Tuesday, October 18, 2011

Heart failure hospital stays fall, saving billions (AP)

CHICAGO � Hospital stays for heart failure fell a remarkable 30 percent in Medicare patients over a decade, the first such decline in the United States and forceful evidence that the nation is making headway in reducing the billion-dollar burden of a common condition.

But the study of 55 million patients, the largest ever on heart failure trends, found only a slight decline in deaths within a year of leaving the hospital, and progress lagged for black men.

"While heart failure hospitalizations have decreased nationally overall, certain populations haven't seen the full benefit of that decrease," said lead author Dr. Jersey Chen of Yale University School of Medicine.

Possible explanations for the decline in hospital stays abound, including healthier hearts, better control of risk factors like high blood pressure, and more patients treated in emergency rooms and clinics without being admitted to hospitals, said Dr. Mariell Jessup, medical director of the Penn Heart and Vascular Center in Philadelphia.

"I think it's extraordinary news," said Jessup, who wasn't involved in the new research. "Many efforts at changing the natural history of this disease seem to be having an effect, especially with the hospitalization rate. But it's still a very problematic disease."

More than 5 million Americans and 22 million people globally have heart failure. Their hearts strain to pump blood because of damage, often from a heart attack or from high blood pressure. Fluid backing up into the lungs can leave people struggling to breathe.

Heart disease contributes to heart failure. Last week, federal health officials reported that the prevalence of self-reported heart disease in the U.S. decreased from nearly 7 percent to 6 percent from 2006 to 2010.

Fewer hospital stays saves Medicare a lot of money because heart failure is the most common cause of hospitalization in older patients.

From 1998 to 2008, the rate fell from 2,845 hospitalizations per 100,000 Medicare beneficiaries to 2,007 per 100,000, according to research appearing in Wednesday's Journal of the American Medical Association.

If the rate had remained the same, there would have been 229,000 more heart failure hospital stays in 2008 at an additional cost to Medicare of $4.1 billion, Chen said.

Other reasons for declining hospital stays may include specialized pacemakers and better use of medications such as ACE inhibitors that relax blood vessels, diuretics that prevent fluid buildup, digoxin that boosts heartbeat strength and beta blockers that ease strain on the heart.

Shortness of breath sent heart failure patient Maria Marure to several Chicago hospitals this year. In August, the 56-year-old spent a week at Our Lady of the Resurrection Medical Center, where leaders are focused on keeping heart failure patients healthy once they're home and avoiding readmissions. Next year, the nation's new health law begins punishing hospitals with high readmission rates for heart failure by shrinking Medicare payments.

The Chicago hospital made sure Marure had a medical interpreter to translate a nurse's instructions into Spanish and convey her questions. Marure said it was the first time she understood her heart failure and why it was important for her to watch her weight � which can signal excess fluid. The hospital sent her home with a scale, made sure she had home care and a nurse called her periodically.

Even with all that, in less than three weeks, Marure was struggling to breathe again. A doctor sent her to a different hospital, where she was admitted for four days.

That patient's experience illustrates why heart failure is still a challenge, despite the new findings � as does the one-year death rate found in the study. The proportion of patients who died within a year after being discharged fell, but only slightly, from about 32 percent to about 30 percent during the decade.

"The death rate is still unacceptably high," said Dr. Mihai Gheorghiade of Northwestern University's Feinberg School of Medicine in Chicago. Hospitals need to aggressively treat heart failure patients' other ailments and immediately schedule follow-up care after discharge, said Gheorghiade, who wrote an accompanying editorial in the journal.

"It is a sign of hope. However, we are far from achieving our goals," he said.

___

Online:

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

___

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



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Study: Vaccine reduces malaria in African children (AP)

ATLANTA � The quest for the world's first malaria vaccine appears to have taken a big step.

The first results from a late-stage test in seven African countries were released Tuesday. They show the experimental shots cut the number of cases of malaria in half in young children.

The vaccine still is at least three years away. More testing must be completed to see how well it works in infants and how long protection lasts. Then the vaccine will be reviewed by government agencies in Europe and in individual African nations.

GlaxoSmithKline developed the vaccine. It targets a malaria parasite found in sub-Saharan Africa. There are no plans to market it in the United States.

The research results were released at a malaria conference in Seattle.



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Monday, October 17, 2011

Doctors: Pap remains best test for cervical cancer (AP)

There's more news on cancer screening tests � this time for women.

Scientists advising the government say a Pap test is a good way to screen young and middle-aged women for cervical cancer, and it's only needed once every three years. But they say there is not enough evidence yet to back testing for HPV, the virus that causes the disease.

That's at odds with the American Cancer Society and other groups, which have long said that using both tests can be an option for women over 30.

Those groups and the government advisory task force separately plan to release proposed new guidelines for cervical cancer screening on Wednesday and invite public comment. The task force is the same group that recommended against routine PSA tests to screen for prostate cancer, saying they were doing more harm than good for men at average risk.

Cervical cancer screening is a success story. In the United States, cases and death rates have been cut more than in half since the 1970s because of Pap smears � lab exams of cells scraped from the cervix, the gateway to the uterus. The test can find early signs of this slow-growing cancer and treat them before a tumor has a chance to develop.

So "the bar is set pretty high" for a test to replace or supplement Paps, said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore.

Not enough is known about the benefits and especially the harms of HPV testing, concludes the scientific review she led that was published on Monday. The task force that asked for the review voted unanimously in March that there was insufficient evidence to recommend for or against HPV testing, but has continued to discuss the issue and will give its advice on Wednesday.

Here's the dilemma: Infections with HPV, the human papillomavirus, are very common especially in young women. They usually go away on their own and only pose a cancer risk when they last a year or more.

Tests that find these infections might lead many women to more invasive follow-up tests that can weaken the cervix and cause problems having children later. No big studies measure these harms, and a test that flags more potential cancers might not be better.

"A lot of people use the word `superior' to mean it catches more cancer. But the other side of it is, does it catch more things that are not cancer? You have to weigh benefits versus harms for any screening test," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

The evidence review finds little risk of cervical cancer in women under 21 and says screening below that age may be harmful. It also says screening can stop at age 65 if a woman has had adequate screening in the past and is not otherwise at high risk.

The review was published Monday in the Annals of Internal Medicine.

The same journal also published a study on another women's cancer issue � breast cancer screening. That research supports having mammograms every other year instead of annually. Over time, there are more false alarms with annual screening, and going every two years does not significantly raise the risk of a late-stage cancer being found, researchers report.

Breast cancer screening has been an emotional issue since 2009 when the government task force said women at average risk of the disease don't need mammograms until age 50 and then just every other year to age 74. The cancer society and others still advise annual tests starting at age 40.

The federally funded study gives a real-world view of the downside of screening � the worry, expense and medical risks of biopsies and other tests that ultimately prove unnecessary. It looked at false alarms at various intervals of screening for nearly 170,000 women ages 40 to 59 in ordinary community settings, plus nearly 4,500 other women with invasive breast cancer.

About 61 percent of women who get a mammogram every year for a decade will be called back at least once for extra tests that turn out not to show breast cancer, the study found.

Screening every other year drops this false alarm rate to 42 percent without a big risk of cancer being discovered at a late stage. And a tip for women: If you changed where you go for mammograms, bringing or having doctors send your last one to be compared to the new one cuts in half the chance of a false alarm.

Women who started having mammograms in their 40s versus their 50s were more likely to have a false alarm just because they were having more tests � not because mammography is less accurate in that age group.

False alarms "are part of the price to pay for early detection," said study leader Rebecca Hubbard of Group Health Research Institute, part of a Seattle-based managed care system. Women need to know how common they are, and "if it happens to them they will feel less anxiety," she said.

Dr. Robert Smith, the cancer society's director of cancer screening, said the study should have more precisely defined intervals � it called annual screening an interval of 9 to 18 months, and biennial screening, 19 to 30 months.

"A false positive is commonly discussed as if it were a catastrophic event. For the large majority of women, it isn't," and surveys say women will accept the risk in return for finding cancer early, he said.

.___

Online:

Journal studies: http://www.annals.org

Cervical cancer science review: http://tinyurl.com/6lc2rzg

Task force advice: http://www.ahrq.gov/clinic/pocketgd1011/gcp10s2.htm

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

Cancer Society: http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

___

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



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CDC: Add $2 per drink for US excessive drinking (AP)

ATLANTA � The toll of excessive drinking works out to about $2 per drink, in terms of medical expenses and other costs to society, according to a new federal research.

The Centers for Disease Control and Prevention study calculated societal costs from binge and heavy drinking beyond what consumers pay at the bar or liquor store. It's the first such federal estimate in more than a dozen years.

The study looked at costs that included � among other things � lost work productivity, property damage from car crashes, expenditures for liver cirrhosis and other alcohol-associated medical problems, and money spent on incarceration of drunk drivers and criminals using alcohol.

The CDC estimated excessive drinking cost society nearly $224 billion in 2006, the most recent year for which all necessary statistics were available. That worked out to about $1.90 per drink, 80 cents of which was spent by federal, state or local governments, the researchers estimated. The rest came from drinkers, their families, private health insurers, employers, crime victims and others.

Most of that was related to binge drinking, in which four or five alcoholic beverages are consumed on one occasion.

"Binge drinking results in binge spending," said CDC Director Dr. Thomas Frieden.

CDC officials noted that while some health benefits have been associated with, say, a glass of wine each day, there are no health benefits linked to excessive drinking. They also said the new study likely represents an underestimate of the total cost.

Smoking has been estimated to cost society about $193 billion annually. An older study estimated the cost of not exercising to be around $150 billion.

The study was released Monday by the American Journal of Preventive Medicine.



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Sunday, October 16, 2011

No cupcakes here! Gold-medal school fights obesity (AP)

DANVILLE, Ill. � Five-year-olds dance hip-hop to the alphabet. Third-graders learn math by twisting into geometric shapes, fifth-graders by calculating calories. And everyone goes to the gym � every day.

In the middle of America's heartland, a small public school, Northeast Elementary Magnet School, has taken on a hefty task � reversing obesity.

And it's won a gold medal for it, becoming the first elementary school in the country to receive that award from the Alliance for a Healthier Generation. The Alliance was founded by the American Heart Association and the William J. Clinton Foundation to reduce childhood obesity. Only two other schools have taken the gold.

The cafeteria here serves fresh fruit and veggies, low-fat or no-fat milk, no sodas or fried foods and no gooey desserts. There are no sweets on kids' birthdays and food is never used as a reward. Teachers wear pedometers and parents have to sign a contract committing to the school's healthy approach.

Northeast Elementary is not in some posh, progressive suburb. It's in Danville, Ill., an economically struggling city of 30,000 in farm country some 150 miles south of Chicago. But teachers, parents and students have embraced the rigorous curriculum and kids even call it "fun."

From the outside, it's a drab 50's-era yellow brick building in a blue-collar neighborhood of modest frame homes, a few blocks from a homeless shelter and a Salvation Army donation center. Inside, it's a cheerful oasis for almost 300 kids and has caught the attention of some of the nation's biggest obesity-fighting advocates.

Former President Bill Clinton says the steps Northeast has taken are an exemplary way to tackle "a terrible public health problem."

"We will never change it by telling people how bad it is. We've got to show people how good it can be," Clinton said, paraphrasing a colleague at the Alliance's June awards ceremony in Little Rock, Ark.

Northeast's strict, no-goodies program might sound extreme, but students seem to have bought it.

During a recent nutrition lesson, first-graders sat raptly on the hallway floor as a teacher read "The Very Hungry Caterpillar," a classic kids' story about a caterpillar that can't seem to stop eating � all kinds of fruit at first. But when the bug moved on to chocolate cake and ice cream, the youngsters gasped and said in hushed tones, "junk food," as if it were poison.

"We're a healthy school," says 10-year-old Naomi Woods, a shy, slim fifth-grader. "We're not allowed to eat junk food or stuff like that."

Sandy-haired Timothy Mills, a fourth-grader, says the focus "just keeps us more fit, plus we have a lot more fun."

Like Mills, an earnest, heavy-set 9-year-old, Northeast kids aren't all skinny. Even some kindergartners are clearly overweight. But they still jump enthusiastically to the alphabet song, and though chubbier kids struggle to run around the football field during gym class, there doesn't seem to be much grumbling.

Physical education teacher Becky Burgoyne said it's sometimes tough to get kids of "all different shapes and sizes" to be physically active.

"I just ask that students do their best and improve on what they can already do," Burgoyne said.

Some schools "may have physical education twice a week, once a week, and that's not acceptable. Children need to move," she said. "To have a healthy body is to have a healthy brain and therefore they become better at reading and math and science. It all works together."

The students mostly mirror Danville and surrounding Vermilion County � generally poorer, less healthy than the state average, with many families struggling with obesity and related problems.

The percentage of overweight kids at Northeast increased in 2009, the program's third year, but dropped slightly last year, to 32 percent; 17 percent are obese. Those are similar to national figures, Principal Cheryl McIntire said. With only three years of data, it's too soon to call the slight dip in the percentage of overweight children a trend. But she considers it a promising sign, and there's no question that the children are learning healthy habits.

In a recent math class, fifth grade teacher Lisa Unzicker explained how food labels can be misleading by listing only calories per serving, not per container. Pointing to an image of a pretzel bag label projected on a screen at the front of the classroom, she taught students to figure out how many calories are in a whole bag, based on the amount in each serving.

You have to be careful about potato chips and candy bars, she told the class. "This is why it pays to be a very conscious consumer."

Teachers and parents credit McIntire for the school's success. The principal joined Northeast in 2008, a year after the staff moved to adopt the healthy focus, and has made it her mission to instill that mantra.

McIntire literally "walks the walk." When students need a talking-to, she walks to their classrooms and escorts them to and from her office rather than just messaging for them. When it's her turn for recess duty, she walks with her pedometer around the school's big field instead of standing on the sidelines. She recalls a student recently calling out, "Hey, Mrs. McIntire, are you doing your steps?"

McIntire is closely involved with choosing school menus and secured money from the state and local school district that have paid for fresh produce, including things like kiwi fruit that many children have never seen before.

A recent lunch menu featured whole-grain, reduced-fat cheese pizza, broccoli and cauliflower buds, sweet corn, chilled pears, low-fat pudding, and 1 percent low-fat milk.

McIntire has changed her own eating habits, giving up potato chips and shedding 15 pounds since last year.

Tall, slender and a youthful 56, McIntire guides Northeast with a firm but loving hand. She greets students by name each morning, helps with untied shoelaces, and offers hugs. And she scolds kids who have messy uniforms or are rude to their classmates.

School hallways feature signs about good food choices and being healthy, and a poster about the Alliance's gold award is prominently displayed near the school office.

The Alliance established a Healthy Schools' program in 2006, with funding from the Robert Wood Johnson Foundation. It helps schools that want to become healthier and meet alliance criteria for winning medals. More than 500 schools have won bronze and silver awards. Those gold medals are tougher to come by. Memorial High School in West New York, N.J., was the first school in the country ever to win a gold. Last year, Northeast became the first elementary school to do that. Rio Hondo Elementary in suburban Los Angeles is the latest to win it.

Ginny Ehrlich, chief executive officer for the Alliance for a Healthier Generation says of Northeast, "They truly stand out." The school has done a remarkable job of making "healthy eating and activity the norm."

Since Northeast is a magnet school, students have to apply to attend, although they don't need to test in. Besides committing to the healthy mindset, parents must volunteer 26 hours at the school each year.

"There certainly are people who are much more invested than others, but we have gotten so much positive feedback from parents," McIntire said.

In her first year, McIntire recruited students by posting advertisements in the local newspaper. "I don't need to do that anymore," she said. For the current school year, there were more than 80 applications for 48 kindergarten slots.

"We have people calling everyday wondering if their child can get in," she said.

Shelbi Black says Northeast has had an "amazing, life-altering" influence on her kids, 10-year-old Kayla and Carter, 5. They've come home requesting fruits and vegetables they used to reject. Carter was thrilled to make frozen fruit shish kebobs in school, and Kayla "was so excited the other day because she made her goal in running the mile and she was so happy that she knocked down her time from last year," Black said.

Tim Mills' mom, Charlyn Hester, says since the school adopted the healthy program, her family has switched from eating lots of convenience foods to lean grass-fed beef and lots of fruits and vegetables. Her oldest daughter, a recent Northeast graduate, has slimmed down and Hester says she thinks Tim and his 11-year-old sister will, too. Hester herself has lost almost 100 pounds since 2009.

The family's grocery bills are higher, but Hester, a freelance writer, says she and her husband, a security officer, have decided it's worth spending more on food and forgoing things like a new car, for their kids' health.

"It's not necessarily a financial hardship, but it's certainly an investment," she said.

Health department officials say they have not calculated obesity rates for children in Danville and the county. Psychologist Richard Elghammer, who works with a large rural health clinic in Danville, says about one-third of the kids treated there are overweight or obese � similar to the national average. National data suggest that the county's obesity rate alone for adults, about 32 percent, is also similar to the national average. About two-thirds of adults are overweight.

But Vermilion County rates of obesity-related illness including heart disease are higher, and more than 80 percent of county residents don't eat government-recommended amounts of fruits and vegetables, according to national surveys.

Dr. Thomas Halloran, an internist who treats adults in Danville, has been working to provide financial support and resources to Northeast, through his medical group, Carle Clinic. Halloran says many of his patients have diabetes and other illnesses tied to a lifetime of obesity and poor health habits. By instilling healthy habits in kids starting in kindergarten, the school is making an important contribution to the community's health, Halloran said.

___

Online:

Alliance for a Healthier Generation: http://www.healthiergeneration.org

Northeast's Facebook page: http://on.fb.me/oAutYo



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Friday, October 14, 2011

Boston hospital performs double hand transplant (AP)

BOSTON � A quadruple amputee who received new hands through a transplant operation says he is looking forward to doing ordinary things again: getting dressed, taking a shower, making coffee and, sweetest of all, touching the faces of his two grandsons.

Richard Mangino, 65, of Revere, lost his arms below the elbows and his legs below the knees after he had a kidney stone in 2002 and contracted a severe bloodstream infection.

Last week, a team of more than 40 surgeons, nurses and support staff at Boston's Brigham and Women's Hospital worked for more than 12 hours performing a hand transplant.

Mangino said at a news conference Friday that he had adjusted to his life as a quadruple amputee. The former director of the ground crew for United Airlines at Boston's Logan airport, Mangino taught himself to do daily activities with his prostheses, mowing the lawn, shoveling snow and painting. He said people kept telling him what a "miracle" he was.

"But the one miracle I have prayed for, since my oldest grandson Trevor was born, was to be able to feel the sense of touch again ... to touch his and Nicky's little faces, and stroke their hair, and to teach them to throw a ball," he said. "To me, that would be a miracle. And today, my miracle has come true."

Doctors said it will take six to nine months for Mangino to regain sensory function in his hands, but days after surgery he began independently moving his fingers.

The donor's name was not made public.

In a statement, the wife of the donor said her husband, in talking about donation, always said, "It's just a body."

"I didn't have to struggle with the decision," she said of donating her husband's hands. "After I digested what it entailed, I thought, if it can help someone else out � I felt strongly that my husband would feel the same way," she said in her statement.

Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and Women's, said there have been approximately 50 hands transplanted worldwide, about a dozen of them in the United States. He said Mangino's surgery was only the fourth bilateral hand transplant in the U.S.

Mangino's procedure was the second bilateral hand transplant by surgeons at Brigham and Women's, which has performed four face transplants.

In May, a Connecticut woman who was mauled by a chimpanzee received a new face and two hands at the hospital, but the hand transplant failed after Charla Nash developed pneumonia and other complications after surgery.

Mangino's surgery involved multiple tissues, including skin, tendons, muscles, ligaments, bones and blood vessels on his forearms and hands.

He said he is looking forward to being able to do everyday things without having to struggle.

"I won't have to perform a miracle anymore to just get up in the morning," he said.



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