Snoring Health Risks

People who snore, have trouble falling asleep may have increased risk of metabolic syndrome.
Bloomberg News (12/1, Lopatto) reports that, according to a study published in the journal Sleep, "people who snore, have trouble falling asleep, or who wake up in the morning feeling fatigued have an increased risk of developing conditions tied to diabetes and heart disease." In a study of 812 people, researchers found that "adults who reported frequent loud snoring had twice the risk of developing metabolic syndrome -- conditions that include obesity, high blood pressure, and diabetes -- during a three-year follow-up period, compared with quieter sleepers." What's more, "the risk jumped 80 percent in people who had difficulty falling asleep and 70 percent in those who said their sleep wasn't refreshing."

Autism Genetic Update

Autism associated with defects in mitochondria.
The Los Angeles Times (11/30, Maugh) "Booster Shots" blog reported that, according to a study published in the Dec. 1 issue of the Journal of the American Medical Association, children with autism may "have a high incidence of defects in mitochondria, the 'powerhouses' of cells." For the study, researchers from the University of California-Davis "enlisted 10 autistic children, ages two to five...and 10 healthy children of the same age." They found that "one of the 10 autistic children had a full-blown mitochondrial respiratory disease -- a much higher rate than is seen in the normal population -- and that more than half of them had some problems with their mitochondria."
"Mitochondrial dysfunction been implicated in neurological conditions ranging from Parkinson's and Alzheimer's disease to schizophrenia and bipolar disorder," HealthDay (11/30, Goodwin) pointed out, noting that "there are many unknowns, including how mitochondrial dysfunction in brain cells might alter brain function in a way that leads to some of the symptoms of autism, including communication and social difficulties." The study authors "also don't know when the mitochondrial dysfunction starts -- in the womb, in infancy or later, and how that might impact the onset of autism or what other environmental or genetic factors may also contribute."
Nevertheless, WebMD (11/30, Boyles) reported, "based on their findings and those of earlier studies, the researchers concluded that the incidence of mitochondrial disease may be 550 to 770 times higher in autistic children than in the general population." MedPage Today (11/30, Neale) also covers the story.

Childrens OTC Medication Dosing

Dosing instructions for OTC medicines for children confusing, hard to follow.
The Los Angeles Times (12/1, Roan) reports that, according to a study published online Nov. 30 in the Journal of the American Medical Association, "many over-the-counter, liquid medications meant for children contain dosing instructions and measuring cups or droppers that rarely match each other and could confuse even the most careful parent or caretaker." As a result, "this could easily lead to under- or over-dosing, with potentially dangerous consequences, researchers said."
"Twenty-six percent of products had no dispensers, such as a cup or medicine dropper, forcing parents to measure out doses themselves," USA Today (12/1, Szabo) reports. "But even products with dispensers had problems." For example, "label instructions on 99% of these products conflicted with markings on the dispensing cup or dropper."
Bloomberg News (12/1, Cortez) reports that last year, the Food and Drug Administration issued voluntary industry "guidelines (pdf) for the labels on nonprescription liquid children's medicines and measuring devices...after numerous overdoses were attributed to confusing labels." The results of this new study, which was conducted by "Shonna Yin, a pediatrician at the New York University School of Medicine and Bellevue Hospital Center," may now "be used to evaluate how well companies that make over-the-counter children's medicines improve their products, the researchers said."
The Columbus Dispatch (12/1, Crane) reports that in an accompanying editorial suggested that "uniform use of milliliters as a measurement would help reduce errors and ensure that parents don't get confused or reach for a spoon when given directions based on teaspoons."

Prostate Cancer Update

Active surveillance for low-risk prostate cancer may provide better QoL.
The Los Angeles Times (11/30, Kaplan) "Booster Shots" blog reported, "Last year, about 192,000 American men were diagnosed with prostate cancer," and "for 16% to 40% of them, the disease is deemed to be so low-risk that no immediate medical intervention is necessary. Instead, they can undergo 'active surveillance.'" Now, new research reveals that "too many men are passing up a good thing."
The study detailed in the Journal of the American Medical Association "'isn't designed to tell people what is best," Harvard Medical School's Julia Hayes told Bloomberg News (12/1, Ostrow). "It is designed on an individual level to provide a starting point for discussion between the physician and the patient," she added. "Sixty percent of men who are screened and diagnosed are over-treated," yet, "those men would be reasonable candidates for active surveillance if they and their doctor are comfortable with that approach."
Before reaching those conclusions, "Hayes and colleagues developed a model to look at the quality-of-life benefits and risks associated with active surveillance, internal radiation therapy (brachytherapy), intensity-modulated radiation therapy (IMRT), or radical prostatectomy in a hypothetical group of men aged 65 who were diagnosed with localized, low-risk prostate cancer," WebMD (11/30, Mann) reported. "Men aged 65 with low-risk prostate cancer who chose active surveillance (with IMRT if the cancer progressed) scored highest in terms of quality-adjusted life expectancy (QALE)." In fact, "this strategy produces 11.07 quality-adjusted life-years (QALY)."
In comparison, "brachytherapy produced a 10.57 QALYs rating, followed by IMRT at 10.51 QALYs, and surgery to remove the prostate at 10.23 QALYs," HealthDay (11/30, Gardner) reported. "QALYs are a measure often used by scientists to indicate 'the number of good quality years of life left,' explained" an expert not involved in the study, "and therein lie some of the complexities of translating these findings into the real world of real men." In other words, said Duke University Medical Center's Dr. Stephen Freedland, "it depends on your definition of 'good.'"
The authors of an accompanying editorial pointed out, "as did the authors of the paper, that individual patient preferences still play a central role in the decision, particularly for those for whom anxiety caused by active surveillance would result in a relatively low quality of life," MedPage Today (11/30, Phend) reported. The study authors also "noted that they had been conservative in modeling, potentially exaggerating the uncertainty in the results. But, despite the 'substantial uncertainty surrounding this clinical question, active surveillance appears to be a reasonable alternative to initial treatment,' they concluded." The Wall Street Journal (11/30, Hobson, subscription required) "Health Blog" also covered that study.
Men with long index fingers may be less likely to develop prostate cancer. Bloomberg News (12/1, Fourcade) reports, "Men with long index fingers are at lower risk of prostate cancer," according to a paper in the British Journal of Cancer. "Scientists in the UK who compared the hands of 1,500 prostate cancer patients and 3,000 healthy men found that those whose index was longer than their ring finger were 33 percent less likely to develop the potentially fatal disease." Investigators pointed out that "finger length is set before birth, influenced by the level of sex hormones babies are exposed to in the womb." And, a "longer index finger points to less testosterone, which may protect against cancer later in life, they said."
Prostate gland swelling after seed insertion may prompt migration. MedWire (11/30, Guy) reported "that seed migration after prostate cancer treatment with brachytherapy (BRT) is common, and may be caused by the swelling of the prostate gland after seed insertion," according to a paper in the Japanese Journal of Clinical Oncology. "Among the 62 BRT patients in the study, 69.4% had experienced seed migration 30 days after the seeds were implanted," researchers at the National Center for Global Health and Medicine explained. "They add that the percentage of prostate swelling differed significantly between the pre-BRT monitoring scans and initial post-BRT scans."

Best Diet Advice

Study finds benefits of high protein, low carb diet for keeping weight off.
The AP (11/29) reports, "More turkey, less white bread and mashed potatoes. Just in time for holiday feasting, a large study found that diets higher in protein and lower in carbohydrates can help overweight adults who managed to drop some weight keep it off." European researchers "led by Denmark's University of Copenhagen" write in a study in Thursday's New England Journal of Medicine that "diets rich in lean meats, poultry and beans, and low in starchy carbs appear 'to be the ideal for the prevention of weight regain.'"
MedPage Today (11/24, Walsh) reported that among participants "who completed an eight-week, low-calorie weight loss phase and then entered a maintenance phase in which they consumed diets with variations in protein content and glycemic index, weight regain was 0.93 kg higher, a statistically significant difference, in those on low-protein diets compared with those on high-protein diets (95% CI 0.31 to 1.55, P=0.003)." Weight "regain also was higher by 0.95 kg (95% CI 0.33 to 1.57, P=0.003) in participants who consumed a diet with a high glycemic index, according to Thomas Meinert Larsen, PhD, from the University of Copenhagen, and colleagues."
HealthDay (11/24, Doheny) reported that "with his colleagues, Larsen evaluated 938 adults with an average body-mass index (BMI) of 34, which is considered obese. In all, 773 completed the initial weight-loss phase and then were assigned to one of five different maintenance plans." Those "on the low-GI diet had an average weight regain of 2 pounds less than those on the high-GI diet."
HeartWire (11/25, Wood) reported Dr. Larsen said "whether that ability to maintain a healthy weight-or the means used to attain it-have implications for the heart remains to be seen." Larsen said, "So far we have looked at body-weight maintenance: whether that translates into a lowered cardiovascular risk, this is of course too preliminary to say."
The Boston Globe (11/29, Cooney) reports after "six months, people who followed the high-protein, low glycemic index diet were more likely to keep their weight stable or continue to lose weight than the people who ate a low-protein, high glycemic index diet. The difference between the groups averaged about five pounds." Perhaps "equally important, only a quarter of the people in the high-protein, low glycemic index group dropped out of the study compared with a third of those in the low-protein, high glycemic index group."
Glycemic index remains opaque concept for consumers. The Los Angeles Times (11/29, Roan) reports diet researchers "reported Thursday that a high-protein, low-glycemic-index diet may work best for maintaining a weight loss," but "they concede that many people may not understand just how to achieve such a diet." While it's "easier to understand which foods are high in protein -- eggs, turkey and dairy products -- knowing the glycemic index (GI) of foods can be trickier. Moreover, just because a food is low on the glycemic index doesn't mean it's more healthful, said the authors of the Diogenes study, published Thursday in the New England Journal of Medicine."

Second Hand Smoke Stats

Secondhand smoke sickens millions, kills more than 600,000 people worldwide each year.
USA Today (11/27, Szabo) reported, "Secondhand smoke sickens millions and kills more than 600,000 people worldwide each year, including more than 165,000 children under 5, according to the first report to estimate the worldwide burden of disease and death from tobacco." After looking at data collected from 192 countries, investigators with the World Health Organization "found more than half of the deaths are from heart disease, followed by deaths from cancer, lung infections, asthma and other ailments." The team also noted that "more than two-thirds of the children's deaths are in Africa and Asia, where they have less access to important public health services, such as vaccines, and less advanced medical care."
And the "mix of infectious diseases and secondhand smoke is a deadly combination," lead investigator Armando Peruga told the AP (11/29). The researchers also pointed out in their Lancet paper that "secondhand smoke had its biggest impact on women, killing about 281,000. In many parts of the world, women are at least 50 percent more likely to be exposed to secondhand smoke than men.
According to the CNN (11/26, Falco) "The Chart" blog, "researchers believe more needs to be done to create complete smoke-free indoor environments at work, in public places and on public transportation." Specifically, "educating and empowering women can make a big difference is protecting children and non-smoking adults from the deadly effects of secondhand smoke." Bloomberg News (11/26, von Schaper) also covered the study.

High Deductible Health Plans

Costs forcing more Americans to select high-deductible health plans.
NBC Nightly News (11/28, story 5, 2:20, Morales) reported, "This is the time of year when millions of Americans are asked to make their annual choices for health insurance. With the cost of healthcare skyrocketing, more and more people are forced to accept deductibles so high they end up paying most of the medical bills themselves." NBC (Costello) discussed a family whose deductible is $7000, with the result that "every doctor visit, every antibiotic every trip to the ER is out of pocket." Costello added, "To contain costs companies are increasingly only offering healthcare plans with sky high deductibles. This year, 18 million Americans are enrolled in high deductible plans compared with 13 million last year. Yet, insured Americans are also going to the doctor less, getting fewer tests and filling fewer prescriptions than a year ago."