Seasonal Flu Vaccine Even Less Effective Than Thought: CDC
And nasal version appears to provide no protection at all for young children
THURSDAY, Feb. 26, 2015 (HealthDay News) -- This year's flu vaccine is even more disappointing than previously reported, showing just 18 percent effectiveness against the dominant H3N2 strain of flu, health officials reported Thursday.
That's a drop from the 23 percent protection level estimated for the flu shot earlier in the season, said experts at the U.S. Centers for Disease Control and Prevention.
The situation for children was even worse. The CDC panel pegged the effectiveness of the injected vaccine for kids aged 2 to 8 to be just 15 percent.
And the nasal-spray version of the vaccine may not protect young children at all, health officials said.
"Studies can't confirm that the [nasal] vaccine has a benefit," said Dr. Joseph Bresee, chief of the Epidemiology and Prevention Branch at CDC's National Center for Immunization and Respiratory Diseases.
Why the poor performance?
"These low numbers, which are lower than we normally see, are because the flu viruses that are circulating have mutated to look very different than the vaccine strains," Bresee explained.
He added that the H3N2 flu strain that is currently circulating was not factored into this season's vaccine because decisions about which strains to target were made last February. As happens each year, choices about which strains to include are made months in advance so that manufacturers have time to make enough vaccine, Bresee explained.
In fact, this new strain of H3N2 was seen for the first time in March 2014 and didn't become dominant until September, Bresee noted. "That was much too late to make a new vaccine," he said.
"This is a very unusual circumstance where a new strain develops and becomes a dominant strain so quickly and after the vaccine had already been produced," he said.
On Thursday, the Word Health Organization made its recommendation for the makeup of next season's vaccine, Bresee said. Next week, the U.S. Food and Drug Administration will decide which strains will be included in next season's flu vaccine for the United States. Bresee said the FDA usually follows the WHO recommendations.
WHO recommended that this year's mutated H3N2 strain as well as updated versions of other strains be included in next season's vaccine, Bresee added.
Although this year's vaccine is only somewhat effective and the flu season has peaked, Bresee still recommends getting a flu shot.
"Year in and year out, flu vaccines are still the best way to protect yourself against flu," he said. "Most years, the vaccine is 50 to 70 percent effective. The vaccine doesn't protect everybody every time, but it's odds on the best way to protect yourself against flu."
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, agreed that the vaccine is still the best protection against flu.
"Yes, it's still worth getting it though the season has already peaked," he said.
The CDC said that the flu season isn't over yet, and there is an increasing number of B viruses circulating, which are a better match to the vaccine and could bring final vaccine effectiveness numbers up.
This year's flu season has also hit children hard, the agency said, with 86 children dying from complications of flu by Feb. 7. For context, the CDC noted that in an average year, child deaths from flu vary from as few as 30 to as many as 170 or more.
The CDC currently recommends that everyone aged 6 months and older get vaccinated. Even if the flu shot isn't a perfect match to circulating strains, vaccination can still prevent some infections and reduce severe disease that can lead to hospitalization and death, the agency said.
Other ways to treat and prevent flu from spreading include early treatment with antiviral drugs such as Tamiflu and Relenza, and washing hands frequently and covering your mouth when coughing or sneezing.
Early treatment with antiviral drugs is especially important for children aged 2 and younger, along with adults aged 65 and older, the agency said. Others for whom these vaccines are essential are people with diabetes, heart disease or breathing problems, they added.
Visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/flu/ ).
SOURCES: Joseph Bresee, M.D., chief, Epidemiology and Prevention Branch, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention; Marc Siegel, M.D., professor, medicine, NYU Langone Medical Center, New York City
U.S. Ebola Survivor Dr. Craig Spencer Gives His Side of the Story
Former volunteer in fight against West African outbreak felt vilified by media, politicians
THURSDAY, Feb. 26, 2015 (HealthDay News) -- Many U.S. politicians and media outlets hyped the threat of U.S. cases of Ebola last year, according to a newly written personal account by Dr. Craig Spencer, the last American Ebola patient treated in the United States.
He also believes that officials and the media unnecessarily maligned those who were risking their lives to combat the West African epidemic.
Spencer contracted the virus while performing aid work at an Ebola treatment center in Guinea, and fell ill days after his return to New York City. He entered Bellevue Hospital on Oct. 23 as New York's first Ebola patient, and spent 19 days there recovering from his infection.
"Though I didn't know it then -- I had no television and was too weak to read the news -- during the first few days of my hospitalization, I was being vilified in the media even as my liver was failing and my fiancee was quarantined in our apartment," Spencer wrote in a letter in the Feb. 26 New England Journal of Medicine.
While he was in the hospital, media outlets hyped the potential threat of Ebola and criticized Spencer for going out into the city after his return, he wrote. At the same time, politicians used the virus seemingly to score election-season points with voters by enacting poorly considered quarantines.
"After my diagnosis, the media and politicians could have educated the public about Ebola," Spencer wrote. "Instead, they spent hours retracing my steps through New York and debating whether Ebola can be transmitted through a bowling ball."
Fear motivated these decisions, and Spencer said as an American aid worker he well understands that fear, "because I felt it on a personal level."
He often woke up in the middle of the night during his work in Guinea, sweating and heart racing, convinced that he'd contracted Ebola even though his temperature was normal.
"Ebola is frightening not just because of its high fatality rate, but also because of how little we know about it," he wrote. "We cannot explain exactly what it does to our bodies, nor tell patients who survive it how it may affect them in the future."
While he found the high-pressure work rewarding, Spencer felt profound relief when he left Guinea following his tour of duty. He remembers "the calm that settled over me the last time I left the [Ebola treatment] center, knowing that I'd no longer be exposed to Ebola."
Back in New York, Spencer continued to worry that he might fall ill with Ebola and infect his fiancee or others.
"Touching others and shaking hands -- forbidden actions throughout West Africa -- still made me uncomfortable," he wrote. "Twice a day, I held my breath in fear when I put a thermometer in my mouth."
The day of his hospitalization, Spencer woke up knowing something was wrong. He felt warmer and more tired than usual, and seemed to be breathing more quickly. When he took his temperature and found it elevated, he immediately called in and was rushed to the hospital.
But while he struggled in the hospital, the outside world picked over his daily activities since his return from West Africa and criticized him for moving freely about, Spencer said.
The media gave scant attention to the fact that all available evidence on Ebola "suggested that it was nearly impossible for me to have transmitted the virus before I had a fever," he wrote.
At the same time, the governors of New York and New Jersey implemented strict home quarantine rules that demonized workers fighting the raging epidemic and acted counter to the best public health practices, Spencer wrote.
"Instead of being welcomed as respected humanitarians, my U.S. colleagues who have returned home from battling Ebola have been treated as pariahs," he wrote. "I believe we send the wrong message by imposing a 21-day waiting period before they can transition from public health hazard to hero."
Spencer pointed out that society needs to have faith in the science-based infection-control protocols developed by public health professionals because those protocols have worked. He noted that the protocols worked for him because he didn't infect anyone. And, those protocols have "worked for hundreds of my colleagues who have returned from this and past Ebola outbreaks without infecting anyone," he added.
Spencer noted that for many politicians, the Ebola epidemic seems to have ended on Election Day. For the U.S. media, it appeared to end about a week later when he walked out of Bellevue Hospital virus-free, the last American patient treated in the United States for Ebola.
"But the real Ebola epidemic still rages in West Africa," he wrote. "The number of new cases is stabilizing in some areas and declining in others, but more than 23,000 people have been infected, and many are still dying from this disease."
Dr. Amesh Adalja, a senior associate at the UPMC Center for Health Security in Baltimore, said that Spencer's letter "makes an important point that bears repeating: decision making must be based on scientific evidence and not driven exclusively by fear."
Adalja added, "It was unfortunate that Dr. Spencer was vilified, not because of any risk he actually posed, but due to endorsement of unwarranted fear by policymakers and many in the media."
For more on the Ebola virus, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Amesh Adalja, M.D., senior associate, UPMC Center for Health Security, Baltimore; Feb. 26, 2015, New England Journal of Medicine
U.S. Pedestrian Death Rate Leveling Off, But Still Too High
Governors' safety group reports more than 2,100 killed in early 2014
THURSDAY, Feb. 26, 2015 (HealthDay News) -- The number of pedestrians killed on U.S. roads is expected to remain unchanged from 2013 to 2014, according to a report from the Governors Highway Safety Association (GHSA).
But that number is still about 15 percent higher than it was in 2009, the report says.
The analysis of preliminary data from the first six months of 2014 found that 2,125 pedestrians died nationwide, compared with 2,141 in the first six months of 2013.
"This is a clearly a good news, bad news scenario," Jonathan Adkins, GHSA executive director, said in an association news release.
"While we're encouraged that pedestrian fatalities haven't increased over the past two years, progress has been slow. Protecting pedestrians is a priority for GHSA and our members; we're determined to drive the number down to zero," he added.
Even as a growing number of Americans choose walking as their preferred way to get around, efforts to improve pedestrian safety have stalled, according to report author Allan Williams, former chief scientist at the Insurance Institute for Highway Safety.
"Pedestrian deaths declined steeply from 7,516 in 1975 to 4,735 in 2013. But when you consider the percentage of pedestrians killed in all motor vehicle crashes, the gains are less pronounced. The rate was 17 percent in the late 1970s and early 1980s. It fell to a low of 11 percent in the past decade, but climbed back to 14 percent in 2013," Williams said in the news release.
He noted that that nation's four most populous states -- California, Florida, Texas and New York -- accounted for 43 percent of all pedestrian deaths in the United States in 2013. Delaware and Florida had the highest rates of pedestrian deaths at nearly 3 per 100,000 residents.
In 2013, pedestrians accounted for the highest percentage of road deaths (45 percent) in Washington, D.C. In New York, pedestrians accounted for 28 percent of road deaths, followed Nevada and Delaware, where pedestrians account for 25 percent of the road deaths in each state.
The report did offer some good news. In 24 states and the District of Columbia, pedestrian deaths were down in the first half of 2014 compared with the same period in 2013, while deaths remained the same in five states. There were nine or fewer pedestrian deaths in 16 states, with Nebraska and Wyoming each reporting just one.
There have been large drops in pedestrian deaths involving seniors and children since 1975. For example, children aged 12 and younger accounted for 21 percent of pedestrian deaths in 1975, but that rate fell to 4 percent in 2013. However, the report found there was a 28 percent increase in the deaths of pedestrians ages 20 to 69 between 1975 and 2013.
About 70 percent of pedestrian deaths involve males, and many of them are hit by vehicles at night and in the fall and winter months, the report said.
Alcohol appears to be a major risk factor for pedestrian deaths. In 2013, 36 percent of pedestrians 16 and older who died had blood alcohol concentrations of .08 or higher, according to the report.
The U.S. Centers for Disease Control and Prevention has more about pedestrian safety (http://www.cdc.gov/Motorvehiclesafety/Pedestrian_safety/index.html ).
SOURCE: Governors Highway Safety Association, news release, Feb. 26, 2015
ADHD May Raise Odds for Premature Death
Risk is small, but a sign the disorder is a serious problem, experts say
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- People with attention-deficit hyperactivity disorder (ADHD) are more than twice as likely to die prematurely as those without the common disorder, a new study finds.
The risk is small, but it's a clear indication that the disorder is a serious problem, the researchers said.
In a study of more than 2 million people, Danish researchers found that accidents were the most common cause of premature death among people with ADHD. And the risk was significantly higher for women and those diagnosed in adulthood, the researchers added.
"Our results add to the overwhelming existing evidence that ADHD is a true disorder and should not be taken lightly," said lead researcher Dr. Soren Dalsgaard, a senior researcher at Aarhus University.
Still, Dalsgaard stressed that the actual number of premature deaths among those with ADHD was small. "Although ADHD doubles the risk, it is important to note that the absolute risk is very low," he said. Out of more than 32,000 people with ADHD, 107 died early, he noted.
ADHD is a neurodevelopmental disorder that affects at least 11 percent of American children aged 4 to 17, according to the U.S. Centers for Disease Control and Prevention. They tend to be inattentive, impulsive and hyperactive, which can cause them to struggle academically and socially. The disorder often lingers in adulthood.
The new study was published online Feb. 26 in The Lancet.
"It's common for people with ADHD to be impulsive and act without thinking, which can lead to accidents," said Stephen Faraone, author of an accompanying journal editorial.
Faraone agreed with Dalsgaard that the risk of premature death related to ADHD is small. "But the increase is another sign that this is a serious disorder that needs to be taken seriously," he said.
Treating ADHD is the best way to reduce the risk of dying early, added Faraone, director of child and adolescent psychiatry research at SUNY Upstate Medical University in Syracuse, N.Y.
Treatments can include medication, psychotherapy, training or a combination of treatments, according to the U.S. National Institute of Mental Health.
For the study, Dalsgaard and colleagues collected data on nearly 2 million people included in a large Danish registry who were followed from their first birthday to 2013. Maximum follow-up was 32 years.
More than 32,000 of the people had ADHD. Over the years, 107 people with ADHD died. They were about twice as likely to die prematurely as people without the disorder, even after the researchers took into account factors such as sex, family history of mental problems and parents' age and education.
Accidents were responsible for more than half of the 72 deaths for which there was a known cause.
The risk of dying prematurely rose along with age at ADHD diagnosis. People diagnosed at age 18 or older were more than four times as likely to die early, compared with those without the condition. In contrast, children diagnosed before age 6 had about double the risk of dying prematurely, compared with those without ADHD, researchers say.
In addition, girls and women with ADHD had a higher risk of an early death, compared with boys and men with the condition, the study team found.
Research has shown that ADHD often occurs with other behavioral problems, Dalsgaard said. These can include a substance use disorder, oppositional defiant disorder (a pattern of angry/irritable mood and defiant behavior) or conduct disorder (disruptive and violent behavior and problems following rules), he said.
When ADHD was combined with all three disorders, the odds for premature death were more than eight times higher than for people without ADHD or a co-existing behavioral disorder, the researchers noted.
"ADHD has huge impacts on everyday life, and people with ADHD and their families deserve that this is acknowledged," Dalsgaard said.
Visit the U.S. National Institute of Mental Health (http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml ).
SOURCES: Soren Dalsgaard, M.D., Ph.D., senior researcher, Aarhus University, Denmark; Stephen Faraone, Ph.D., professor, psychiatry, director, child and adolescent psychiatry research, SUNY Upstate Medical University, Syracuse, N. Y.; Feb. 26, 2015, The Lancet, online
Could a Bad Night's Sleep Make You Eat More Fatty Food?
Study suggests it might, raising the risk for potential weight gain
WEDNESDAY, Feb. 25, 2015 (HealthDay News) -- Skipping just a single night of sleep leads to a shift in brain activity that seems to spark a desire to consume more fat the following day, a new study suggests.
The study offers potential insights into the relationship between lack of sleep and the risk of obesity, researchers said.
"The main finding of this study is that one night of sleep loss altered function within the brain's 'salience network,' " explained study senior author Hengyi Rao.
The salience network is a pathway in the brain thought to guide decision-making, according to Rao. He is an assistant professor of cognitive neuroimaging in neurology and psychiatry within the division of sleep and chronobiology at the University of Pennsylvania's Perelman School of Medicine.
What's more, Rao added, a brain scan analysis revealed exactly how the network changed in response to sleep loss, which ultimately enabled his team to accurately predict how much more fat an individual might consume following lack of sleep.
"This study is the first to link [such] changes in regional brain function with actual food intake after sleep deprivation," he said.
Rao and his colleagues reported their findings recently in Scientific Reports.
The study authors explained that the salience network is composed of three sections that are all positioned at the front part of the brain. These areas are collectively involved in the onset and interpretation of emotions, sensory perception and mental strategizing.
To explore the network's reaction to a lack of sleep, the study enlisted 46 healthy, mostly non-obese adults aged 21 to 50.
All were nonsmokers, and all said they routinely slept between 6.5 and 8.5 hours a night. None suffered from any particular sleep disturbances or any ongoing medical or psychological complications.
All were asked to spend five consecutive days (including four nights) in a sleep laboratory. On the first night all got a full night of rest, amounting to nine hours of time spent in bed, after which brain scans were conducted to record normal network function following good sleep.
Then, 34 of the participants were randomly selected to be in the "sleep-deprived group" on the second night. This meant they were kept awake all night, while the remaining participants got eight hours of sleep.
Brain scans were then conducted again, after which all participants were allowed to move about, watch TV, read, play video and board games, and eat as much or as little as they wanted. All food was ordered from an available menu, and all intake was recorded.
The result: those in the sleep-deprived group consumed roughly 950 extra calories during the night they were forced to stay awake. Total calorie consumption was about the same among the sleep-deprived group during the day that followed their all-nighter as it was among those who had normal sleep.
However, when calories were broken down by content, investigators found a big difference between the groups. Those who hadn't slept consumed a lot more fat and a lot less carbohydrates than those who had slept.
At the same time, the sleep-deprived group showed markedly greater activity in terms of salience network function.
The researchers concluded that people who experience bouts of forced wakefulness -- such as those in the military, truck drivers or medical personnel -- may be prone to making unhealthful food choices due to a related shift in brain activity.
Rao acknowledged that the current study only explored the impact of a single night of sleep loss. However, "it is likely that chronic partial sleep deprivation would affect the brain in a similar way," he said, "and that maintaining adequate sleep may be a key strategy for maintaining a healthy weight and diet."
Derk-Jan Dijk is a professor in the departments of sleep and physiology, and director of the Surrey Sleep Research Centre at the University of Surrey in England. He suggested that going forward it will be important to examine how both the brain and dietary habits are affected by ongoing sleep loss experienced by people who routinely get only five to six hours of sleep a day.
Overall, the study findings support the link between sleep patterns "and changes in food intake and subsequent obesity. Of course, in the real world it is not total sleep loss that is the main problem, but chronic insufficient sleep," Dijk explained.
"Nevertheless," he added, "the current study is important because it provides hints to the brain mechanisms involved in the link between sleep loss and changes in food intake."
There's more on sleep and diet at the National Sleep Foundation (http://sleepfoundation.org/sleep-topics/diet-exercise-and-sleep ).
SOURCES: Hengyi Rao, Ph.D., research assistant professor of cognitive neuroimaging in neurology and psychiatry, division of sleep and chronobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Derk-Jan Dijk, Ph.D., professor, departments of sleep and physiology, and director, sleep-wake research, Surrey Clinical Research Centre, faculty of health and medical sciences, University of Surrey, United Kingdom; Feb. 3, 2015, Scientific Reports
Could Coffee Lower Risk of Multiple Sclerosis?
Studies link several cups daily with reduced odds for the disease
THURSDAY, Feb. 26, 2015 (HealthDay News) -- People who down several cups of coffee every day may have a decreased risk of developing multiple sclerosis, a new study suggests.
The study, of 5,600 Swedish and U.S. adults, found that those who drank four to six cups of coffee a day were about one-third less likely to develop multiple sclerosis (MS), compared with people who did not drink coffee.
Researchers stressed that the findings do not prove that coffee fights MS -- a disease in which the immune system mistakenly attacks the protective sheath around nerve fibers in the brain and spine. Symptoms can include muscle weakness, numbness, vision problems and difficulty with balance and coordination.
"This doesn't mean we should be recommending rampant coffee drinking," said lead researcher Dr. Ellen Mowry, an assistant professor of neurology at Johns Hopkins University in Baltimore.
There could, for instance, be something else about coffee drinkers -- such as a diet or lifestyle habit -- that is the real explanation behind their lower MS risk, Mowry explained.
"Until we are able to prove that coffee -- or some component of coffee, like caffeine -- is actually helpful, we can't make any recommendations," she cautioned.
And that is partly because all that caffeine could have negative effects, too, she said.
Still, the findings do build on evidence that coffee and possibly caffeine specifically are "neuroprotective," Mowry said. Higher coffee intake has been linked to lower risks of other diseases that involve degeneration in brain cells, including Parkinson's disease and Alzheimer's, she noted.
And, Mowry added, scientists have found that high caffeine intake can protect lab mice from developing an MS-like condition -- by blocking part of the inflammatory process that damages nerves in the brain and spine.
"So it's plausible that coffee has some protective effect, with the caveat that a lot of things seen in lab animals do not pan out in humans," Mowry said.
She is scheduled to present the findings -- which are considered preliminary until published in a peer-reviewed medical journal -- in April, at the annual meeting of the American Academy of Neurology in Washington, D.C. The academy released the results Thursday, ahead of the conference.
The findings come from two separate study groups: a Swedish group that included more than 1,600 adults with MS and about 2,800 without the disease, and a U.S. group of 584 MS patients and 581 individuals free of the disease.
In the U.S. group, people who regularly drank at least four cups of coffee a day were one-third less likely to have MS, versus people who avoided coffee. In the Swedish group, people who drank six or more cups of coffee daily had a one-third lower MS risk.
The typical Swedish "cup" of coffee is smaller than the U.S. version, Mowry noted, so the results are consistent.
What's more, the Swedish study had longer-term data, and the researchers found that high coffee intake over five to 10 years had a similarly protective effect against MS.
That is, of course, if it's an effect of coffee at all. Mowry's team ruled out some other explanations -- such as age, smoking habits, and sun exposure. (Higher vitamin D levels have been linked to a lower risk of developing MS, and less severe symptoms.) But the researchers could not account for all the possible differences between coffee lovers and non-drinkers.
"This is a very interesting, well-done study," said Nicholas LaRocca, vice-president of health care delivery and policy research for the National Multiple Sclerosis Society.
"But no one should start drinking coffee because of one study," he added.
LaRocca said it will be crucial to understand why heavy coffee consumption is linked to lower MS risk. "What's the mechanism?" he said. "If we can identify it, that could open up new targets for therapies to slow the progression of MS."
In the bigger picture, LaRocca said, more studies are looking into the lifestyle factors that might affect MS risk or severity -- from smoking to sunlight exposure to diet and exercise.
"We have a number of disease-modifying drugs to treat MS," LaRocca said. "But people are also looking for ways that they can live better with MS. So understanding how lifestyle affects the course of the disease is very important."
According to the National Multiple Sclerosis Society, at least 2.3 million people worldwide have MS. It is more common in women than men, and typically strikes between 20 and 50 years of age.
The National Multiple Sclerosis Society has more on living well with MS (http://www.nationalmssociety.org/Living-Well-With-MS/Health-Wellness ).
SOURCES: Ellen Mowry, M.D., assistant professor, neurology, Johns Hopkins University School of Medicine, Baltimore; Nicholas G. LaRocca, Ph.D., vice president, health care delivery and policy research, National Multiple Sclerosis Society, New York City; Feb. 26, 2015, news release, American Academy of Neurology
Epilepsy Surgery Gets High Marks From Patients in Survey
92 percent said it was worthwhile, with fewer seizures and higher quality-of-life
THURSDAY, Feb. 26, 2015 (HealthDay News) -- More than nine in 10 epilepsy patients who had brain surgery to try to control their seizures are happy they did so, a new survey reveals.
The review appears to be driven by the fact that patients saw the number of debilitating seizures they experienced after surgery either drop significantly or disappear altogether, the researchers noted.
"One percent of the U.S. population has epilepsy, and among that group there are about 750,000 patients with recurring seizures that are not well-controlled," said study co-author Dr. Marianna Spanaki-Varelas, director of the Henry Ford Comprehensive Epilepsy Program at Henry Ford Hospital in Detroit. "Of those, 30 to 35 percent are [surgical] candidates because they do not respond to the roughly 15 appropriate epilepsy drugs that we have."
A great majority of those who have surgery say it was worthwhile because many remain seizure-free long after surgery and many see a big improvement in their quality of life, Spanaki-Varelas noted.
The survey findings are published in the February issue of Epilepsy & Behavior.
The surgery, during which a portion of the brain is removed to treat debilitating seizures, is typically reserved for patients whose seizures originate in a single spot in the brain.
"We would not operate on people who have more than one spot of the brain that generates seizures," Spanaki-Varelas said. "And we also would not operate on focal patients whose problem brain region is too close to areas that control motor or sensory function or speech."
That said, Spanaki-Varelas added that epilepsy surgery is still "highly underutilized in this country." She said only 1,500 Americans have the surgery each year, even though recent research has shown that the procedure is actually no more risky than hip replacement surgery.
"There is a misconception, even among physicians, that surgery should be considered the very last resort," Spanaki-Varelas explained. "But we should not delay surgery until all drugs are tried. If a patient fails on one, two or, at maximum, three medications, alone or in combination, then they need to be considered as [surgical] candidates."
That position, Spanaki-Varelas noted, is supported by the American Academy of Neurology.
To assess how well epilepsy patients fare following surgery, the study authors focused on a pool of 470 men and women with epilepsy. All had been operated on at Henry Ford between 1993 and 2011.
Of the group, 50 patients had died since surgery. After reviewing electronic medical records and recent clinic notes, the research team was ultimately able to conduct follow-up phone surveys with more than 250 patients.
On average, quality-of-life surveys were conducted nearly 11 years post-surgery, though more than one-quarter of the patients (27 percent) were reached more than 15 years following their initial operation.
The result: 92 percent of patients said they considered their surgery to be "worthwhile."
Slightly less than one-third said they were currently seizure-free, while three-quarters described the results of their surgery as "favorable," meaning total seizure relief or only rare occurrences of "disabling" seizures.
Those "favorable" outcomes held steady over time, seen among 77 percent of patients during the five years after surgery and among 78 percent of patients who reached the 15-year-plus mark.
Seizure-free status was somewhat less steady, seen among roughly 40 percent prior to the five-year mark, but only among 29 percent after five to 10 years. Between 10 and 15 years after surgery, the numbers rose back to 38 percent, only to drop to 26 percent among the 15-year-plus group.
On the quality-of-life front, one-fifth of the patients said they were no longer taking any kind of anti-seizure medication following surgery. What's more, although the use of antidepressants increased to 30 percent following surgery (up from 22 percent beforehand), 51 percent said they were able to drive post-surgery, compared with just 35 percent before.
Dr. Rama Maganti, director of the Wisconsin Comprehensive Epilepsy Program at the University of Wisconsin in Madison, said the findings weren't surprising, and agreed that some patients should be offered the surgery option sooner than is typically the case.
"Both neurologists and patients view it as a last resort," he said. "But in fact we think it should be done earlier rather than later, because the outcomes for patients who don't respond to medicine are usually the same regardless. And most patients can be evaluated for surgery using only noninvasive tests like an MRI or PET scan. So, there really is no point in delaying."
There's more on epilepsy at the Epilepsy Foundation (http://www.epilepsy.com/start-here/introduction-epilepsy/ ).
SOURCES: Marianna Spanaki-Varelas, M.D., Ph.D., M.B.A., senior staff neurologist, and director, Henry Ford Comprehensive Epilepsy Program, Henry Ford Hospital, Detroit; Rama Maganti, M.D., professor, department of neurology, and director, Wisconsin Comprehensive Epilepsy Program, University of Wisconsin, Madison, Wisc.; February 2015, Epilepsy and Behavior
Fewer Americans Burdened by Medical Bills: Study
Health reform, recovering economy may be easing families' financial problems, experts say
THURSDAY, Feb. 26, 2015 (HealthDay News) -- The number of Americans struggling to pay medical bills has declined every year since 2011 and particularly since 2013, a new government report shows.
Health policy and medical bill experts believe the new patient protections and coverage offered under the Affordable Care Act, as well as the steadily improving national economy, may have contributed to families' financial relief.
A less positive possibility is that some families in "high-deductible" health plans may be holding off on using medical services, experts added.
In 2011, 56.5 million people under the age of 65 were in families that had problems paying medical bills in the previous 12 months. But that dropped to just under 48 million people in the first half of 2014, according to the U.S. National Center for Health Statistics (NCHS), part of the U.S. Centers for Disease Control and Prevention.
"So we're seeing almost 9 million fewer people in that age group who are in families having problems payment medical bills," said Robin Cohen, an NCHS statistician and the report's author.
NCHS examined people with bill-paying problems by age, gender, race and ethnicity, insurance status and economic status. In every year since 2011, each demographic group experienced year-over-year relief from all types of medical bills, including doctor and hospital charges.
"To me, it's just kind of like a 'Wow,' " said Lynn Blewett, a professor of health policy and management at the University of Minnesota School of Public Health.
Since 2011, the proportion of children and adults under age 65 in families strained by medical expenses has declined by 3.5 percentage points. A good chunk of that improvement -- nearly 2 percentage points -- occurred between 2013 and the first half of 2014, when the number of people reporting medical bill-paying problems dropped by more than 4 million.
"It's a precipitous drop," Cohen observed.
Even though the latest numbers are based on just six months of data, the 2014 numbers are valid and provide an apples-to-apples comparison with 2013 data, she said.
NCHS began asking Americans about their medical bill-paying difficulties in 2011. The report provides early estimates of the problem based on household surveys involving more than 370,000 people.
Blewett said the improvement in bill-paying concerns may reflect, among other factors, a reduction in uninsured Americans and an increase in people with coverage through programs like Medicaid and the state Children's Health Insurance Program.
The number of uninsured Americans under age 65 fell to almost 41 million in the first quarter of 2014, from slightly more than 44 million in 2013. And the numbers have tumbled steadily since 2010, the year President Barack Obama signed the Affordable Care Act (ACA) into law, according to CDC data.
Health policy experts say early gains in health insurance are due in part to the extension of coverage to young adults under their parents' health insurance plans, and the expansion of Medicaid eligibility rules in some states. Each of these policy changes were part of the ACA, sometimes referred to as Obamacare.
The landmark law's expansion of private health plans through federal and state marketplaces began in October 2013, for 2014 insurance coverage.
But many people waited until February or later to sign up, said David Warner, a health and social policy professor at the University of Texas at Austin.
Warner doesn't believe sign-ups through the new ACA health insurance marketplaces are reflected in the NCHS report, since coverage would not have kicked in for the vast majority of medical bills people incurred over the previous year.
However, some of the earlier implemented ACA initiatives, such as guaranteed coverage for children regardless of pre-existing conditions, may have contributed to the trend the report found, he said.
And it may be that more people are qualifying for financial help under hospitals' financial assistance policies, reasoned Marc Chapman, owner of Chapman Consulting L.L.C., based in Austin, Texas, which negotiates hospital and medical bills for consumers.
The ACA requires not-for-profit hospitals to tell patients about their financial assistance programs and how to apply for help before attempting to collect on a patient's bill.
Even some for-profit hospitals are reducing rates paid by uninsured patients to what they would have charged insurance companies, Chapman added.
Experts also noted a possible darker side to the reduction in medical bill-paying problems. Since a growing number of Americans are enrolled in high-deductible health plans, some people may be forgoing care. As a result, they're not piling up medical bills.
Chapman said he's not fielding as many calls from patients who are totally uninsured, but he is hearing from people who are discovering, "Oh my gosh, I've got a $10,000 deductible or a $5,000 deductible." And in those cases, he says there's nothing he can do to help them.
Community Catalyst has more on how the ACA helps families with medical bills ( http://www.communitycatalyst.org/doc-store/publications/Debt_Collection_FAQ_withchart.pdf ).
SOURCES: Robin Cohen, Ph.D., statistician, U.S. National Center for Health Statistics, Hyatttsville, Md.; Lynn Blewett, Ph.D., professor, health policy and management, University of Minnesota School of Public Health, Minneapolis, Minn.; David Warner, Ph.D., health and social policy professor, University of Texas at Austin; Marc Chapman, owner, Chapman Consulting L.L.C., Austin, Texas; U.S. National Center for Health Statistics, report
Gene Mutations Tied to Leukemia Rise With Age, Study Finds
But just having cancer-linked DNA doesn't mean the disease will develop, study authors stressed
THURSDAY, Feb. 26, 2015 (HealthDay News) -- For many people, an increase in genetic mutations that could trigger leukemia seems to be an inevitable part of aging, a new study finds.
The British researchers looked specifically at mutations in blood stem cells.
"Over time, the probability of these cells acquiring mutations rises," co-lead author Thomas McKerrell, of the Wellcome Trust Sanger Institute, said in an institute news release. "What surprised us was that we found these mutations in such a large proportion of elderly people," he added.
In the study, researchers looked at more than 4,200 people without any evidence of blood cancer. They found that up to 20 percent of people aged 50 to 60, and more than 70 percent of people older than 90, have blood cells with the same gene changes seen in leukemia.
Just carrying a particular mutation doesn't mean that a leukemia is guaranteed, however.
"Leukemia results from the gradual accumulation of DNA mutations in blood stem cells, in a process that can take decades," McKerrell explained.
"This study helps us understand how aging can lead to leukemia, even though the great majority of people will not live long enough to accumulate all the mutations required to develop the disease," he said.
Study senior author George Vassiliou, of the Sanger Institute and Cambridge University Hospitals NHS Trust, agreed.
"These mutations will be harmless for the majority of people, but for a few unlucky carriers they will take the body on a journey towards leukemia," he said. With the new study, "we are now beginning to understand the major landmarks on that journey," Vassiliou explained.
The study was published Feb. 26 in the journal Cell Reports.
The U.S. National Cancer Institute has more about leukemia (http://www.cancer.gov/publications/patient-education/wyntk-leukemia ).
SOURCE: Wellcome Trust Sanger Institute, news release, Feb. 26, 2015
Get Checked for Diabetes While Getting Your Teeth Cleaned?
Study found testing blood from mouth was as accurate as finger prick at diagnosing condition
THURSDAY, Feb. 26, 2015 (HealthDay News) -- The dentist's office may be a good place to screen people for diabetes, a new study suggests.
"In light of findings from the study, the dental visit could be a useful opportunity to conduct diabetes screening among at-risk, undiagnosed patients -- an important first step in identifying those who need further testing to determine their diabetes status," wrote principal investigator Shiela Strauss. She is an associate professor of nursing and co-director of the Statistics and Data Management Core for New York University's Colleges of Nursing and Dentistry.
The NYU study of 408 dental patients found that blood collected from the mouth during dental procedures was 99 percent as accurate for hemoglobin A1c (HbA1c) testing as finger-prick blood samples.
Testing HbA1c is recommended by the American Diabetes Association for diagnosing diabetes and for monitoring blood sugar levels among those with diabetes.
The study was published Feb. 26 in the American Journal of Public Health.
About 8 million of the 29 million Americans living with diabetes are undiagnosed, the researchers noted.
While diabetes screening at dental visits can help all people at risk for the disease, those aged 45 and older would likely get the greatest benefit, the researchers said.
The American Academy of Family Physicians has more about diabetes (http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes.printerview.all.html ).
SOURCE: New York University, news release, Feb. 26, 2015