The study notes that those restaurants also introduced healthier choices around the same time the law was passed.

Meanwhile, the sandwich shop Subway showed a big increase in the average calorie count of a lunch order, which the authors linked to the popularity of its "$5 foot-long" deal, introduced nationally in 2008.

The study found that more than 20 percent of customers at Subway and Au Bon Pain paid attention to the calorie counts, an increase from the overall average of 15 percent. Women were more likely to use them when deciding what to order, as were people in wealthier neighborhoods. Young people were the least likely to use them.

The study noted that people are increasingly relying on food prepared away from home.

"There is a strong and growing consensus that consumers want to know what they are eating so that they can make informed choices," the authors wrote.

In a separate development on Tuesday, McDonald's announced changes to its iconic Happy Meal, making the portion of French fries smaller and adding fruit.

Marion Nestle, a professor at New York University's Department of Nutrition, Food Studies and Public Health and author of the blog "Food Politics," said the study confirms that once people pay attention to the calorie counts, they make dietary changes.

"The next step has to be to get more people to look at the info," she said.

In New York City's Midtown at lunchtime on Tuesday, Carlos Munoz, a 29-year-old student at a technical school, munched on a chicken wrap, fries and a soda from McDonald's.

"I don't really pay any mind to it," he said of calorie counts. "I figure one bad thing a day I should be able to burn away."

But he supported their presence on menus.

"You should know what you're putting into your body," he said. "If I'm ever curious, I'd like to know I can get the information."

Inside Starbucks, Alexandra Casey, 23, of Worcester, Ma., said she looks at calorie counts when they're posted. But as a vegan and avid runner, she was more concerned with overall nutritional content rather than just calories. For example, nuts might be high in calories but they're still a better choice than cake.

Casey applauded New York for leading the way in posting the counts but said eateries should provide more comprehensive information about the food and beverages they offer.

"It's not just about a number," she said. "The question is, what's the content of those calories."

___

Karen Zraick can be reached at http://www.twitter.com/karenzraick

___

Online:

http://www.bmj.com/content/343/bmj.d4464

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Study: Medicare drug plan saves hospital costs (AP)

CHICAGO � A new study suggests that Medicare's 5-year-old prescription drug plan is keeping seniors out of hospitals and nursing homes, saving the federal program an estimated $12 billion a year in those costs.

The savings only offset a portion of the $55 billion a year the government spends on Medicare Part D, as the drug plan is known. But the study's authors say it means seniors are staying healthier and enjoying a better quality of life.

"This is what people always hope for: If people get drug coverage, they won't need hospitalization," said Marsha Gold of the nonpartisan Mathematica Policy Research, who wasn't involved in the new study. "If it holds up, that's great news."

The Harvard analysis, appearing in Wednesday's Journal of the American Medical Association, found Medicare saved an average of about $1,200 a year for each senior citizen who had inadequate drug coverage before Medicare Part D. Most of the savings came from hospital and nursing home costs.

That translates to an annual savings of $12 billion, experts said.

With subsidized drug coverage, seniors can afford drugs that prevent trips to the emergency room by lowering cholesterol and blood pressure and controlling diabetes, said lead author Dr. Michael McWilliams of Harvard Medical School.

Other savings come from doctors no longer admitting patients to hospitals just so Medicare would pay for drug treatments � like injectable clot-busting drugs for deep vein thrombosis � that can be given more cheaply in a doctor's office, McWilliams said.

"Spending on one type of service can reduce spending on another type of service," McWilliams said. "By expanding Medicare to include drug benefits, clearly we're spending more, but we're getting a lot of value out of that spending."

The findings suggest that lawmakers, while grappling with reducing the federal deficit, should consider all of Medicare's moving parts and how they affect each other, experts said.

"It's critical to think about the entire program. They can't just be thinking about how to pay hospitals differently," said Julie Donohue, a health policy researcher at the University of Pittsburgh, who wasn't involved in the new study. "They have to think about the whole delivery system and the whole Medicare system."

It's tough for researchers to pinpoint the effect of a policy change because they usually can't randomly assign people to participate in a program or not. Medicare Part D is voluntary. Enrollees pay premiums that cover about 25 percent of the cost. There were 23 million Part D beneficiaries last year.

For the new study, researchers analyzed nondrug Medicare spending for about 6,000 seniors from 2004 through 2007.

The Medicare drug benefit started in January 2006. Before then, about 2,500 of the seniors in the study reported having generous drug coverage, which many bought as supplemental insurance. About 3,500 reported having limited or no drug coverage.

By comparing spending trends before and after 2006, the researchers were able to calculate any nondrug savings.

Previous studies show Medicare Part D increased use of antibiotics and drugs for diabetes, high blood pressure, depression and other chronic conditions.

The nation's 1-year-old health care law is gradually closing the Medicare drug coverage gap, the "doughnut hole," which also should keep seniors out of hospitals, McWilliams said.

But another view on the doughnut hole came from Joseph Antos, a health policy expert at the conservative-leaning American Enterprise Institute. Antos said the doughnut hole "turned out to be a very good idea" because it encourages seniors to use cheaper generics instead of more expensive brand-name drugs.

"It's disastrous policy to whittle away at the doughnut hole," Antos said. "If we see generic usage drop, that means the program is going to cost more."

___

Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson.

___

Online:

JAMA: http://jama.ama-assn.org

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials