Chest Scans May Incidentally Help Spot Heart Disease Risk

Chest CT scans taken for routine diagnostic purposes even those not related to cardiovascular disease concerns can be used by radiologists to screen for signs of heart disease risk, new research suggests. "Radiologists can predict cardiovascular disease fairly well using incidental findings of calcifications of the aortic wall on CT, along with minimal patient information, such as age, gender and the reason for the CT," study lead author Dr. Martijn Gondrie, of the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht in the Netherlands, said in a news release from the Radiological Society of North America.

"Ultimately, this easily executed extra risk stratification has the potential to reduce future heart attacks or other cardiovascular events," Gondrie added. The study findings were released online Sept. 28 in advance of publication in the November print issue of Radiology. Gondrie and colleagues pointed out that chest CT scans have increased in quality and frequency of use over the past decade, resulting in a greater pool of incidental findings that clinicians can theoretically use to assess risk for all sorts of additional health complications. Such incidental findings can be a bonus because they do not expose the patient to additional radiation or additional scanning costs, the study authors explained.

To assess the potential usefulness of such findings, Gondrie's team analyzed incidental data regarding a number of different aortic abnormalities that had been gleaned from nearly 1,200 chest CT scans conducted for reasons having nothing to do with heart health. The researchers found that when all the various types of abnormalities cited were taken as a whole, the incidental heart-related findings were in fact helpful in predicting future heart disease risk. The authors concluded that their work "generates the much-needed insights that allow more effective utilization of the increasing amount of diagnostic information, and it could potentially change the way radiologists contribute to the efficiency of daily patient care."
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Poor Health Habits Linked to Subpar Work Performance

People who engage in unhealthy habits such as smoking, eating a poor diet and not getting enough exercise turn out to be less productive on the job, new Dutch research shows. Unhealthy lifestyle choices also appear to translate into a greater need for sick leave and longer periods of time off from work when sick leave is taken, the study reveals. The finding is reported in the Sept. 28 online edition of the journal Occupational & Environmental Medicine.

"More than 10 percent of sick leave and the higher levels of productivity loss at work may be attributed to lifestyle behaviors and obesity," Alex Burdorf, of the department of public health at Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues noted in a news release from the journal's publisher. Between 2005 and 2009, Burdorf and his associates surveyed more than 10,600 people who worked for 49 different companies in the Netherlands.

Participants were asked to discuss both lifestyle and work habits, rating their work productivity on a scale of 0 to 10, while offering information about their weight, height, health history and the number of days they had to call in sick during the prior year. The investigators found that 56 percent of those polled had taken off at least one day in the preceding year because of poor health. Being obese, smoking, and having poor diet and exercise habits were contributing factors in just over 10 percent of sick leave occurrences.

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Better Screening Urged for Self-Injury in Teens

Doctors often fail to screen their adolescent eating-disorder patients for evidence of self-inflicted physical harm in the form of cutting or burning, new research reveals. The observation stems from work conducted by researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital in Palo Alto, Calif. Led by Dr. Rebecka Peebles, the research team published its findings in the Sept. 28 online edition of the Journal of Adolescent Health. Peebles and her colleagues noted that eating disorders typically found among adolescents, such as bulimia and anorexia, are often associated with a higher risk for self-inflicted injury. This, Peebles noted in a Stanford news release, often stems from a troubled patient's need to try "to feel pain."

"Patients describe a feeling of release that comes when they cut or burn themselves," she said. "They'll cut with a razor or a scissor blade. Sometimes we've even had kids who will take the tip of a paper clip and gouge holes. To burn themselves, they'll heat up a metal object and press it to their skin, or they'll use cigarettes." Prior research has indicated that between 13 percent and 40 percent of all American adolescents engage in some form of self-injury. The practice is also linked to a higher risk for suicide, the study authors noted. To see how often this happens and how often doctors proactively screen for the association, the investigators focused on the medical records of 1,432 patients between the ages of 10 and 21 years, who had sought treatment for an eating disorder at the Comprehensive Eating Disorders Program at Packard Children's Hospital between 1997 and 2008.

More than 90 percent of the patients were female, three-quarters were white, and the average age was 15, the researchers noted. Nearly 41 percent were found to have engaged in intentional self-inflicted injury. More than 85 percent of the time this took the form of cutting themselves. Yet despite the high prevalence, only about half of the patients had been asked by hospital staff if they had hurt themselves on purpose. Those who were asked tended to fit a classic profile: they were female, older, white and had a diagnosis of bulimia and/or substance abuse of some kind. "The question is," said Peebles, "are we missing other kids who are not meeting this profile? This is part of why we wanted to look at this. If you see an innocent-looking 12-year-old boy, you don't even think of asking about self-injurious behavior. We need to get much better about universal screening."

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As Science Unlocks Secrets, Cancer Rates Fall
Cancer is one of the most feared diseases on the planet, and the second leading cause of death in the United States. But medical science is slowly conquering cancer, according to an assessment of cancer trends produced by the U.S. National Cancer Institute in conjunction with the U.S. Centers for Disease Control and Prevention, the American Cancer Society and the North American Association of Central Cancer Registries. Death rates and diagnosis rates from all cancers combined are declining significantly, both for men and women overall, and for most racial and ethnic populations within the United States, the report found.

New diagnoses for all types of cancer combined decreased an average of almost 1 percent a year from 1999 to 2006, and deaths attributed to cancer decreased 1.6 percent a year from 2001 to 2006, according to the report, an annual evaluation released each December. Doctors predict that the rates will keep falling because research has begun unlocking the secrets of how different cancers begin and develop. "We're beginning to understand that each cancer has an individual pathway to development," said Dr. Alan G. Thorson, president of the American Cancer Society, a clinical professor of surgery and director of colon and rectal surgery at Creighton University in Omaha, Neb. "We know now how to look at cancer, find its source and go for that source, which makes all the difference in the world."

The decrease in cancer incidence and deaths has been driven mainly by advances in detecting and treating the major types of cancer in men and women, according to the report. Incidence and death rates are declining for lung, prostate and colorectal cancer in men, and for breast and colorectal cancer in women, the report said. Also, increases in the other major cancer for women, lung cancer, have tapered off, with rates remaining stable since 2003. There's no single explanation for the decrease in these major cancers, doctors said. Rather, the decreases are chalked up to effective detection and treatment tools designed for each form of cancer. For example, public tobacco policy has been crucial in reducing lung cancer rates in men and leveling them out for women, said Dr. Brenda Edwards, associate director of the Surveillance Research Program at the U.S. National Cancer Institute.
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Recent Stress May Reduce Cancer Therapy Effectiveness

Physical or mental stress one or two days before cancer treatment may reduce the effectiveness of the therapy, researchers have found. In a series of experiments using breast cancer cell cultures, a research team at Ohio State University found that mental and physical stress including rigorous exercise activates a stress-related protein that can trigger a chain reaction that enables cancer cells to survive cancer treatments. Specifically, the investigators discovered that the presence of the heat shock factor-1 (HSF-1) protein could impair the process that kills cancer cells even after their DNA was damaged by radiation or chemotherapy, according to the report published in the Sept. 21 online edition of the journal Molecular Cancer Research.

It may be possible to develop drugs that suppress HSF-1 and use these drugs as a supplement to cancer therapy, the study authors suggested in a university news release. In the meantime, patients should try to avoid physical and mental stress in the days before cancer treatment, they recommended. "One of the known inducers of (HSF-1) is exercise. I am not against exercise, but the timing is critical. It looks like any intense or prolonged physical activity a couple of days before the start of cancer therapy is highly risky, and has potential to reduce the benefits of treatment," lead author Govindasamy Ilangovan, an associate professor of internal medicine, said in the news release.
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Surgery May Be Best for Irregular Heartbeat in Young

Young people with the kind of irregular heartbeat known as atrial fibrillation may be better off undergoing surgery to fix the problem instead of taking medication first, a new study suggests. Atrial fibrillation, which causes a person's pulse rate to change from minute to minute, can boost the risk of stroke and cause other problems. The condition is rare in younger people and can occur for no known reason. There are a number of treatments for atrial fibrillation, including medication, cardioversion and catheter ablation. A heart specialist who's familiar with the new study findings said ablation is indeed a worthwhile alternative. "Younger patients tend to respond very well to this therapy," said Dr. John Day, medical director of heart rhythm services at Intermountain Medical Center in Murray, Utah.

In the study, which was released online Sept. 21 in advance of publication in the journal Circulation: Arrhythmia & Electrophysiology, researchers examined the medical records of 1,548 patients who underwent catheter ablation between 2000 and 2008 in the University of Pennsylvania Health System. The average age of the patients was 56 years, and 70 percent were men. The investigators found that younger patients had fewer complications than older ones and did just as well after the surgery. A year after surgery, 87 percent of the patients under the age of 45 had experienced little or no atrial fibrillation.

Why choose the surgery instead of medication? "While atrial fibrillation is more common with increasing age, clinical experience has suggested that younger patients tend to be more symptomatic and less willing to take long-term medications," Dr. Peter Leong-Sit, study lead author and an arrhythmia physician at London Health Sciences-University Hospital in London, Ontario, Canada, said in a news release from the American Heart Association. The surgery isn't cheap. It can cost $30,000-$40,000, Day noted. But studies have shown it can be cheaper in the long run if the alternative is a lifetime of medications and complicated testing and care, he added.
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Injections May Relieve Drooling in Nerve-Damaged Kids

Botulinum toxin injections may temporarily relieve drooling in children with certain neurological conditions, a new European study has found. Depending on its severity, drooling can lead to stigmatization and social neglect, numerous daily clothing changes, skin irritation around the mouth, aspiration pneumonia and dehydration, Dr. Arthur Scheffer of Radboud University Medical Center in Nijmegen, the Netherlands, and colleagues noted in a news release about their study. In the study, Scheffer's team gave botulinum toxin injections to 131 children, average age 10.9 years, with cerebral palsy or other non-progressive neurological conditions, as well as moderate to severe drooling.

The injections were confined to the submandibular glands, which are responsible for 70 percent of saliva production while a person is resting. Two months after the injections, the average drooling quotient had fallen to 15.5 (on a scale of zero to 100) from 28.8 at the start of the study. And, the study authors noted, 61 patients achieved a 50 percent reduction in drooling. At the eight-month follow-up, the average drooling quotient was 18.7, according to the report in the September issue of the journal Archives of Otolaryngology Head & Neck Surgery.

The findings "indicate that most patients who initially respond well to injection can expect an effect to last between 19 and 33 weeks. Although the 46.6 percent success rate might appear low, its safety and efficacy make botulinum toxin a useful first-line invasive treatment if conservative measures have failed," the researchers concluded in the news release from the journal's publisher. Botulinum toxin injections have been used safely for years, according to the American Academy of Pediatrics. Side effects can include rash, whole-body muscle soreness, difficulty swallowing and weakness in the injected muscles, but they usually go away quickly, the AAP notes.
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Cyber Bully Victims Often More Depressed Than Aggressors

Students who are victims of cyber bullying at school are more likely to suffer depression than their tormentors, according to researchers. Bullying, which traditionally involved physical violence, verbal harassment or social exclusion, now often includes "cyber" bullying, a form of electronic aggression. Cyber bullying allows bullies to engage in aggressive behaviors via computers or cell phones. Previous studies on traditional bullying have found that bully-victims (those who both bully others and are bullied themselves) were at highest risk for depression.

This new study included U.S. students in grades 6 through 10 who completed a questionnaire designed to measure their levels of depression, and were asked whether they were either perpetrators or victims of bullying. "Notably, cyber victims reported higher depression than cyber bullies or bully-victims, which was not found in any other form of bullying," Jing Wang and colleagues at the U.S. National Institute of Child Health and Human Development (NICHD) wrote in their report, published in the current issue of the Journal of Adolescent Health.

The study authors added that "unlike traditional bullying, which usually involves a face-to-face confrontation, cyber victims may not see or identify their harasser; as such, cyber victims may be more likely to feel isolated, dehumanized or helpless at the time of the attack." The findings highlight the need to monitor and provide treatment for victims of cyber bullying, the researchers said in an NICHD news release.
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High Blood Sugar Levels Increase Infection Risk From General Surgery

High blood sugar levels can increase the risk of surgical site infections in patients having general surgery, researchers report. Doctors have long been aware that people with diabetes are more prone to surgical infections, and the relationship between high blood sugar and increased risk of infection after surgery is well known in heart and intensive care unit surgery, where blood sugar is carefully monitored. But this appears to be the first study to quantify the risk after general surgery, noted the study authors, from Albany Medical College in New York.

"We wanted to find out how much increased glucose in your blood had a role in infection in general surgery," said lead researcher Ashar Ata, from the College's Department of Surgery. "Surprisingly, we did find that by the time your glucose is higher than 140 milligrams per deciliter, the infection went from 1.8 percent to almost 10 percent." When blood sugar levels reach that point, medical staff should intervene to control them, Ata said, adding, "We found the higher the blood glucose, starting at about 110 milligrams per deciliter, the more likely you are to have an infection."

The report is published in the September issue of the Archives of Surgery. The procedures Ata's group looked at included appendectomy, colon surgery, hemorrhoid removal and gallbladder removal, he said. These operations all fall under the definition of general surgery. For the study, Ata's team looked at medical records of 2,090 patients who had had general or vascular surgery between Nov. 1, 2006, and April 30, 2009. Among these patients, the researchers studied the blood sugar levels of 1,561 patients, including those who had vascular surgery, colorectal surgery and other types of general surgery.
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No Gender-Based Difference Seen in Anti-HIV Drug Response
Men and women have the same responses to the anti-HIV drugs darunavir and ritonavir, researchers have found. The new study included 429 HIV-positive patients at 65 sites in the United States, Puerto Rico and Canada. HIV is the virus that causes AIDS. The participants were given 600 milligrams of darunavir and 100 mg of ritonavir twice daily. The treatment response rates were 73 percent in women and 73.5 percent in men, the investigators found. Rates of adverse events were also comparable between the sexes. The most common side effects were nausea, diarrhea and rash. The findings are published in the Sept. 21 issue of the journal Annals of Internal Medicine. The Gender, Race and Clinical Experience (GRACE) study was funded by Tibotec Therapeutics, which markets darunavir.

The study authors noted that 32.8 percent of the female participants dropped out before the end of the study, compared with 23.2 percent of the males. This suggests that more needs to be done to retain women in clinical trials. "It is critical that women are involved in clinical trials to evaluate the efficacy and toxicity of new treatments not just for HIV but for all diseases," lead author Dr. Judith Currier, a professor of medicine and chief of the division of infectious diseases at the David Geffen School of Medicine at the University of California, Los Angeles, said in a UCLA news release.
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Breast Reconstruction After Mastectomy: Now or Later?
Two new studies may help breast cancer patients and their doctors make treatment decisions involving immediate breast reconstruction after mastectomy. One study finds that about half of women who need radiation therapy after having had a mastectomy with immediate reconstruction develop complications that require additional surgery. Another study finds that chemotherapy does not affect complication rates after mastectomy and immediate reconstruction. Both reports are published in the September issue of the Archives of Surgery. The growing trend toward immediate reconstruction "has turned into a runaway train," said researcher Dr. Rodney Pommier, professor of surgery at Knight Cancer Institute, Oregon Health & Science University in Portland. Some women, he said, would be better off delaying it.

Pommier and his colleagues evaluated 302 women who had mastectomies; of these, 152 had reconstruction, including 131 immediately, and 100 had radiation after the mastectomy. Among those 100 who needed radiation, complications occurred in 44 percent of those who had immediate reconstruction, but only in 7 percent of those who did not have immediate reconstruction. Both scenarios having radiation after mastectomy and having reconstruction done immediately strongly predicted the risk of complications, Pommier's team found. Radiation tripled the risk, and immediate reconstruction increased the risk eightfold.

Implants had to be removed in 31 percent of patients who had radiation after mastectomy, compared to just 6 percent of those who did not have to have radiation, the researchers reported. "We were surprised that one in three lost implants," he said. His team was also surprised at the complication rates overall. "I think it was known that complication rates are fairly high, but I don't think they have been quantified," he noted. The results, Pommier said, have changed his thinking. He now suggests that having a biopsy of the sentinel lymph node before deciding whether to have immediate reconstruction would be wise. "If the sentinel node is negative, there is a low probability they would get radiation," he explained.
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Discrimination Can Hurt Teens, Body and Soul

Discrimination experienced by U.S. teens from Latin American and Asian backgrounds can affect their grades and health, and is associated with depression, distress and reduced self-esteem, a new study has found. University of California, Los Angeles researchers asked 601 high school seniors, who generally range in age from 17 to 19 years, to record any discriminatory events or comments they experienced over two weeks. They were also asked to note any physical symptoms, such as headaches, stomachaches and general pain.

Nearly 60 percent of the teens reported discrimination from other teens, 63 percent reported discrimination from adults, and 12 percent said they experienced discrimination every day. Latin American teens reported more adult discrimination than Asian American teens, while Asian American teens reported more adult discrimination than white teens of European descent. Both Latin American and Asian American teens reported more discrimination by their peers than the white teens. Teens who experienced higher levels of peer or adult discrimination reported more aches, pain and other symptoms, and had lower overall grade-point averages, the investigators found.

The study was released online in advance of publication in an upcoming print issue of the Journal of Research on Adolescence. Discrimination can be especially hard on teens, the study authors noted. "These are the years when social identity is arguably more salient among teenagers who are struggling with defining who they are. Adding on a 'layer' of discrimination is not an easy thing for them to deal with," one of the study authors, Andrew J. Fuligni, a professor of psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior, said in a university news release. "Discrimination significantly predicted lower, higher levels of depression, higher levels of distress, lower self-esteem and more physical complaints," Fuligni added. "So the bottom line? Discrimination is harmful."
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Absent Father Might Mean Earlier Puberty for Higher-Income Girls
Girls growing up in higher-income homes without a biological father are likely to reach puberty earlier than others, new research finds. "In higher-income families, father absence predicted earlier puberty, but it did not in lower-income, father-absent," said study leader Julianna Deardorff. "Girls in upper-income households without a father were at least twice as likely to experience early onset of puberty, as demonstrated by breast development," she said. The researchers defined higher income as $50,000 or more a year.

Early maturation in girls is linked with emotional and substance use problems and earlier sexual activity. These girls also face a higher risk for breast cancer and other reproductive cancers later in life. Previous research has linked absent-father households and earlier puberty, but this study adds more information, said Deardorff, an assistant professor of public health at the University of California, Berkeley. "We were looking at very early signs," such as breast development and the growth of pubic hair, she said. Other researchers have focused on the start of menstruation without looking at factors such as income and ethnicity, according to background information in the study.

Girls are reaching puberty earlier in the United States, where the average age of menstruation is about 12 years, Deardorff said. Recent research has found some girls starting to develop breasts as early as age 7 or 8. For their study, published Sept. 17 in the Journal of Adolescent Health, Deardorff and her colleagues followed 444 girls, aged 6 to 8 at the start, and their mothers. They gathered extensive data on factors such as weight, height, stage of breast and pubic hair development, father's presence and income. Eighty percent of the girls said their fathers did not live with them.
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Low-Dose Aspirin May Reduce Colon Cancer Risk

Taking low-dose aspirin daily may reduce the risk of colorectal cancer, new research finds. Prior research has shown higher doses of aspirin reduces the risk of colon cancer. But this study is among the first to show that lower doses which have less risk of side effects such as gastrointestinal bleeding may also be effective, said Eric Jacobs, strategic director of pharmacoepidemiology for the American Cancer Society. For this study, researchers in Scotland asked 2,279 people with colorectal cancer and 2,907 people without colorectal cancer to answer questions about diet and lifestyle choices could affect cancer risk. Participants were asked how often they took low-dose aspirin, as well as non-aspirin NSAIDs such as naproxen and ibuprofen in the year prior to their cancer diagnosis or recruitment in the study.

About 18.1 percent of those without cancer reported taking aspirin during that time, compared to 15.5 percent of those who had colorectal cancer. Participants who reported taking low-dose aspirin regularly for a year or more were about 22 percent less likely to have colorectal cancer. The reduction was clinically significant among those who reported taking low-dose aspirin for more than five years, according to the study: They were 30 percent less likely to develop cancer than their peers who didn't take the painkillers. Although the greatest risk reduction occurred in those consuming more than 525 milligrams of aspirin a week, the protective effect was present even for the lowest daily dose.

"The new case-control study from Scotland is one of the largest to date to have specifically examined low dose aspirin, and provides some evidence that using low-dose aspirin for five or more years may also reduce colorectal cancer risk," said Jacobs, who was not involved in the research. "However, previous studies of low-dose aspirin and colorectal cancer have had mixed results, and results of this study need to be confirmed." The study also found that taking any NSAID regularly was associated with a reduced risk of colorectal cancer, compared to those who didn't use the painkillers. The subjects and controls had been matched for age, gender and locale as well as smoking, alcohol and fiber intake, and the findings held true even after results were adjusted for weight, body-mass index and other factors, according to the study, which was published in the current issue of the journal Gut.
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Placebo Pill Gives Boost to Some Women's Sex Drive

About one-third of women given a placebo pill to treat a low libido reported improvements in their sex lives, a finding researchers say is evidence of the powerful and somewhat mysterious mind-body connection surrounding arousal and desire. After drugs like Viagra and Cialis revolutionized the treatment of male sexual dysfunction in the late 1990s, a flurry of clinical trials were conducted in women in the hopes that the drugs could do the same to revive a woman's flagging sex drive. The drugs flopped in women. But recently, researchers went back and looked at the old data on Cialis and found that not only did about 35 percent of women given the placebo pill experience significant improvement in psychological aspects of sex such as desire, many reported improvements in the physical aspects of arousal, including better lubrication, more frequent orgasms or more easily attainable orgasms, according to the study.

"Everything across the board improved in some women," said study author Andrea Bradford, a post-doctoral fellow at the Baylor College of Medicine in Houston. The study is published in the current issue of the Journal of Sexual Medicine. In the original study, 50 women aged 35 to 55 who were diagnosed with female sexual arousal disorder were given either Cialis or a placebo for 12 weeks. The women, most of whom were married, were asked to have sex at least three times a month. "Many went above and beyond," Bradford noted. Women also had to keep a diary of how often they had sex and how satisfying it was. Bradford suspects the improvements were due to several aspects of the study the hope that the pill might be working plus speaking with medical professionals about sex, thinking about sex and trying to have better sex.

"I think just the act of attending to their sex lives was very therapeutic for some women," Bradford said. Over time, the frequency with which women had sex dropped some, but they continued to report better sex lives overall. "It was quality over quantity," she said. When sex is no longer satisfying, women tend to avoid it, noted Aline Zolbrod, a Boston-area clinical psychologist and sex therapist. Without at least giving it a try, there's little hope sex will get better. "I love this study," Zolbrod said. "It does what we'd like to get our patients to do, which is to start having sex again. Instead of getting into bed and sighing, 'Oh, this is never going to work,' instead they are getting into bed and thinking, 'Let's see what happens.' When you have that attitude and you have sex almost once a week, for some women it really did the trick."
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Research Sheds Light on Why Autism Is More Prevalent in Boys

A new study is helping unravel an enduring mystery surrounding autism: Why boys are much more likely to be affected by the disorder than girls. An international team led by Dr. John Vincent, of the Centre for Addiction and Mental Health in Toronto, examined specific genes in almost 3,000 people with an autism spectrum disorder (ASD) and 246 others with intellectual disability. They then compared that data to genes from more than 10,000 control individuals. Reporting in the Sept. 15 issue of Science Translational Medicine, the team found that mutations in the PTCHD1 gene are linked to inherited forms of autism and intellectual disability in about 1 percent of affected people in the study. It was not found in any of the controls, however. "Our data indicate that mutations at the PTCHD1 locus are strongly associated with ASD," the researchers concluded. They also noted that this gene is typically located on the single X-chromosome in males.

The study "provides further clues as to why ASD affects four times more males than females," said Andy Shih, vice president for scientific affairs at Autism Speaks. "PTCHD1 is part of a neurobiological pathway that determines the development of human embryos. It is one of several genes recently implicated in both ASD and intellectual disabilities." The finding adds a little more clarity to the murky origins of autism, Shih said. While each new genetic discovery "may only account for a small fraction of the cases, collectively they are starting to account for a greater percentage of individuals in the autism community, as well as providing insights into possible common pathogenic mechanisms," he said. "Identification of a male-linked genetic mutation begins to address the previously unknown basis for often reported skewed male-to-female ratio in autism."
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Radiation Exposure Raises Likelihood of Second Cancer

Radiation exposure increases the risk that cancer survivors will go on to develop another malignancy, finds a new study. It was known that radiation exposure can cause cancer but it wasn't known whether it increases a person's risk of developing more than one. In order to find out, American and Japanese researchers analyzed data from more than 10,000 survivors of the atomic bomb attacks on Hiroshima and Nagasaki who developed primary cancers. "We found that radiation exposure increased the risks of first and second cancers to a similar degree," study first author Dr. Christopher Li, a breast cancer epidemiologist and a member of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center in Seattle, said in a center news release.

"People exposed to radiation who developed cancer also had a high risk of developing a second cancer, and the risk was similar for both solid tumors and leukemias in both men and women," Li said. The link between radiation exposure and second cancers was especially strong for radiation-sensitive cancers such as leukemia and tumors of the lung, colon, breast, thyroid and bladder. The study appears in the Sept. 15 issue of the journal Cancer Research. "Our findings suggest that cancer survivors with a history of radiation exposure should continue to be carefully monitored for second cancers," Li said. He also thanked his Japanese colleagues for their collaboration. "Through innumerable publications, [they] have transformed the tragedy of the atomic bombings to fundamental scientific advancements that have impacted radiation protection standards and policies worldwide," Li said.
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Expert Panel Links Popular Bone Drugs to Rare Fracture
An expert panel concludes that bone-strengthening bisphosphonate drugs such as Actonel, Boniva and Fosamax can actually raise risks for a rare type of fracture of the thighbone. The panel is urging the U.S. Food and Drug Administration which has been awaiting the report to add a special warning to that effect on the drugs' labeling. "Bisphosphonates may be related to atypical femur fractures," said Dr. Elizabeth Shane, a professor of medicine at Columbia University's College of Physicians and Surgeons in New York City. She is the lead author of the report, which was compiled by a special task force at the American Society for Bone and Mineral Research.

"These fractures are very unusual," Shane added. "But we are still concerned that patients could still have these fractures. There may well be a link between these fractures and bisphosphonates." The FDA has been given a copy of the panel report for review, she said. The findings are published Sept. 14 in the Journal of Bone and Mineral Research. Bisphosphonates a class of prescription medications use to treat osteoporosis have been shown to lessen the odds of getting common bone fractures of the hip and leg. However, they may also help trigger a weakness that makes a particular type of thigh bone fracture more likely in rare cases, the panelists said.

There has been conflicting evidence on a such a link, however. For example, one study published in 2008 in the New England Journal of Medicine did find a correlation between the long-term use of Fosamax and atypical fractures in postmenopausal women. But a study published this March in the same journal seemed to refute the connection. The FDA had looked to the expert panel to help provide some clarity. The group's new recommendations came after a thorough review of 310 of these atypical thigh fractures. In that review, the panel found that 94 percent of these patients had taken bisphosphonates. Most had taken the drugs for five years or more. Shane noted these fractures are so unusual that they make up less than 1 percent of all hip and thigh fractures.
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U.S. Meets Initial Breast-feeding Goal, Falls Short on Others

Seventy-five percent of U.S. newborns delivered in 2007 started life breast-feeding a figure that meets federal goals but that rate plummeted to 43 percent at six months and 22 percent at one year, a federal government study released Monday shows. Half of the states had breast-feeding initiation rates above 75 percent, which is the National Healthy People's 2010 goal. That program also calls for 50 percent of infants to continue breast-feeding for six months and 25 percent for one year, said the U.S. Centers for Disease Control and Prevention's 2010 Breast-feeding Report Card. "Meeting the national breast-feeding initiation goal is a great accomplishment in women's and children's health, but we have more work ahead," Dr. William Dietz.

"We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces and communities to continue breast-feeding beyond the first few days of life so they can make it to those six- and 12-month marks," he said. The report shows that breast-feeding initiation rates ranged from 52.5 percent in Mississippi to nearly 90 percent in Utah. Breast-feeding rates at six months ranged from about 20 percent in Louisiana to more than 62 percent in Oregon, while rates at one year ranged from 8 percent in Mississippi to nearly 40 percent in Oregon.

U.S. hospitals had an average score of 65 out of 100 possible points on a CDC survey that measures infant nutrition and care, according to the report card. The scores ranged from 50 in Mississippi to 81 in New Hampshire. Less than 4 percent of U.S. births occur at facilities designated as Baby-Friendly, a program sponsored by the World Health Organization and UNICEF. The program outlines 10 steps that support the initiation of breast-feeding and identifies hospitals that meet internationally recognized standards for maternity and breast-feeding support. "High initiation rates tell us that a lot of moms plan to breast-feed, but these rates do not indicate that a birth facility is doing what it need to support them in their effort," Carol MacGowan, public health advisor for the CDC division, said in the news release.
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More Kids Who Play Basketball Suffering Head Injuries
Children's basketball may be getting rougher or the kids may be bigger, but either way the number of head injuries is soaring, researchers report. "Although the total number of injuries decreased during the study period, the number of traumatic brain injuries increased by 70 percent," said study author Lara McKenzie, of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio. "These injuries are exceedingly high in this popular sport," she added. "This is cause for alarm." McKenzie thinks the increased size of players is one factor in the increase in concussions. Another is that the game has become more competitive, she said. Why total injuries have gone down by 20 percent over the 11 years covered by the study is not clear, McKenzie added.

"We don't want to discourage kids from physical activity. We don't want to discourage kids from playing basketball, either," she said. "But we need to recognize that there are some inherent risks in any activity." McKenzie added that the problem of traumatic brain injury needs to be addressed. "Maybe we need to do more education of coaches, athletes and parents to recognize the signs of concussion and help to prevent them," she said. The findings are published in the Sept. 13 online edition of the journal Pediatrics. For the study, McKenzie's team used data from 1997 to 2007 from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System to estimate the number of children injured while playing basketball.

Over the study period, the researchers found an estimated 4,128,852 children were treated in emergency rooms for injuries sustained while playing the sport. That's 375,350 every year. While the total number of injuries went down over the study period, traumatic brain injuries increased 70 percent, the researchers found. The most common other injuries were sprains in the legs 30.3 percent, particularly of the ankle. Boys were more likely to suffer cuts, fractures and dislocations, while girls were more likely to suffer concussions and knee injuries. Children 15 to 19 years of age were three times more likely to injure their knees and ankles, while younger children, aged 5 to 10, were more likely to suffer concussions, fractures and dislocations, the study found.
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FDA Panel to Mull Ban on Diet Drug Meridia

The U.S. Food and Drug Administration will ask an expert panel later this week whether or not the diet drug Meridia should be banned due to suspected heart risks. In documents released Monday ahead of the panel meeting, which begins Wednesday, the agency said that members of its Endocrinologic & Metabolic Drugs Advisory Committee will be asked to consider a number of options, including taking no action, adding label warnings and/or restrictions to the use of Meridia, or to withdraw from the U.S. market. The meeting comes on the heels of a study released earlier this month that linked the drug to an increased risk of nonfatal heart attacks and stroke, although taking the drug did not seem to up the risk of death in patients with a history of heart problems.

The trial involved almost 11,000 older, overweight or obese adults with type 2 diabetes or heart disease or both who were randomized either to take Meridia or a placebo and followed for about 3.4 years. In the group taking Meridia, 11.4 percent had a heart attack, stroke or died as the result of a heart problem, versus 10 percent in the control group, a 16 percent increase. People taking Meridia also had a 28 percent higher risk for nonfatal heart attack and a 36 percent raised risk for nonfatal stroke, compared to those taking placebo, the authors found. The study stirred mixed reactions from experts. According to the authors of the trial, which was funded by Meridia's maker, Abbott, the findings are generally in line with what has been known about the drug and shouldn't change how it is used.

"The only time you've got an increase in heart attacks or strokes were in those patients who had had previous heart disease or strokes, in other words, the people who should never have received the drug in the first place," said Dr. Philip T. James, a professor at the London School of Hygiene and Tropical Medicine in England, and first author on the paper, which was published in the Sept. 2 issue of the New England Journal of Medicine. Since January, sibutramine (Meridia) has carried a label warning that it should not be used by people with preexisting heart disease, so "the current prescription is entirely appropriate," James said. However, not everyone agreed. According to Dr. Greg Curfman, executive editor of the NEJM and co-author of an accompanying editorial, the FDA's January warning was based on preliminary information only. The new study results represent the first hard data, "the first outcomes trial," he said.
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Recurring Stroke Risk Higher for Some Hispanics

Mexican-American stroke survivors with a heart rhythm disorder called atrial fibrillation are more than twice as likely to suffer a second stroke compared to white patients, a new study finds. It also found that even though these strokes are more likely to be severe among Mexican-Americans, they don't have a greater risk of death after a second stroke. In people with atrial fibrillation, the heart's upper chambers (atria) beat irregularly and don't pump blood effectively. This can cause blood to pool within the atria, which can lead to the formation of blood clots that can break off and travel to the brain, causing a stroke.

This study included 88 Mexican-Americans and 148 white stroke survivors with atrial fibrillation. Compared to the white patients, the Mexican-American stroke survivors were younger, less likely to have completed 12 years of education, more likely to have diabetes, and less likely to have a primary care physician. Over a median follow-up of 427.5 days, 19 Mexican-Americans and 14 whites had at least one recurrent stroke. All but one of those cases involved an ischemic stroke, which is caused by blocked blood flow to the brain. One Mexican-American patient suffered a hemorrhagic stroke, which is bleeding in the brain.

The study appears in the current issue of the journal Stroke. "Based on some of our prior research, we were not necessarily surprised by the higher recurrence rate in Mexican-Americans with atrial fibrillation, but the greater severity of recurrent strokes in Mexican-Americans was surprising," co-author Dr. Darin B. Zahuranec, an assistant professor of neurology at the University of Michigan Cardiovascular Research Center in Ann Arbor, said in an American Heart Association news release. One reason for the difference in stroke rates could be that Mexican-Americans may not have managed the blood-thinning drug warfarin often used to prevent stroke in the most optimal way, Zahuranec said. He and his colleagues did not evaluate outpatient use of warfarin, which might have contributed to the increased risk of stroke in Mexican-Americans.
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Clearing Kids for Sports Participation Sparks Conflicts
Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends. So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious. The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete? Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation.

"I think everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics," said Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, who helped write a joint position statement in 2007 from the American College of Sports Medicine and the American Heart Association. That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to the groups' recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG." The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history [taken] from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.
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Most Americans Still Not Eating Enough Fruits, Veggies

In 2000, the U.S. government set modest goals for the amount of fruit and vegetables people should eat, but a decade later the majority of Americans are not even close to reaching those thresholds, health officials said Thursday. In fact, according to the U.S. Centers for Disease Control and Prevention, in 2009, 67.5 percent of adults ate fruit less than two times daily and 73.7 percent ate vegetables less than three times per day. The goals of Healthy People 2010 were for 75 percent of people to eat at least two servings of fruit and 50 percent to eat at least three servings of vegetables every day. "Over the last decade we have looked at behavioral intervention, like counseling to get people to include their fruits and vegetables," said report co-author Dr. Jennifer Foltz, a researcher in the CDC's National Center for Chronic Disease Prevention and Health Promotion. "But it's not so easy."

"In the next decade, we are going to work on making the healthy choice the easy choice," she said. New programs will involve promoting gardening, farmer's markets and bringing more fruits and vegetables into schools and workplaces, Foltz said. In addition, Foltz said there could be programs to help retailers increase the availability of fruits and vegetables through incentives like tax breaks as well as making it easier for low-income people to afford fresh fruit and vegetables. Foltz noted that low-income Americans are more likely not to have access to fresh fruits and vegetables at affordable prices, which is why programs specifically targeted at this population are needed.

The report is published in the Sept. 10 issue of the CDC's Morbidity and Mortality Weekly Report. Despite efforts to increase healthy eating, over the past decade there has been a 2 percent decrease in fruit consumption and no change in the vegetable consumption, the researchers found. No state has yet met the Healthy People 2010 goals, Foltz said. In fact only one state, Idaho, rose in the amount of fruits and vegetables ate while 10 states saw a decrease in fruit and vegetable consumption. The 10 states where significant decreases in fruit and vegetable consumption were seen are Arizona, Kansas, Maryland, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee and West Virginia, according to the report.
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Substance Abuse Admissions Double Among Older Adults
The number of people aged 50 and older admitted for substance abuse treatment in the United States has more than doubled since the early 1990s, says a federal government study released Thursday. Admissions for people in this age group increased from 102,700 in 1992 to 231,200 in 2008, and whites accounted for the majority of admissions in both 1992 and 2008, said the Substance Abuse and Mental Health Services Administration (SAMHSA) study. The proportion of blacks admitted for treatment increased from 19.9 percent to 28.8 percent, while the proportion of Hispanics increased from 9.8 percent to 11.3 percent, the researchers found. The proportion of women admitted for treatment increased from 18.1 percent (18,391) to 25.1 percent.

The researchers also identified some significant changes in the sociodemographic characteristics of older admissions. Unemployment in this group rose from 19.4 percent in 1992 to 31 percent in 2008, full-time employment decreased from 23.4 percent to 16.7 percent, wages/salary as a principal source of income declined from 32.3 percent to 24.4 percent, and the proportion with no principal source of income rose from 11 percent to 28.8 percent. "This rise in substance abuse treatment among older adults and the changes in the socioeconomic situations of this treatment group reflect the changing landscape over the past 17 years and highlights the importance of providing additional specialized treatment services and social supports to address these needs," SAMHSA administrator Pamela S. Hyde said in an agency news release.

"To truly battle substance abuse and lower substance abuse levels on all fronts requires a combined effort from the federal government, states and local communities. And people of all ages need to be aware that there is help available to them so that they can take action before a substance abuse problem becomes a devastating addiction," she added. The study also noted changing trends in marital status and the types of living arrangements among older adults admitted for substance abuse treatment. The proportion of those who said they'd never married increased from 13.2 percent in 1992 to 30.2 percent in 2008, those who were currently married decreased from 33.3 percent to 21.5 percent, and those who were divorced/widowed declined from 43.9 percent to 21.5 percent. Homelessness in this group of people increased from 15.9 percent to 19.5 percent, while the proportion of those living independently decreased from 72.4 percent to 67.1 percent.
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2 Genes Have Possible Link to Deadly Ovarian Cancer
Mutations in two genes may be associated with one of the most deadly types of ovarian cancer, U.S. researchers have found. In the study, researchers at the Johns Hopkins Kimmel Cancer Center looked for mutations in 18,000 protein-encoding genes in ovarian clear cell tumors from eight patients. The investigators found 268 mutations in 253 genes, with an average of 20 mutations per tumor. Further investigation revealed that two genes ARID1A and PPP2R1A were more commonly mutated than other genes. ARID1A mutations were present in 57 percent of tumors while PPP2R1A mutations were present in 7.1 percent of tumors, according to the report published in the Sept. 8 online edition of Science Express.

ARID1A is a gene whose product normally suppresses tumors. PPP2R1A is a gene that, when altered, helps turn normal cells into tumor cells. The genes had not previously been linked to ovarian cancer, the researchers explained in a news release from the Johns Hopkins Kimmel Cancer Center. The findings "may provide opportunities for developing new biomarkers and therapies that target those genes," Nickolas Papadopoulos, associate professor of oncology and director of Translational Genetics at the Ludwig Center for Cancer Genetics & Therapeutics at the cancer center, said in the news release. Ovarian clear cell carcinoma, which accounts for about 10 percent of cancers that start in cells on the surface of the ovaries, mainly affects women aged 40 to 80 and is resistant to chemotherapy, according to background information in the news release.
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Working Overtime Adds to Heart Risk for Out-of-Shape Men

Working Overtime Adds to Heart Risk for Out-of-Shape Men
Out-of-shape men who work long hours more than double their risk of dying from heart disease compared to non-fit men working fewer hours, researchers report. The study also found that when men are fit, working long hours doesn't boost heart risk at all. The new study included 5,000 Danish men, aged 40 to 59 years, who worked at 14 different companies. Their fitness levels were assessed at the start of the study and they were followed-up for more than 30 years. During that time, 587 (about 12 percent) of the men died as result of narrowed and hardened arteries (also known as ischemic heart disease).

The study, released online Sept. 6 in advance of publication in an upcoming print issue of the journal Heart, also found the following:

* Compared with men who worked less than 40 hours per week, unfit men who worked 41 to 45 hours a week were 59 percent more likely to die of heart disease, although they were not more likely to die of other causes.
* Compared with unfit men, those who were physically fit and worked longer hours were 45 percent less likely to die of heart disease and 38 percent less likely to die of other causes.
* Being both unfit and working more than 45 hours per week more than doubled a man's risk of dying of heart disease compared with those who worked less than 40 hours per week.

"The finding that working more than 45 hours a week is associated with more than a doubled risk of [death from heart disease] among men with low physical fitness, and not among men with moderate or high physical fitness, is a new observation," Andreas Holtermann, of the National Research Centre for the Working Environment in Copenhagen, and colleagues said in a news release from the journal's publisher. "If the relationship is causal, it obviously has major implications for the prevention of heart disease," they added.
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Chemicals in Rugs, Cookware May Be Linked to Raised Cholesterol in Teens
Common chemicals found in everything from non-stick cookware to grease-resistant food packaging appear to be associated with increases in cholesterol levels in adolescents, a new study suggests. People are exposed to these chemicals known as perfluoroalkyl acids (PFAAs)in dust, drinking water, non-stain carpets, waterproof fabrics, microwave popcorn bags and a host of other household products. "This is the first study that takes an in-depth look at an association between these chemicals and health effects in children," said study author Stephanie J. Frisbee, research instructor in the Department of Community Medicine at West Virginia University School of Medicine in Morgantown.

The PFAA compounds in question include perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS). "We found a positive association between PFOA and PFOS and total [cholesterol] and LDL cholesterol," she said. As the blood levels of these chemical increased, so did cholesterol, Frisbee added. The American Chemical Council, an industry group, did not respond to repeated attempts by HealthDay to get comment on the findings. The report is published in the September issue of the Archives of Pediatrics & Adolescent Medicine. For the study, Frisbee's team looked at cholesterol levels in more than 12,000 children and adolescents who are part of the C8 Health Project.

This project resulted from the settlement of a class-action lawsuit against Dupont over the landfill dumping of chemicals that contaminated groundwater in six water districts in two states near the company's plant in Parkersburg, West Virginia, and exposed residents to levels of C8 (another name for PFOA) far higher than that of the general population. Among the participants, the average PFOA concentration was 69.2 nanograms per milliliter and average PFOS concentration was 22.7 nanograms per milliliter. Among 12- to 19-year-olds, the PFOA concentrations were higher than those seen in the general population, but PFOS concentrations were similar to those seen in samples from the general population, the researchers found.
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Health Care Reform: Will It Empower or Perplex Consumers?

Are American consumers "health literate" enough to play a leading role in their health care and coverage decisions? That question will be put to the test in 2014, when more than 30 million uninsured adults begin shopping for health plans through state insurance exchanges a core element of the national health reform package signed into law by President Barack Obama in March. Stakeholders hope to avoid another debacle like the one that occurred nearly five years ago when Medicare launched its then-new prescription drug benefit, called Medicare Part D. "If you look back at Part D, we learned a lot about how multiple choices in plans and in drug-plan coverage overwhelms, confuses, undermines people's confidence that they can manage the system," said Christina Zarcadoolas, an associate professor in the department of preventive medicine at the Mount Sinai School of Medicine in New York City and a health literacy expert.

Health literacy the capacity to obtain, process and understand basic health information to make appropriate health decisions isn't a new concept. But as consumers are encouraged to play a more active role in choosing health insurance coverage, using preventive services and screening tests and managing chronic health conditions, it's becoming more critical. "Health literacy is needed to make health reform a reality," U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement in May announcing the National Action Plan to Improve Health Literacy, a set of goals and strategies for creating a "health-literate society." "Without health information that makes sense to them, people can't access cost-effective, safe and high-quality health services," she said.

More than one-third of U.S. adults have only basic (22 percent) or below basic (14 percent) health literacy. Just 12 percent have "proficient" health literacy skills, while less educated and poorer individuals, in general, have lower health literacy, according to a U.S. Department of Education analysis. To improve health literacy, the Department of Health and Human Services (HHS) is encouraging health organizations and insurers to use plain language and pictures or graphs to communicate with consumers, among other enhancements. These strategies "have the potential to both reduce the complexity and demands of the health care delivery system and educate and empower Americans so they are able to fully benefit from the Affordable Care Act and take charge of their health," an HHS spokeswoman said in statement prepared for HealthDay.
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Winter Sports Tourists at Higher Risk of Heart Attack

Skiers and other winter sports tourists who visit the Alps are at increased risk for heart attack due to low temperatures, high altitude and inadequate conditioning for intense physical exertion, finds a new study. The risk is greatest during the first two days of vacation, said a research team of cardiologists at the Medical University of Innsbruck, Austria, who focused on winter tourists in the Tyrolean Alps. "Every year, millions of tourists visit the Tyrolean Alps to participate in a variety of winter sports, each of which carries a certain risk of accident and injury," study senior author Dr. Bernhard Metzler, an associate professor of cardiology at the university, said in a news release from the European Society of Cardiology.

"Previously it had been shown that sudden cardiac death accounts for a staggering 40 percent of the total fatalities amongst winter sports tourists in the Austrian Alps and, of these, acute [heart attack] is the leading cause," he added. Metzler and colleagues analyzed data from 170 patients who suffered a heart attack during a winter sports vacation between 2006 and 2010. About 56 percent of the patients suffered their heart attack within the first two days of beginning intense physical activity, although just 19 percent had a known cardiac condition. Prior to their vacation, more than half of the patients got less than the minimum levels of physical activity recommended by the European Society of Cardiology.

Altitude may have been a major factor, the study authors noted. The patients' heart attacks occurred at a mean altitude of 1,350 meters (4,429 feet), compared to the mean altitude of 170 meters (557 feet) where they lived. The researchers also found that about 70 percent of the patients had at least two risk factors for coronary artery disease, including smoking, diabetes or high cholesterol levels. People planning winter sports holidays in the mountains need to prepare themselves with regular exercise beforehand, the study authors suggested. Once at the resort, they should increase their level of physical activity gradually, they added. The researchers presented their findings last week at the European Society of Cardiology Congress, in Stockholm, Sweden.
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