Friday, February 19, 2010
Protect Your Heart at Every Age
You're never too young—or too old—to start lowering your heart disease risk. Of course, exercising, eating healthy and reducing stress are key throughout life, but due to physiological changes that happen as we age, certain risk factors do become more of a threat.
In Your 20s
Stub Out a Social Smoking Habit
Smoking is enemy number one when it comes to heart disease, and even just a few cigarettes can do damage: New research from McGill University in Montreal found that smoking just one cigarette a day stiffens your arteries by a whopping 25 percent. Plus, smoking erases the hormonal advantage you have from estrogen, which can leave you vulnerable to a heart attack before menopause, explains Dr. Bonow.
Don't Ignore the Birth Control Factor
Remember that hormonal contraceptives slightly increase the risk of blood clots, so if you've ever had one, make sure to discuss it with your doctor before going on birth control. And if you're currently a smoker, don't take oral contraceptives, because the combo can be especially dangerous, says Sharonne N. Hayes, MD, director of the Women's Heart Clinic at Mayo Clinic in Rochester, Minnesota.
Watch Your Alcohol Intake
Moderate amounts of alcohol can have a beneficial effect on your heart. (By "moderate," we mean one drink a day or about 5 ounces—but many restaurants serve far more than that.) Overdoing it can raise triglycerides, increase blood pressure and lead to weight gain, thanks to all those empty calories.
In Your 30s
Get a Grip on Stress
When you're juggling career and family, it's crucial to find stress management techniques that work. "Untamed stress has a direct negative impact on heart health," says Dr. Stevens. "The constant bombardment of adrenaline raises blood pressure and destabilizes plaque in your arteries, making it likely to cause a clot or heart attack."
Lose the Baby Weight
No, you don't have to fit into your skinny jeans by the time the baby's 6 months old, but do aim to get back to your pre-pregnancy weight within one to two years. "Carrying around extra pounds can lead to high cholesterol, high blood pressure and other heart disease risk factors," Dr. Bonow says. Also remember that it's easier to lose weight in your 30s than in your 40s, when your metabolism slows down.
Stay Social
It's important to stay connected to friends and family for the sake of your mood and heart. Research at the University of Pittsburgh School of Medicine found that high levels of loneliness increase a woman's risk of heart disease by 76 percent. On the flip side, having strong social support can help lower your blood pressure and improve other cardiovascular functions. Set aside time once or twice a week to call friends, or make a monthly dinner date.
In Your 40s
Make Sleep a Priority
Thanks to peri-menopause, fluctuating hormone levels can interfere with a good night's sleep. But not getting at least seven hours of shut-eye regularly can lead to increased blood pressure, low-grade inflammation and higher levels of the stress hormone cortisol, all of which are harmful for your blood vessels and heart, explains Jennifer H. Mieres, MD, a cardiologist at New York University School of Medicine and coauthor of Heart Smart for Black Women and Latinas. Lack of sleep has also been linked to weight gain. So establish good habits: Turn in (and wake up) at the same time every day—even on weekends—and do your best to relax before going to bed, whether it's watching a favorite funny TV show or reading.
Reassess Your Risk Factors
You may discover that your cholesterol, blood pressure and blood sugar levels have changed in this decade, even if you aren't doing anything differently, says Dr. Hayes. In fact, 22 percent of 40-something women have high blood pressure and 50 percent have high cholesterol (a jump from 38 percent of women in their 30s), according to the National Heart, Lung, and Blood Institute. Also, be sure to get your thyroid checked around 45; hypothyroidism (an underactive thyroid gland), which becomes more common as women get older, can negatively affect your cholesterol levels as well as your heart.
Step Up Strength Training
You start to lose muscle mass more rapidly in your 40s, which causes your metabolism to slow down since muscle burns more calories than fat. Unfortunately, this makes it harder to stave off those extra pounds. To help maintain muscle and keep your metabolism going, aim for two 15-minute sessions weekly of lifting weights, using a resistance band or doing other toning exercises.
Carve out Personal Time
"Between the demands of work and family, it becomes even more challenging to find time for yourself in your 40s," says Dr. Mieres. But it's crucial to do so—not only to help ease stress but also to guard against depression, which commonly crops up in this decade and can raise your risk of heart disease. "Find at least 10 minutes of ‘me' time every day to do something—even if it's just chatting on the phone with a friend—that helps you destress and regroup," says Dr. Mieres.
In Your 50s
Move More
Around menopause, you tend to gain extra weight around your belly, which can lead to insulin resistance, inflammation and heart strain. Cardiovascular fitness also starts to decline, particularly if you're not that physically active to begin with. "Unfortunately, at this point, women have to burn more calories to stay at the same weight," Dr. Stevens says. Start taking the stairs instead of the elevator whenever you can, walk faster around the mall, or jog to the mailbox to send letters instead of sticking your hand out the car window as you drive by. Small changes really do add up.
Have an ECG
Silent heart abnormalities become more common in your 50s, and an electrocardiogram (ECG) to check your heart's electrical activity can pick them up, says Dr. Goldberg. Also ask your doctor if you should have a stress test; this is especially important if you're just starting to exercise.
Add Fiber
Besides being good for your cholesterol and blood sugar, pumping up your fiber intake (think whole grains like oatmeal, brown rice and flaxseeds, as well as beans, fruits and veggies) can help prevent constipation, which becomes more of a problem as you get older and your digestive system starts to slow down.
In Your 60s
Get Even More Vigilant About Screenings
After you go through menopause and get older, your blood pressure and cholesterol tend to go up, and blood vessels get stiffer. "Have your blood sugar, blood pressure and cholesterol measured yearly," advises Dr. Goldberg.
Consider Medication
If you have hypertension or high cholesterol, the way you've been managing it before may not be enough. "As you get older, you may need more aggressive therapy," Dr. Bonow says. "High blood pressure that was controlled with one medication may now require three to control it." Talk to your doctor about whether you need to add to or adjust your medications to control your risk factors.
Be Alert to Symptoms
Now is when the first noticeable symptoms of heart disease may appear, so it's important to know what's normal for your body and be on the lookout for worrisome signs like chest discomfort, shortness of breath or changes in exercise tolerance—meaning you suddenly feel winded going up a flight of stairs or feel unusually tired for no apparent reason, says Dr. Mieres. If these appear, see your doctor pronto!
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Thursday, February 11, 2010
Vaccine May Prevent TB in People With HIV
TUESDAY, Feb. 9 (HealthDay News) -- A new vaccine prevents tuberculosis in people with HIV, a new study shows.
Phase III trials of 2,000 HIV-infected people in Tanzania found that the mycobacterium vaccae (MV) vaccine reduced the rate of definite tuberculosis (TB) by 39 percent. The findings have been published online in the journal AIDS.
TB is the most common cause of death among people in developing countries who have HIV/AIDS, and the results of the clinical trials are a "significant milestone," according to principal investigator Dr. Ford von Reyn, director of the DarDar International Programs for the infectious disease and international health section at Dartmouth Medical School, in Hanover, N.H.
"Since development of a new vaccine against tuberculosis is a major international health priority, especially for patients with HIV infection, we and our Tanzanian collaborators are very encouraged by the results," von Reyn said in a news release from the journal's publisher.
The next step, he said, involves improving manufacturing methods so that sufficient quantities of the MV vaccine can be produced for further studies and possible use in patients.
Because people newly infected with HIV risk contracting TB almost immediately, the researchers said, it's important that they get the MV vaccine before they begin taking antiretroviral drugs to fight the HIV infection.
More information
The American Lung Association has more about TB.
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Scientists find first genes linked to stuttering
NEW YORK – Why people stutter has long been a medical mystery, with the condition blamed over the years on emotional problems, overbearing parents and browbeating teachers. Now, for the first time, scientists have found genes that could explain some cases of stuttering.
"In terms of mythbusters, this is really an important step forward," said Jane Fraser, president of the Stuttering Foundation.
Researchers taking part in a government-funded study discovered mutations in three genes that appear to cause the speech problem in some people. Stuttering tends to run in families, and previous research suggested a genetic connection. But until now, researchers had not been able to pinpoint any culprit genes.
Dennis Drayna, a geneticist and senior author of the study, said he hopes the results help convince doubters that stuttering "is almost certainly a biological problem."
The research — released Wednesday by the New England Journal of Medicine — also points to a possible enzyme treatment for stuttering someday.
Without a known cause, stuttering has been attributed to such things as nervousness, lack of intelligence, stress or bad parenting. Stutterers were told it was all in their heads. Fraser said parents contact her group worried they have done something to cause their children's stuttering. Were they too strict? Too attentive? Didn't pay enough attention?
The gene discovery should lift that guilt, she said.
Drayna and other experts said that while stress and anxiety can make stuttering worse, they do not cause it. "It really is not an emotional disorder. It doesn't come from your interactions with other people," he said.
Stuttering usually starts in children as they are learning to talk. Most youngsters lose their stutter as their brain develops. For some, the stuttering persists. An estimated 3 million Americans stutter. Treatments include speech therapy and electronic devices.
"This is a very difficult disorder to study," said Drayna, who is with the National Institute on Deafness and Other Communication Disorders. "You can't study it in cells in a dish. You can't study it in a test tube. You can only study it in awake humans."
To find the genes, Drayna and others first looked at a large, inbred Pakistani family with many members who stuttered, and discovered a mutation on chromosome 12. Then they found the same mutation and two other mutated genes in a group of nearly 400 other people from Pakistan, the U.S. and England who stutter.
They didn't find the mutations in a similar group of people who don't stutter, except in one Pakistani volunteer.
The researchers estimate that the three gene variants account for 9 percent of all stuttering cases. But they are looking for other stuttering genes. In fact, between 50 percent and 70 percent of stuttering cases are thought to have a genetic component, Drayna said.
"The task of connecting the dots between genes and stuttering is just beginning," Simon E. Fisher of England's Oxford University wrote in an accompanying editorial.
The three implicated genes normally help run the "recycling bin" where cells of the body send their garbage. The mutations apparently interfere with that, affecting brain cells that control speech.
"People had suggested all sorts of causes for stuttering over the years. An inherited disorder of cell metabolism was never on anyone's list," Drayna said.
Two of the stuttering genes have previously been tied to rare diseases that can occur when the cell's recycling bin malfunctions.
Other related disorders are now being treated by replacing a missing enzyme, and that could eventually be a treatment method for some kinds of stuttering, the researchers said.
Kristin Chmela, a speech therapist from suburban Chicago who specializes in treating stuttering, said she was teased and bullied for her own stuttering while growing up, and "there were lots of days where I was afraid to go to school."
She said she is looking forward to sharing the gene discovery with those she treats: "It's going to be very interesting to see the reaction on some of their faces."
___
On the Net:
New England Journal: http://www.nejm.org
Stuttering Foundation: http://www.stutteringhelp.org
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Mumps outbreak in NY, NJ tops 1,500 cases
ATLANTA – A mumps outbreak among Orthodox Jews in New York and New Jersey has now surpassed 1,500 cases and shows no sign of ending soon, health officials said Thursday.
The 7-month-old outbreak began last summer at a boys camp in the Catskills. The campers were from Orthodox Jewish families, and cases multiplied when they returned to their close-knit communities in and around New York City.
Most had a mumps vaccination, but the shots don't prevent all cases, according to the Centers for Disease Control and Prevention. The mumps vaccine is 79 to 95 percent effective if two doses are given, so illnesses will still occur in vaccinated people when the virus spreads, health officials said.
With 1,521 cases, the mumps outbreak is the largest in the U.S. since 2006, when nearly 6,600 cases were reported, mostly in six Midwestern states. Usually fewer than 300 cases are reported annually.
Mumps is spread by coughing and sneezing. Common symptoms are fever, headache and swollen glands. Most cases are in children and teens. It is a mild disease but sometimes can lead to complications such as hearing loss, meningitis and swollen testicles that — in rare cases — can lead to sterility.
In the new outbreak, the first identified case was an 11-year-old boy who got sick in late June. He had just returned from the United Kingdom — where vaccination rates are lower and mumps is more common — before going to the camp in Sullivan County in upstate New York. About 25 campers got sick.
Since then, hundreds of cases have been diagnosed in Orthodox Jewish enclaves in the New York City borough of Brooklyn, in nearby Orange and Rockland counties and in four counties in New Jersey.
Orthodox Jews account for more than 97 percent of the cases, which most likely has to do with the insular nature of their community, said Dr. Guthrie Birkhead of the New York State Department of Health.
Many Orthodox Jewish families are large, and the virus spreads well in packed households, said Kathleen Gallagher, a CDC epidemiologist. She said seating arrangements in religious schools may also be contributing, with students facing each other across tables instead of in rows of desks facing forward.
Since 1989, health officials have recommended that children get two doses of a combination vaccine against measles, mumps and rubella. Birkhead said vaccination rates for Orthodox Jewish kids are about the same as those for other New York schoolchildren.
Among 1,100 from the new outbreak, the CDC said 88 percent had gotten at least one vaccine dose, 75 percent had two doses. Health officials last month began offering a third dose in some schools where the outbreak has persisted. So far, cases are continuing.
"We're not out of the woods yet," said Birkhead.
___
On the Net:
CDC report: http://www.cdc.gov/mmwr
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Proposed autism diagnosis changes anger "Aspies"
Now, many Aspies, a nickname for people with Asperger's syndrome, are upset over a proposal they see as an attack on their identity. Under proposed changes to the most widely used diagnostic manual of mental illness, Asperger's syndrome would no longer be a separate diagnosis.
Instead, Asperger's and other forms of autism would be lumped together in a single "autism spectrum disorders" category. Some parents say they'd welcome the change, thinking it would eliminate confusion over autism's variations and perhaps lead to better educational services for affected kids.
But opponents — mostly older teens and adults with Asperger's — disagree.
Liane Holliday Willey, a Michigan author and self-described Aspie whose daughter also has Asperger's, fears Asperger's kids will be stigmatized by the autism label — or will go undiagnosed and get no services at all.
Grouping Aspies with people "who have language delays, need more self-care and have lower IQs, how in the world are we going to rise to what we can do?" Willey said.
Rebecca Rubinstein, 23, a graduate student from Massapequa, N.Y., says she "vehemently" opposes the proposal and will think of herself as someone with Asperger's no matter what.
Autism and Asperger's "mean such different things," she said.
Yes and no.
Both are classified as neurodevelopmental disorders. Autism has long been considered a disorder that can range from mild to severe. Asperger's symptoms can vary, but the condition is generally thought of as a mild form and since 1994 has had a separate category in psychiatrists' diagnostic manual. Both autism and Asperger's involve poor social skills, repetitive behavior or interests, and problems communicating. But unlike classic autism, Asperger's does not typically involve delays in mental development or speech.
The American Psychiatric Association's proposed revisions, announced Wednesday, involve autism and several other conditions. The suggested autism changes are based on research advances since 1994 showing little difference between mild autism and Asperger's. Evidence also suggests that doctors use the term loosely and disagree on what it means, according to psychiatrists urging the revisions.
A new autism spectrum category recognizes that "the symptoms of these disorders represent a continuum from mild to severe, rather than being distinct disorders," said Dr. Edwin Cook, a University of Illinois at Chicago autism researcher and member of the APA work group proposing the changes.
The proposed revisions are posted online at http://www.DSM5.org for public comment, which will influence whether they are adopted. Publication of the updated manual is planned for May 2013.
Dr. Mina Dulcan, child and adolescent psychiatry chief at Chicago's Children's Memorial Hospital, said Aspies' opposition "is not really a medical question, it's an identity question."
"It would be just like if you were a student at MIT. You might not want to be lumped with somebody in the community college," said Dulcan who supports the diagnostic change.
"One of the characteristics of people with Asperger's is that they're very resistant to change," Dulcan added. The change "makes scientific sense. I'm sorry if it hurts people's feelings," she said.
Harold Doherty, a New Brunswick lawyer whose 13-year-old son has severe autism, opposes the proposed change for a different reason. He says the public perception of autism is skewed by success stories — the high-functioning "brainiac" kids who thrive despite their disability.
Doherty says people don't want to think about children like his son, Conor, who will never be able to function on his own. The revision would only skew the perception further, leading doctors and researchers to focus more on mild forms, he said.
It's not clear whether the change would affect autistic kids' access to special services.
But Kelli Gibson of Battle Creek, Mich., whose four sons have different forms of autism, thinks it would. She says the revision could make services now designated just for kids with an "autism" diagnosis available to less severely affected kids — including those with Asperger's and a variation called pervasive developmental disorder-not otherwise specified.
Also, Gibson said, she'd no longer have to use four different terms to describe her boys.
"Hallelujah! Let's just put them all in the same category and be done with it," Gibson said.
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