THURSDAY, Nov. 30, 2017 (HealthDay News) — Drinking three to four cups of coffee a day is not only safe for most people, it might protect against heart disease or an early death, a new review suggests.
The finding, which applies to so-called “moderate” coffee drinking, stems from a review of more than 200 previous studies.
The fresh analysis also linked moderate coffee drinking to a lower risk for developing prostate, endometrial, skin and liver cancers, type 2 diabetes, liver disease, gout, gallstones and dementia.
Some of the studies in the review also showed a lower risk for Parkinson’s disease, depression and Alzheimer’s.
However, the review did not prove that coffee drinking caused these health risks to drop. And it also found that coffee may be somewhat problematic for pregnant women and slightly increases the risk for fracture among all women.
The review was led by Dr. Robin Poole, a specialist registrar in public health at the University of Southampton in England. He collaborated with researchers from the University of Edinburgh in Scotland.
The review suggested that drinking coffee in moderate amounts seemed to reduce the chances of dying from any disease, compared with those who didn’t drink coffee at all.
The biggest benefit was linked to consuming three cups a day. Drinking more than that was not linked to any harmful effects, but it also was not associated with substantially increased health benefits.
One heart expert said the findings should give coffee lovers reasons to smile.
“Many people have felt that abstaining from coffee is associated with being healthy, but this meta-analysis shows this is not necessarilytrue,” said Dr. Suzanne Steinbaum, director of Women’s Heart Health at Lenox Hill Hospital, in New York City. “Drinking up to 3 cups a coffee a day can be part of living a healthy life, not only reducing heart disease, but also not increasing the risk of neurologic diseases, such as Alzheimer’s or Parkinson’s.”
“If you are contemplating whether or not to get a cup of coffee in the morning or not, the study allows us to have a bit of peace of mind whenenjoying that morning cup of joe,” Steinbaum added.
The analysis was published online Nov. 22 in the BMJ.
THURSDAY, Nov. 30, 2017 (HealthDay News) — Police and federal agents cracking down on the makers of “designer drugs” like Spice are getting high from the mind-altering substances themselves, a new U.S. government report shows.
After one raid, six of nine agents had signs of Spice and “kratom” — an herbal supplement with opium-like effects — in their urine, according to the report from the U.S. Centers for Disease Control and Prevention.
Spice is a mix of herbs and man-made chemicals that mimic the psychoactive effects of marijuana. But it’s often more potent than the real thing, and inhaling or swallowing Spice can lead to serious reactions, the researchers noted.
“Intentional [Spice] use has resulted in multiple toxicities, but little is known about occupational exposure,” wrote researchers led by Dr. Loren Tapp, a medical officer at the CDC.
Because of this, federal agents requested a health hazard evaluation in 2014. Agents’ urine was tested before and after a raid.
Occupational safety investigators also tested the air and surfaces in the illegal laboratory. They found a Spice compound and kratom.
No signs of Spice or kratom were detected in the nine agents’ urine before the raid, but six showed evidence of one or more of these substances afterwards, the researchers reported.
From their previous dealings with Spice, four of the agents recalled feeling “high.” Others recalled having cough, eye or throat irritation, dizziness or lightheadedness.
At the time, there were no policies regarding work practices or personal protection during raids and evidence processing, the report noted.
To do their job safely, the researchers said, law enforcement agents need basic safety measures, such as gloves and protective clothing, plus showers and locker rooms.
“A properly designed forensic facility and good hygiene practices can reduce personal exposures to potential contaminants during law enforcement raids and while handling evidence,” Tapp’s team wrote.
In addition to personal protective equipment, agents should be banned from eating, drinking and smoking while processing Spice evidence, the report said.
The recommendations were published in the Dec. 1 issue of the CDC’s Morbidity and Mortality Weekly Report.
Although several Spice compounds are banned in the United States, drugmakers frequently modify the compounds to avoid illegal status. They package them as “herbal incense” and label them “not for human consumption,” according to the report.
Care homes have been applying unfair charges and over-the-top fees for self-funders, an official review shows.
The Competition and Market Authority found some homes had applied large upfront costs and charged families for weeks after their relatives had died.
The watchdog also highlighted how those paying for themselves were charged much more than council-funded residents.
The average weekly charge for self-funders was £846 – 40% more than local authority rates.
The CMA said it meant private individuals were effectively paying a multi-million pound subsidy every year to keep the ailing £16bn sector afloat.
It said another £1bn of government money was needed to create a fair and properly-funded system.
The year-long review by the markets watchdog also highlighted:
An inadequate complaints system making it difficult for families to raise concerns
Unclear terms and conditions
Fees being raised after residents have moved in
Insufficient support at a national level to help families navigate their way round the system
Families and friends being unfairly banned from visiting
You don’t fight when you are bereaved
One family member who was left with charges is Debra Ives, from Thetford, Norfolk.
She said she and her siblings were “disgusted” when they were given a care home bill to cover the four weeks after the death of their mother, Jean Richardson, in October.
“The day after she died we removed her personal belongings, leaving the room free for future residents,” she told the BBC.
“Within in a week we were issued with an invoice for four weeks post-death care costs of more than £3,000 to cover the use of the room, food and care she’d never get, and the cost of re-advertising the room.
“We were absolutely disgusted.
“We had signed a contract which stated that four weeks notice would be charged but we thought this would come into play if we had to move Mum. Never did we think it would mean a post death charge at full rates.”
Liz Chesworth’s family was charged more than £3,500 for a full month’s care despite her father spending just 24 hours of the month in his care home before he died.
“After just being bereaved, I did not feel up to fighting over money,” she said.
Meanwhile, Robert Hampson was horrified to discover he was being chased by a debt collection agency two years after the death of his aunt.
Her care home had tried to charge £5,000 for the cost of the place for the month after her death.
But he had refused, believing it “unreasonable”.
Prof Martin Green, of Care England, defended some of the charges families face, saying financial liability did not end with death.
But he conceded there was a need for more “transparency” and said the CMA had raised some “useful” points.
The CMA is now taking action in test cases against a few homes responsible for the most extreme cases of upfront charges and fees being levied after death – some of which have been applied for four weeks.
Officials at the watchdog have issued enforcement notices and say they will pursue cases in court if the care homes fail to respond.
The CMA has also warned the rest of the sector to take note as the practices could be in breach of consumer protection law.
Dr Woodhouse said finding the Down’s syndrome focusing issue had been “astonishing” and the biggest achievement for researchers was discovering the difference that bi-focals could make.
She said Evie was helped after her mother contacted the unit and was sent details of the research and this led to new bi-focals being prescribed.
“She struggled to draw the letters with her old glasses but there was enormous improvement with the new ones.
“Three weeks later she wrote her own name spontaneously for the first time, it was quite moving.”
HOW JAMES IS HELPED TO WORK AND PLAY
James Harris, 12, likes to play video games at his home in Barry, Vale of Glamorgan, but he would not be able to without his specially-designed glasses.
He first saw the experts at Cardiff University when he was just two years old and was found to be very long-sighted.
James goes to a mainstream school. The unit’s research has led to bold and enlarged print being provided on materials to help him access books and school work. His teachers also now know that children with Down’s have difficulty reading lines – so these are made bolder too.
This visual approach also sees eye examinations adapted for him.
Mother Kate said: “At the unit they’re very aware of the specific learning profile of individuals with Down’s syndrome and how visually aware they are and then in contrast to that what poor auditory memory they have”.
“So lots of talking to James and lots of instructions. A normal clinic environment just wasn’t going to work and for some children it can make it look like they’re being very badly behaved”.
This Queen’s Anniversary Prize – one of the most prestigious prizes in academia – is the first to be awarded for optometry.
It is a recognition of the work accomplished so far but the Cardiff unit still has more it wants to do – including helping one of the first children it tested.
Dr Woodhouse first saw Gareth John when he was six months old; he is now 25.
His eyesight has been fine for most of his life until recently.
THURSDAY, Nov. 30, 2017 (HealthDay News) — Just because your newborn isn’t a crybaby doesn’t mean he doesn’t feel pain, new research suggests.
Newborns display a stronger brain response to pain when they’re under stress, but it isn’t reflected in their behavior, British researchers found.
For the study, the investigators monitored brain activity and facial expressions of 56 healthy newborns to assess their response to the pain of a medically necessary heel stick.
Those with higher levels of background stress — as determined by heart rate and levels of a stress hormone in saliva — had more brain activity in reaction to the pain. But that didn’t seem to trigger a change in their behavior.
The study was published Nov. 30 in the journal Current Biology.
“When newborn babies experience a painful procedure, there is a reasonably well-coordinated increase in their brain activity and their behavioral responses, such as crying and grimacing,” said researcher Laura Jones, of University College London.
“Babies who are stressed have a larger response in the brain following a painful procedure. But, for these babies, this greater brain activity is no longer matched by their behavior,” she said in a journal news release.
Jones said the findings provide another reason to minimize both pain and stress when treating and caring for babies. Stressed babies may not seem to respond to pain, even though their brain is processing it.
“This means that caregivers may underestimate a baby’s pain experience,” Jones said.
THURSDAY, Nov. 30, 2017 (HealthDay News) — Patients apparently are more likely to complain about younger doctors. Case in point: ophthalmologists.
A new study of more than 1,300 ophthalmologists at Vanderbilt University in Nashville found that as the age of these doctors increased, patient complaints decreased.
“In a time where increasing attention is being paid to aging physicians and mandatory screening for cognitive impairment, the patient’s voice can be a powerful tool for understanding performance,” said the study’s lead researcher, Dr. William Cooper. He’s a professor of pediatrics and health policy at Vanderbilt’s School of Medicine.
“Therefore, if a physician suddenly has a change and increase in the frequency of patient complaints against a backdrop of colleagues who typically have fewer complaints, then that person may warrant further evaluation,” Cooper said.
The study couldn’t pinpoint why patients complain more about younger doctors, Cooper noted.
However, ophthalmologist Dr. Michael Repka has ideas as to why older doctors receive fewer complaints.
With age, he said, comes experience that helps doctors interact better with their patients. Repka is a professor of ophthalmology with Johns Hopkins Medicine, and vice chair of clinical practice at the Wilmer Eye Institute in Baltimore.
“Less experience means that you might say things that you wish you didn’t say, as you knew not to say 10 years later,” he said, adding that people learn from their errors.
Also, patients might see older doctors as more experienced and knowledgeable, and thus are less likely to complain about them, said Repka, who wasn’t involved with the study.
A doctor’s ability to manage patients does get better with age, he said, but younger doctors might have an edge when it comes to current medical practices.
Still, Repka said, all doctors — regardless of age and in all areas of medicine — get complaints. “I don’t think this is particular to ophthalmology,” he said.
“Learning about why patient complaints happen can improve the patient care experience for both the doctor and the patient,” Repka added.
For the study — designed to gauge whether the age of a doctor affected the number of patient complaints — Cooper and his colleagues collected data on 1,342 attending ophthalmologists or neuro-ophthalmologists from 20 health care organizations participating in Vanderbilt’s Patient Advocacy Reporting System.
The eye doctors all graduated from medical school before 2010 and ranged in age from 31 to older than 70.
The investigators found that the rate of patient complaints, registered from 2002 to 2015, decreased as physicians got older. Over the span of the study, the complaint rate gradually increased overall, but with steeper increases for younger doctors.
“We should give a voice to patients who have concerns about the care they receive,” Cooper said. “They can give us important information to guide safety and quality.”
The report was published online Nov. 30 in JAMA Ophthalmology.
The thyroid drug liothyronine will remain available on the NHS in England, after health bosses reconsidered a proposal to restrict access.
Liothyronine (T3) is taken by patients with an underactive thyroid, although most take a cheaper drug called T4.
But the NHS England board said T3 should be prescribed by consultant endocrinologists, rather than GPs.
Patient representatives welcomed the move – but one specialist warned it was simply moving demand.
‘Lack of evidence’
NHS England received around 5,800 responses during its consultation on its proposals to restrict access to “low value” medicines.
But in a board paper, it said liothyronine should be available.
“The main recurring theme – particularly from patients and organisational bodies – is that this is an effective treatment which can, in appropriate circumstances contribute to patient wellbeing, quality of life and condition management.”
A spokeswoman for the British Thyroid Foundation, which represents patients, welcomed the decision.
“We are pleased they have listened to the many patients and professional organisations who provided convincing information that there are thyroid patients for whom this medicine makes a huge difference.
“The uncertainty around this issue has caused confusion and distress and we hope that the guidance will lead to an improvement in care for patients with hypothyroidism.”
But Simon Pearce, professor of endocrinology at Newcastle University and member of the Society for Endocrinology, said the decision was “preposterous”.
He added: “Kicking liothyronine to secondary care isn’t going to solve the problem.
“During 2016 there were 75,000 prescriptions for liothyronine in England. Assuming a prescription lasts for one month, that amounts to about 6,000 patients. Assuming 50% of them will complain and request referral to secondary care, that’s an extra 3,000 new outpatient appointments.
“Assuming each endocrinologist sees around 300 new appointments each year, then you need 10 new endocrinologists. Where are they coming from and who is paying for this?”
The NHS in England also said doctors should still be allowed to prescribe lidocaine plasters to patients with post-herpetic neuralgia (PHN), a nerve pain condition which is a complication of shingles, and that Fentanyl, an opiod painkiller, could be given to palliative care patients.
But they rejected calls for homeopathy and herbal treatments to be prescribed, saying there was a “lack of evidence” to support their use.
And they proposed the Health Secretary Jeremy Hunt should consider putting them on an NHS “blacklist” – along with other items including omega-3 fatty acids and glucosamine supplements.
There will now be further consultation on whether the prescribing of other products such as suncream, cough and cold remedies and indigestion and heartburn medicines which are either available more cheaply over the counter or used for conditions that will clear up on their own, should also be restricted – potentially saving £190m a year.
Draft guidance is set to be published in January next year for consultation.
THURSDAY, Nov. 30, 2017 (HealthDay News) — All prescribers of opioid pain medications — not just high-volume prescribers — play a role in the U.S. epidemic of opioid abuse and overdoses, a new study says.
Deaths from drug overdoses in the United States rose from about 52,000 in 2015 to more than 64,000 in 2016. Most of those deaths involved opioids, including prescription pain medications such as fentanyl and oxycodone (Oxycontin) as well as the illegal drug heroin, according to researchers from the Johns Hopkins Bloomberg School of Public Health.
For the study, the researchers analyzed more than 24 million opioid prescriptions given in 2015 to more than 4 million people in California, Florida, Georgia, Maryland and Washington state.
The investigators found that opioids were often prescribed to high-risk patients by health care providers who typically do not prescribe large volumes of opioids, including primary care physicians, surgeons and providers who are not physicians.
However, these low-volume prescribers accounted for 18 to 56 percent of all opioid prescriptions to high-risk patients, the study found.
This indicates that high-volume prescribers, including so-called “pill mill” doctors, should not be the only focus of public health efforts to combat the opioid abuse epidemic, according to the researchers.
“This crisis has been misconstrued as one involving just a small subset of doctors and patients,” senior author Dr. G. Caleb Alexander said in a Hopkins news release.
“Our results underscore the need for targeted interventions aimed at all opioid prescribers, not just high-volume prescribers alone,” Alexander added.
He is founding co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
The study also found that “opioid shoppers” — people who obtain prescriptions from multiple doctors and pharmacies — accounted for just 0.1 percent of opioid users in the study. The researchers said this may be why prevention efforts focusing on “opioid shoppers” have not led to larger reductions in opioid overdoses.
“The point here is that ordinary low-volume prescribers are routinely coming into contact with high-risk patients — which should be a wake-up call for these prescribers,” Alexander said.
“We need to build systems to help prescribers better identify these patients, screen them for opioid use disorders and improve the quality of their pain management,” he suggested.
The study was published Nov. 30 in the journal Addiction.
THURSDAY, Nov. 30, 2017 (HealthDay News) — The epidemic of opioid abuse in the United States has put hospital ERs on the front line, with staffers increasingly battling infections tied to the problem.
ERs are seeing an increasing number of patients seeking care for severe infections resulting from injected use of heroin, fentanyl, oxycodone and the like, new research shows.
ER radiologists are often the first to diagnose such complications, using X-rays, MRIs, CT scans and ultrasounds to spot infections that typically result from the use of non-sterile needles, the researchers said.
Insights into how the opioid epidemic is playing out in the ER stem from a 12-year analysis that focused on more than 1,000 substance abuse patients who sought care for related complications between 2005 and 2016.
The findings reflect the fact that “the opioid epidemic is a national emergency,” said study author Dr. Efren Flores. He’s an ER radiologist at Massachusetts General Hospital in Boston.
“The results of this study,” he said, “are consistent with our daily practice, where we continue to observe an increase in the number of patients with substance use disorders that present to the emergency department for evaluation of complications related to their illness.”
What’s more, Flores said, many of these patients — at an average age of 36 — “are young adults who are in the beginning of their productive lives.”
Though not a member of the study team, Dr. Paul Petersen noted that “this increase in infections related to IV [intravenous] drug abuse has been expected and is not surprising to the medical community as the opioid epidemic continues to rise in the United States.”
Petersen is a core faculty member of the emergency department at Mount Sinai Medical Center in Miami Beach, Fla.
“IV drug abuse can cause local infections at the injection site, either from bacteria mixed in the drug, on a dirty needle or on dirty skin through which the needle passes,” he explained. “The bacteria can also grow in the bloodstream and prefer to accumulate and grow on the heart valves, causing valvular heart disease.”
“In addition, from the valves, these vegetative infections or clumps of growing bacteria shoot downstream, commonly to the lungs, brain and spine, where they continue to grow and cause disease,” Petersen said.
Complications from these infections are severe, he said. “They are often fatal and commonly cause chronic debilitating diseases of the spine, lungs, heart or brain, requiring multiple surgeries and long-term and/or institutionalized care,” he added.
Two-thirds of the patients in the latest analysis were men, and 78 percent were white.
Most of the complications seen during the study time frame involved localized soft-tissue infections at needle injection sites, according to the researchers. Sometimes the issue was a bacterial infection such as cellulitis. Other cases involved the onset of abscesses.
In some instances, pieces of broken needles were found buried under the surface of a patient’s skin. Bacteria-infected blood vessel blockages known as septic emboli, which have the potential to move into the lung or brain, were another observed concern.
Ultimately, 1 in 10 patients who had radiological screening while in the ER died from the complications.
“Our research validates the severity of this epidemic and uniqueness of this patient population,” Flores said. ER radiologists need to embrace their front-line position by proactively devising ways to increase the likelihood that those who do make it out of the ER stay out going forward.
For example, he suggested that radiologists should consider promoting needle-exchange programs while helping to direct patients into addiction recovery programs once they leave the ER.
Petersen seconded the importance of needle exchange programs and the need to prevent new infections down the road. But he suggested that the epidemic’s front line is actually out in the community, rather than in the ER.
Petersen places his stock in those who have the “greatest exposure to these patients” — social workers, family practitioners, homeless shelter staff members, community clinic workers and urgent care providers. It’s those individuals, he said, who are best placed to teach at-risk individuals about the most effective ways to limit their infection risk.
Flores and his fellow researchers were to present their findings Thursday in Chicago at the Radiological Society of North America’s annual meeting. Research presented at meetings is considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals.
THURSDAY, Nov. 30, 2017 (HealthDay News) — Teens fixated on their smartphones experience changes to their brain chemistry that mirror those prompted by addiction, a new study suggests.
Kids who compulsively used the internet or fiddled with their phones tended to have increased neurotransmitter activity in the anterior cingulate cortex, a region tied to the brain’s systems of behavior reward, control of inhibition and mood regulation, a team of South Korean researchers found.
“This particular region is well-known to be involved in addiction based upon the modulation of those kinds of behaviors,” said Dr. Christopher Whitlow, an associate professor of radiology with the Wake Forest Substance Addiction and Abuse Center in Winston-Salem, N.C. “The authors are showing an effect in part of the circuitry of the brain that’s involved in addiction.”
The research team, led by Dr. Hyung Suk Seo at Korea University in Seoul, used a scanning technique called magnetic resonance spectroscopy (MRS) to evaluate the brains of 19 teenagers diagnosed with internet or smartphone addiction.
Researchers used standardized addiction tests to diagnose the teens and judge the severity of their addiction. Questions focused on the extent to which internet or smartphone use affected their daily routine, social life, productivity, sleeping patterns and emotions.
MRS scans are used to track concentrations of biochemicals in the brain, and are often used to study changes wrought by brain tumors, strokes, mood disorders and Alzheimer’s disease.
Compared against normal teens, teenagers with an internet or smartphone addiction experienced increased levels in their anterior cingulate cortex of a neurotransmitter called gamma aminobutyric acid (GABA), which inhibits or slows down brain signals, the researchers said.
Their smartphone use “alters the function of this key brain area and was correlated with clinical measures of addiction, depression and anxiety,” said Whitlow, who was not part of the study team.
Further, the researchers found that GABA levels either decreased or returned to normal after teenagers received nine weeks of cognitive-behavioral therapy aimed at treating their addiction.
The study “adds some scientific evidence that excessive use of these smartphones is having an impact in the brain which might be similar to other addictive disorders,” said Dr. Edwin Salsitz, an addiction medicine specialist with Mount Sinai Beth Israel in New York City.
Salsitz said he was surprised that the study didn’t focus on dopamine, a brain chemical more typically linked to addiction, but added that GABA is a very important neurotransmitter that works in the same parts of the brain affected by dopamine.
Internet or smartphone addiction can be compared to other forms of behavioral addiction, such as addiction to gambling or pornography, said Dr. Sanjeev Kothare, chief of the division of child neurology at Cohen’s Children’s Medical Center in New Hyde Park, N.Y.
“It’s just an extension of the same idea,” Kothare said.
Parents who are concerned that their teens might be hooked on technology should restrict their smartphone or computer use, Kothare added.
He admits that might be a tough sell, but noted that parents can link reduced smartphone use to rewards such as a sought-after toy or game or more internet access on the weekends.
This study should be followed up in a larger group of participants with scans tracking more brain chemicals, the experts said.
Future researchers might also want to consider using functional magnetic resonance imaging (fMRI) scans, which can track the flow of blood and biochemicals within the brain, Kothare added.
“If you move your right hand, your left motor cortex gets more blood supply, and that is taken as a signal on the MRI,” Kothare said, providing an example of how fMRI could help doctors better understand the possible addictive effect.
The South Korean researchers were scheduled to present their findings Thursday at the annual meeting of the Radiological Society of North America, in Chicago. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.